Epinephrine
EPIPEN
What it isEndogenous catecholamine with alpha and beta agonism; anaphylaxis, cardiac arrest and severe asthma.
Why this oneIt is the only drug that treats every element of anaphylaxis at once.
What limits itIn anaphylaxis it is intramuscular into the thigh, and delay is the main cause of death — there is no reason to wait.
FDA-approved for
- anaphylaxis (~1939)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypotension associated with septic shock | adult | IV infusion 0.05 mcg/kg/min | 0.05–2 mcg/kg/min, titrated to target MAP | 2 mcg/kg/min |
Titration May adjust every 10–15 min in increments of 0.05–0.2 mcg/kg/min to reach target MAP.
Renal Undefined
Hepatic Undefined
Instructions
- Continuous IV infusion into a large vein; ready-to-use, no further dilution
- Avoid catheter tie-in technique and leg veins in elderly/occlusive vascular disease
- Check infusion site frequently; avoid extravasation (tissue necrosis)
- Wean gradually
Cautions
- Acute severe hypertension
- Pulmonary edema (may be fatal)
- Cardiac arrhythmias and myocardial ischemia (esp. with heart disease)
- Extravasation → local tissue necrosis
- Oliguria / renal impairment
- Sulfite allergy
- MAOIs due to risk of hypertension
Adverse reactions
- Tachycardia / arrhythmias (incl. ventricular fibrillation)
- Stress cardiomyopathy, myocardial ischemia/infarction
- Limb ischemia
- Pulmonary edema, hypertension
- Headache, tremor, anxiety
- Hypokalemia, lactic acidosis
- Diaphoresis, skin necrosis with extravasation
Pregnancy Decades of use identify no drug-associated risk of major birth defects/miscarriage; do not delay treatment for shock.
Lactation Low milk transfer expected (poor oral bioavailability, short half-life); do not delay treatment.
NO BOXED WARNINGS
Principal riskDelay is the main cause of death in anaphylaxis
Cost, est. cash$30–$500/month
Generic entry1984
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.
Mechanism of action: Epinephrine ballicule
