Indications:
- Allergic reaction/anaphylactic shock
- Bronchospasm unresponsive to inhaled beta-agonists
Contraindications:
- Allergic reaction: None
- Refractory bronchospasm: Heart disease, History of Acute MI, Age > 45 years, Arrhythmia, Labor
Precautions:
Allergic reaction/anaphylactic shock/refractory bronchospasm:
- Monitor ECG closely
- Patients on beta blockers may need glucagon or higher doses of epinephrine
Side Effects:
Anaphylaxis:
- Tachycardia
- Ventricular dysrhythmias
- Headache
- Flushing
- Nausea/vomiting
- Chest pain
Adult Dose:
- Allergic reaction: 0.3 mg – 0.5 mg IM - standing order, single dose only
- Anaphylactic shock: 0.3 mg – 0.5 mg IM, every 20 minutes, up to total of 3 doses (including any dose given by autoinjector) - standing order
- Administer only one dose for bronchospasm unresponsive to nebulizers, CPAP, or magnesium sulfate
Pediatric Dose:
Standing order:
- Allergic reaction/anaphylactic shock: 0.01 mg/kg (0.01 mL/kg) IM (maximum dose: 0.3 mg (0.3 mL)); single dose only.
- BioTel must authorize additional dose(s).
- Bronchospasm unresponsive to inhaled beta-agonists/anti-cholinergics in children at least 2 years of age: 0.01 mg/kg (0.01 mL/kg) IM (maximum dose: 0.3 mg)
- Bronchospasm refractory to albuterol & NO asthma history in children younger than 2 years of age: 3 mL via nebulizer; may repeat once.
- Suspected croup (respiratory distress, barking cough and/or stridor) in any age pediatric patient: 5 mL via nebulizer; may repeat once.
Route:
IM
Nebulized
Drug Action:
Alpha effects produce peripheral vasoconstriction which:
- Increases coronary and cerebral perfusion
- Increases blood pressure in anaphylaxis
Beta1 effects:
- Increases heart rate
- Improves force of ventricular contractions
Beta2 effects:
- Causes bronchodilation
Class: Sympathomimetic
Onset: 5 minutes – 10 minutes
Duration: 5 minutes – 10 minutes