Drugs List

Therapeutic Indications

Uses

Reversal of hypotension from spinal or epidural anaesthesia

Administration

To be administered at a concentration of ephedrine hydrochloride 3mg/ml by slow intravenous injection over 3 to 4 minutes.

Contraindications

Children under 1 year
Within 2 weeks of discontinuing MAOIs
Breastfeeding

Precautions and Warnings

Anaesthesia
Elderly
Benign prostatic hyperplasia
Cardiac arrhythmias
Diabetes mellitus
History of cardiac disorder
Hypertension
Hyperthyroidism
Ischaemic heart disease
Narrow angle glaucoma
Occlusive peripheral vascular disorder
Pregnancy
Renal impairment
Tachycardia

Contains more than 1 mmol (23 mg) sodium per dose
Treatment to be initiated and supervised by a specialist

Pregnancy and Lactation

Pregnancy

Use ephedrine hydrochloride with caution in pregnancy.

Ephedrine-like drugs are teratogenic in some animal species, but human teratogenicity has not been established.

Significant increases in foetal heart rate and beat-to-beat variability may occur, but these effects may be the result of normal reflexes following hypotension-associated bradycardia. The presence of ephedrine in the foetal circulation is probably a major cause of the foetal heart rate changes.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Ephedrine hydrochloride is contraindicated in breastfeeding.

Ephedrine hydrochloride is excreted in breast milk. Irritability and sleep disturbances have been reported in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anginal pain
Anorexia
Anxiety
Arrhythmias
Blood glucose disturbances
Bradycardia
Cardiac arrest
Cerebral haemorrhage
Confusion
Decreased appetite
Depression
Difficulty in micturition
Dizziness
Dyspnoea
Fear
Flushing
Glaucoma (closed angle)
Headache
Hypersalivation
Hypertension
Hypokalaemia
Hypotension
Insomnia
Irritability
Nausea
Nervousness
Palpitations
Psychotic symptoms
Pulmonary oedema
Restlessness
Sweating
Tachycardia
Tremor
Urinary retention
Vasoconstriction
Vasodilatation
Vomiting
Weakness

Presentation

Injections containing ephedrine hydrochloride

Drugs List

Therapeutic Indications

Uses

Reversal of hypotension from spinal or epidural anaesthesia

Dosage

Adults

Children

Administration

To be administered at a concentration of ephedrine hydrochloride 3mg/ml by slow intravenous injection over 3 to 4 minutes.

Contraindications

Children under 1 year
Within 2 weeks of discontinuing MAOIs
Breastfeeding

Precautions and Warnings

Anaesthesia
Elderly
Benign prostatic hyperplasia
Cardiac arrhythmias
Diabetes mellitus
History of cardiac disorder
Hypertension
Hyperthyroidism
Ischaemic heart disease
Narrow angle glaucoma
Occlusive peripheral vascular disorder
Pregnancy
Renal impairment
Tachycardia

Contains more than 1 mmol (23 mg) sodium per dose
Treatment to be initiated and supervised by a specialist

Pregnancy and Lactation

Pregnancy

Use ephedrine hydrochloride with caution in pregnancy.

Ephedrine-like drugs are teratogenic in some animal species, but human teratogenicity has not been established.

Significant increases in foetal heart rate and beat-to-beat variability may occur, but these effects may be the result of normal reflexes following hypotension-associated bradycardia. The presence of ephedrine in the foetal circulation is probably a major cause of the foetal heart rate changes.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Ephedrine hydrochloride is contraindicated in breastfeeding.

Ephedrine hydrochloride is excreted in breast milk. Irritability and sleep disturbances have been reported in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anginal pain
Anorexia
Anxiety
Arrhythmias
Blood glucose disturbances
Bradycardia
Cardiac arrest
Cerebral haemorrhage
Confusion
Decreased appetite
Depression
Difficulty in micturition
Dizziness
Dyspnoea
Fear
Flushing
Glaucoma (closed angle)
Headache
Hypersalivation
Hypertension
Hypokalaemia
Hypotension
Insomnia
Irritability
Nausea
Nervousness
Palpitations
Psychotic symptoms
Pulmonary oedema
Restlessness
Sweating
Tachycardia
Tremor
Urinary retention
Vasoconstriction
Vasodilatation
Vomiting
Weakness

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2014

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Injectable Medicines Administration Guide, 3rd edition (2010) UCL NHS Foundation Trust. Wiley-Blackwell, Oxford.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Ephedrine hydrochloride 3mg/ml solution for injection in pre-filled syringe. Aguettant Ltd. Revised January 2014.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 28 June 2017