Epinephrine

EPIPEN

Open Epinephrine in the interactive console ↗

Pronunciation: ep-i-NEF-rin

Epinephrine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Epinephrine ballicule

What it isEndogenous catecholamine with alpha and beta agonism; anaphylaxis, cardiac arrest and severe asthma.

Why this oneThe 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.

Epinephrine molecular structure (skeletal formula) — Molecular structure: Epinephrine

Epinephrine prescription history

Animated chart of estimated U.S. prescriptions per year, Asthma/COPD meds (1924–2026). Epinephrine enters in 1930 (estimated).

FDA-approved for

anaphylaxis (~1939)

Principal riskDelay is the main cause of death in anaphylaxis

Classes and tags

Clinical profile

Therapeutic safety burden1 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryC

Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Emergency treatment of type I allergic reactions incl. anaphylaxis	Patients ≥30 kg (≈66 lb)	EpiPen 0.3 mg IM/SC into anterolateral thigh, once	0.3 mg; repeat with an additional device if severe persistent anaphylaxis	More than two sequential doses only under direct medical supervision
Emergency treatment of type I allergic reactions incl. anaphylaxis	Patients 15–30 kg (33–66 lb)	EpiPen Jr 0.15 mg IM/SC into anterolateral thigh, once	0.15 mg; repeat with an additional device if severe persistent anaphylaxis	More than two sequential doses only under direct medical supervision; fixed dose — use other injectable epinephrine if <0.15 mg needed

Renal Undefined

Hepatic Undefined

Instructions

Inject IM or SC into anterolateral thigh, through clothing if necessary; single-dose device
Do not inject IV, into buttock, or into digits, hands or feet
Young children: hold leg firmly and limit movement before and during injection
Seek immediate medical/hospital care after use; emergency supportive therapy only
Inspect solution in window: replace if discolored (pink/brown), cloudy, or contains particles
Residual solution (≈1.7 mL) remains after activation — discard; not for reuse

Available strengths

auto-injector 0.15, 0.3 mg

Cautions

Emergency treatment only — seek immediate medical care; >2 sequential doses only under medical supervision
Injection-related complications (no IV/buttock/digits/hands/feet; hold child's leg)
Serious injection-site infections (incl. Clostridial gas gangrene)
Sulfite content should not deter use
Disease interactions: heart disease, hypertension, hyperthyroidism, diabetes, elderly, pregnancy, Parkinson's

Adverse reactions

Anxiety / apprehensiveness / restlessness
Tremor
Weakness
Dizziness
Sweating
Palpitations
Pallor
Nausea and vomiting
Headache
Respiratory difficulties

Pregnancy No adequate human studies (teratogenic in animals at high multiples of human dose); first-line for anaphylaxis in pregnancy — use as in non-pregnant patients

Lactation No data on human milk or breastfed infants; use as in non-breastfeeding patients

Cost

Epinephrine (EPIPEN)

Strength		#/mo	generic $/unit	CostPlus
0.15 mg	auto-injector	per unit		not offered
0.3 mg	auto-injector	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Epinephrine is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Available combined with: Articaine (SEPTOCAINE)

Generic entry1984

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Self-check

Where is IM epinephrine given for anaphylaxis?
The thigh.
Should epinephrine be delayed in anaphylaxis?
No.