Adrenaline
Adrenalin Stragen · EpiPen · Jext
The only drug that reverses all components of anaphylaxis, and the cornerstone of cardiac arrest treatment. The most clinically dangerous property is not pharmacological but practical: two concentrations with a tenfold difference are used in the same setting.
1 mg/ml is given INTRAMUSCULARLY in anaphylaxis. 0,1 mg/ml is given INTRAVENOUSLY in cardiac arrest. Confusion between concentrations is one of the most frequently reported serious medication errors in emergency medicine.
Dosing in adults
| Indication | Regimen | Comment |
|---|---|---|
| Anaphylaxis, adult | 0,5 mg im (0,5 ml of 1 mg/ml) into the lateral thigh | repeat after 5 min if needed |
| Anaphylaxis, child | 0,01 mg/kg im — 0,15 mg < 6 years · 0,3 mg 6–12 years | same concentration, smaller volume |
| Cardiac arrest | 1 mg iv/io every 3–5 min (0,1 mg/ml) | child 0,01 mg/kg, max 1 mg |
| Infusion for shock | 0,05–0,5 µg/kg/min | in anaphylactic or cardiogenic shock |
No adjustment.
No adjustment.
Anaphylaxis 0,01 mg/kg im (max 0,5 mg). Cardiac arrest 0,01 mg/kg iv/io (max 1 mg).
There is no absolute contraindication in anaphylaxis. Withholding adrenaline due to ischaemic heart disease is a more common mistake than giving it.
Pharmacokinetics
- BIOAVAIL.
- Im and iv
- Vd
- 0,15 l/kg
- t½
- 2–3 min
- PROTEIN BINDING
- Low
- METABOLISM
- COMT and MAO
- EXCRETION
- Renal as metabolites
- INHIBITS
- —
- ONSET
- im 5–10 min · iv immediate