Usual Adult Dose for Asystole

Injectable Solution of 0.1 mg/mL (1:10,000):

• IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
• Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
• Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:

• Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:

• IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
• Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Ventricular Fibrillation

Injectable Solution of 0.1 mg/mL (1:10,000):

• IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
• Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
• Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:

• Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:

• IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
• Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Ventricular Tachycardia

Injectable Solution of 0.1 mg/mL (1:10,000):

• IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
• Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
• Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:

• Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:

• IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
• Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Cardiac Arrest

Injectable Solution of 0.1 mg/mL (1:10,000):

• IV: 0.5 to 1 mg (5 to 10 mL) IV once; during resuscitation effort, 0.5 mg (5 mL) should be given IV every 5 minutes
• Intracardiac: 0.3 to 0.5 mg (3 to 5 mL) via intracardiac injection into left ventricular chamber once
• Endotracheal: 0.5 to 1 mg (5 mL to 10 mL) via endotracheal tube directly into bronchial tree once

Comments:

• Intracardiac injection should only be administered by personnel well trained in this technique and only if there has not been sufficient time to establish an IV route.

Use: For prophylaxis and treatment of cardiac arrest and attacks of transitory atrioventricular heart block with syncopal seizures (Stokes-Adams Syndrome)

The American Heart Association (AHA) recommends:

• IV or intraosseous: 1 mg IV or intraosseous every 3 to 5 minutes during cardiac arrest
• Endotracheal: 2 to 2.5 mg endotracheally every 3 to 5 minutes during cardiac arrest if IV or intraosseous route cannot be established

Use: For administration during cardiac arrest

Usual Adult Dose for Asthma - Acute

Injectable Solution of 0.1 mg/mL (1:10,000):
0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once

Use: For the treatment of acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous administration of other solutions of the drug

Usual Adult Dose for Allergic Reaction

Auto-Injector:
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:

• The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.
• More than 2 sequential doses should only be administered under direct medical supervision.
• The auto-injectors are intended for immediate administration as emergency supportive therapy only and not as a replacement or substitute for immediate medical care.

Injectable Solution of 1 mg/mL (1:1000):
30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed

• Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:

• For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
• Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
• The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):
0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once

Convenience Kit 1 mg/mL (1:1000):
0.2 to 1 mg IM or subcutaneous

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Adult Dose for Anaphylaxis

Auto-Injector:
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:

• The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.
• More than 2 sequential doses should only be administered under direct medical supervision.
• The auto-injectors are intended for immediate administration as emergency supportive therapy only and not as a replacement or substitute for immediate medical care.

Injectable Solution of 1 mg/mL (1:1000):
30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed

• Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:

• For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
• Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
• The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):
0.1 to 0.25 mg (1 to 2.5 mL) IV slowly once

Convenience Kit 1 mg/mL (1:1000):
0.2 to 1 mg IM or subcutaneous

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Adult Dose for Pupillary Dilation

Injectable Solution of 1 mg/mL (1:1000):

• Intraocular: Dilute 1 mL of the 1 mg/mL single-use vial (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to a concentration of 1:100,000 to 1:1,000,000 (10 mcg/mL to 1 mcg/mL) and use the irrigating solution as needed for the surgical procedure
• Intracameral: Following dilution in an ophthalmic irrigating fluid, the solution may also be injected intracamerally as a bolus dose of 0.1 mL at a dilution of 1:100,000 to 1:400,000 (10 mcg/mL to 2.5 mcg/mL)

Comments:

• The Adrenalin(R) formulation is not for ophthalmic use.
• Do not use if the solution is colored, cloudy, or contains particulate matter.

Use: For the induction and maintenance of mydriasis during intraocular surgery

Usual Adult Dose for Hypotension

Injectable Solution of 1 mg/mL (1:1000): 0.05 to 2 mcg/kg/min IV and titrate to achieve desired mean arterial pressure (MAP)

• Dosage may be adjusted periodically, such as every 10 to 15 minutes in increments of 0.05 to 0.2 mcg/kg/min to achieve desired blood pressure goal

Comments:

• Must be diluted prior to use; consult manufacturer product information for appropriate dilution instructions.
• Correct blood volume depletion as fully as possible prior to administration; may be administered before and concurrently with blood volume replacement as an emergency measure.
• Continuous infusion is generally required over several hours or days until patient's hemodynamic status improves; the duration of perfusion or total cumulative dose cannot be known.
• Following hemodynamic stabilization, may wean incrementally over time, such as decreasing doses every 30 minutes over a 12 to 24 hour period.

Use: To increase mean arterial blood pressure in patients with hypotension associated with septic shock

Usual Adult Dose for Shock

Injectable Solution of 1 mg/mL (1:1000): 0.05 to 2 mcg/kg/min IV and titrate to achieve desired mean arterial pressure (MAP)

• Dosage may be adjusted periodically, such as every 10 to 15 minutes in increments of 0.05 to 0.2 mcg/kg/min to achieve desired blood pressure goal

Comments:

• Must be diluted prior to use; consult manufacturer product information for appropriate dilution instructions.
• Correct blood volume depletion as fully as possible prior to administration; may be administered before and concurrently with blood volume replacement as an emergency measure.
• Continuous infusion is generally required over several hours or days until patient's hemodynamic status improves; the duration of perfusion or total cumulative dose cannot be known.
• Following hemodynamic stabilization, may wean incrementally over time, such as decreasing doses every 30 minutes over a 12 to 24 hour period.

Use: To increase mean arterial blood pressure in patients with hypotension associated with septic shock

Usual Adult Dose for Bradyarrhythmia

The manufacturer gives no specific dosing instructions.

The AHA recommends:
2 to 10 mcg/min IV and titrate to patient response

• Alternate dose: 0.1 to 0.5 mcg/kg/min (in a 70 kg patient, 7 to 35 mcg/min) IV; titrate to effect

Use: For patients with symptomatic bradycardia, particularly if associated with hypotension, for whom atropine may be inappropriate or after atropine fails

Usual Pediatric Dose for Cardiac Arrest

The manufacturer gives no specific dosing instructions.

The AHA recommends:
Neonates:

• IV: 0.01 to 0.03 mg/kg (1:10,000 injectable solution) IV once
• Endotracheal: 0.05 to 0.1 mg/kg (1:10,000 injectable solution) via endotracheal route once may be reasonable while attempting to gain IV access

Comments:

• Due to lack of data to support endotracheal use, it is reasonable to provide medications via IV route as soon as venous access is established.

Infants and Children:

• IV or intraosseous: 0.01 mg/kg (0.1 mL/kg of 1:10,000 injectable solution) IV or intraosseous once; may repeat every 3 to 5 minutes
• Maximum dose: 1 mg

Endotracheal: 0.1 mg/kg (0.1 mL/kg of 1:1000 injectable solution) via endotracheal tube once, flush with 5 mL normal saline and follow with 5 ventilations; may repeat every 3 to 5 minutes

• Maximum dose: 2.5 mg

Use: For resuscitation in the pediatric patient

Usual Pediatric Dose for Allergic Reaction

Auto-Injector:
7.5 to 15 kg: 0.1 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed
15 to 30 kg: 0.15 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:

• Since the lowest dose of the auto-injector is 0.1 mg, consider using other injectable forms of this drug if doses lower than 0.1 mg are necessary.
• More than 2 sequential doses should only be administered under direct medical supervision.
• The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.

Injectable Solution of 1 mg/mL (1:1000):
Less than 30 kg: 0.01 mg/kg (0.01 mL/kg) of undiluted drug IM or subcutaneously into anterolateral aspect of thigh; repeat every 5 to 10 minutes as needed

• Maximum dose per injection: 0.3 mg (0.3 mL)

30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed

• Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:

• For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
• Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
• The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):

• Neonate: 0.01 mg/kg IV slowly once
• Infant: 0.05 mg IV slowly once; may repeat at 20 to 30 minute intervals as needed

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Pediatric Dose for Anaphylaxis

Auto-Injector:
7.5 to 15 kg: 0.1 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed
15 to 30 kg: 0.15 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed
30 kg or greater: 0.3 mg IM or subcutaneously into anterolateral aspect of thigh; repeat as needed

Comments:

• Since the lowest dose of the auto-injector is 0.1 mg, consider using other injectable forms of this drug if doses lower than 0.1 mg are necessary.
• More than 2 sequential doses should only be administered under direct medical supervision.
• The manufacturer product information for the specific auto-injector being used should be consulted for administration instructions.

Injectable Solution of 1 mg/mL (1:1000):
Less than 30 kg: 0.01 mg/kg (0.01 mL/kg) of undiluted drug IM or subcutaneously into anterolateral aspect of thigh; repeat every 5 to 10 minutes as needed

• Maximum dose per injection: 0.3 mg (0.3 mL)

30 kg or greater: 0.3 to 0.5 mg (0.3 to 0.5 mL) of undiluted drug IM or subcutaneously into anterolateral aspect of the thigh; repeat every 5 to 10 minutes as needed

• Maximum dose per injection: 0.5 mg (0.5 mL)

Comments:

• For IM administration, use a long enough needle (at least 1/2 inch to 5/8 inch) to ensure injection into the muscle.
• Repeated injections should not be administered at the same site as resulting vasoconstriction may cause tissue necrosis.
• The patient should be monitored clinically for reaction severity and cardiac effects with repeat doses titrated to effect.

Injectable Solution of 0.1 mg/mL (1:10,000):

• Neonate: 0.01 mg/kg IV slowly once
• Infant: 0.05 mg IV slowly once; may repeat at 20 to 30 minute intervals as needed

Uses: For the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging or biting insects, allergen immunotherapy, foods, drugs, diagnostic testing substances, and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis; and for immediate administration in patients who are determined to be at increased risk for anaphylaxis, including those with a history of anaphylactic reactions

Usual Pediatric Dose for Asthma - Acute

Injectable Solution of 0.1 mg/mL (1:10,000):

• Neonate: 0.01 mg/kg IV slowly once
• Infant: 0.05 mg IV slowly once; may repeat at 20 to 30 minute intervals as needed

Use: For the treatment of acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous administration of other solutions of the drug

Usual Pediatric Dose for Pupillary Dilation

Injectable Solution of 1 mg/mL (1:1000):

• Intraocular: Dilute 1 mL of the 1 mg/mL single-use vial (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to a concentration of 1:100,000 to 1:1,000,000 (10 mcg/mL to 1 mcg/mL) and use the irrigating solution as needed for the surgical procedure
• Intracameral: Following dilution in an ophthalmic irrigating fluid, the solution may also be injected intracamerally as a bolus dose of 0.1 mL at a dilution of 1:100,000 to 1:400,000 (10 mcg/mL to 2.5 mcg/mL)

Comments:

• The Adrenalin(R) formulation is not for ophthalmic use.
• Do not use if the solution is colored, cloudy, or contains particulate matter.

Use: For the induction and maintenance of mydriasis during intraocular surgery

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Elderly patients may be particularly sensitive to the effects of this drug. Infuse slowly as there is an increased risk for adverse reactions in this patient population; consider lower starting doses for the treatment of anaphylaxis.

Precautions

CONTRAINDICATIONS: None

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration Advice:

• The specific manufacturer information for the auto-injector chosen should be consulted as not all auto-injectors function the same way nor have the same doses available.
• Consult specific manufacturer product information for administration instructions.
• Auto-injector: For single use only; inspect for particulate matter and discoloration; insert IM or subcutaneously into the anterolateral aspect of the thigh, through clothing if necessary; if the patient is a child, hold the leg firmly in place to limit movement prior to and during injection.
• Adrenalin(R): Not for ophthalmic use.
• Inspect visually for particulate matter and discoloration prior to administration, whenever solution and container permit; do not use if solution is colored, cloudy, or contains particulate matter.

Storage requirements:

• Auto-injector: Store in outer case provided to protect from light; store at room temperature; do not refrigerate.
• Injectable Solution: Protect from light and freezing; store at room temperature; multiple-use vial must be discarded 30 days after initial use.
• Ampule: Store at room temperature; protect from light, freezing, and alkalis and oxidizing agents.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

Patient advice:

• There is a possibility of recurrence of anaphylaxis symptoms after a good response to initial treatment; obtain medical attention following use of this drug.
• Consult patient information leaflet for further advice.

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