AdultPediatricDosage Forms & Strengths prefilled autoinjector or syringe for SC/IM use 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi) injectable solution 0.1mg/mL (1mg/10mL) 1mg/mL Note: Ratio expression of epinephrine concentrations are prohibited on drug labels; however, some may remain in inventory (1:1000 = 1mg/mL; 1:10,000 = 0.1mg/mL) Cardiac Arrest IV Recommended dose: 0.5-1.0 mg (5-10 mL) During a resuscitation effort, 0.5 mg (5 mL) IV q5min Intracardiac Intracardiac injection if there has not been sufficient time to establish an IV route Usual dose ranges from 0.3-0.5 mg (3-5 mL) Endotracheal tube Alternatively, if the patient has been intubated, epinephrine can be injected via the endotracheal tube directly into the bronchial tree at the same dosage as for IV injection 2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored Hypotension Associated with Septic Shock Indicated to increase mean arterial blood pressure in adults with hypotension associated with septic shock Recommended dose: 0.05-2 mcg/kg/minute IV infusion; titrate to desired mean arterial pressure (MAP); may adjust dose q10-15 min by 0.05-0.2 mcg/kg/minute to achieve desired blood pressure goal After hemodynamic stabilization, may wean incrementally q30min over 12-24 hr See also Administration Anaphylaxis Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis 0.1 mg/mL solution 0.1 mg IV at rate of 1-4 mcg/min over 5 min to prevent the need to repeat injections frequently OR may initiate with infusion at 5-15 mcg/min (with crystalloid administration); IV administration should only be done in patients who are profoundly hypotensive or are in cardiopulmonary arrest refractory to volume resuscitation and several epinephrine injections 1 mg/mL solution 0.3-0.5 mg (0.3-0.5 mL) of undiluted epinephrine IM/SC once in anterolateral aspect of the thigh, not to exceed 0.5 mg (0.5 mL) per injection, repeated every 5-10 minutes as necessary Monitor clinically for reaction severity and cardiac effects Prefilled autoinjector or syringe 0.3 mg (contents of 1 autoinjector) SC/IM once in anterolateral aspect of the thigh; may repeat dose after 5-15 minutes if symptoms persist Symptomatic Bradycardia Unresponsive to atropine or pacing: 2-10 mcg//min by IV infusion or 0.1-0.5 mcg/kg/min (7-35 mcg/min in 70 kg patient); titrate to patient response Mydriasis Induction and maintenance of mydriasis during intraocular surgery Use only preservative-free vials without tartaric acid Intraocular irrigating solution Dilute 1 mg (of 1 mg/mL single-use solution) to 1-10 mcg/mL Use as needed during procedure Intraocular intracameral injection Dilute 1 mg (of 1 mg/mL single-use solution) to 2.5-10 mcg/mL Injection volume: 0.1 mL Dosing Considerations Anaphylaxis With severe persistent anaphylaxis, repeat injections with an additional autoinjector may be necessary More than two sequential doses of epinephrine should only be administered under direct medical supervision Dosage Forms & Strengths prefilled autoinjector or syringe for SC/IM use 0.1mg/0.1mL (Auvi-Q) 0.15mg/0.15mL (EpiPen Jr, Auvi-Q, Symjepi) 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi) injectable solution 0.1mg/mL (1mg/10mL) 1mg/mL Anaphylaxis Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis 1mg/mL solution <30 kg (66 lbs): 0.01 mg/kg (0.01 mL/kg) SC/IM, not to exceed 0.3 mg (0.3 mL) per injection, repeated q5-10 min as necessary ≥30 kg (66 lbs): 0.3-0.5 mg (0.3-0.5 mL) SC/IM, not to exceed 0.5 mg (0.5 mL) per injection, repeated q5-10 min as necessary Autoinjector May repeat dose after 5-15 minutes if symptoms persist Infants weighing 7.5-15 kg (16.5-33 lb); Auvi-Q only: 0.1 mg SC/IM once Weight 15 to <30 kg: 0.15 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may repeat dose q5-15min Weight ≥30 kg: 0.3 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may repeat dose q5-15min Asystole/Pulseless Arrest (Off-label) IV, intraosseous 0.1 mg/mL solution: 0.01 mg/kg (0.1 mL/kg) IO/IV; not to exceed 1 mg/dose May repeat q3-5min until return of spontaneous circulation Endotracheal 1 mg/mL solution: 0.1 mg/kg (0.1 mL/kg) endotracheal; not to exceed 2.5 mg/dose May repeat every 3-5 minutes prn until IV/IO access established Symptomatic Bradycardia (Off-label) 0.1 mg/mL solution: 0.01 mg/kg IO/IV q3-5min prn; not to exceed 1 mg/dose 1 mg/mL solution: 0.1 mg/kg (0.1mL/kg) of endotracheal q3-5min prn; flush each dose with at least 5 mL 0.9% NaCl injection Neonates (aged <28 days); 0.1 mg/mL solution: 0.01-0.03 mg/kg IVP (0.1-0.3 mL/kg) q3-5min; higher doses not recommended Neonate IV access not available; 0.1 mg/mL solution: 0.05-0.1 mg/kg endotracheal tube; lower doses not effective; follow each dose with at least 5 mL 0.9% NaCl injection Interaction CheckerEnter a drug name and epinephrineNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (15)disopyramideepinephrine and disopyramide both increase QTc interval. Contraindicated.ibutilideepinephrine and ibutilide both increase QTc interval. Contraindicated.indapamideepinephrine and indapamide both increase QTc interval. Contraindicated.iobenguane I 123epinephrine decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.isocarboxazidisocarboxazid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.linezolidlinezolid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.lurasidoneepinephrine increases toxicity of lurasidone by pharmacodynamic synergism. Contraindicated. Interaction applies only in setting of acute lurasidone overdose. Epinephrine may enhance hypotensive effects of lurasidone in overdose setting.pentamidineepinephrine and pentamidine both increase QTc interval. Contraindicated.phenelzinephenelzine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.pimozideepinephrine and pimozide both increase QTc interval. Contraindicated.procainamideepinephrine and procainamide both increase QTc interval. Contraindicated.quinidineepinephrine and quinidine both increase QTc interval. Contraindicated.selegiline transdermalselegiline transdermal increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.sotalolepinephrine and sotalol both increase QTc interval. Contraindicated.tranylcyprominetranylcypromine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.Serious - Use Alternative (66)amiodaroneepinephrine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amitriptylineepinephrine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.amitriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.amoxapineepinephrine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.amoxapine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.artemether/lumefantrineepinephrine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.cabergolinecabergoline, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.chlorpromazineepinephrine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.clarithromycinepinephrine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.clomipramineepinephrine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.clomipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.desfluranedesflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.desflurane increases levels of epinephrine by decreasing metabolism. Contraindicated.desipramineepinephrine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.desipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.dihydroergotaminedihydroergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.dihydroergotamine intranasaldihydroergotamine intranasal, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.dofetilideepinephrine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.dosulepinepinephrine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.doxapramdoxapram increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.doxepinepinephrine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.doxepin, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.dronedaroneepinephrine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.droperidolepinephrine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.ergoloid mesylatesergoloid mesylates, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.ergotamineergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.erythromycin baseepinephrine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.erythromycin ethylsuccinateepinephrine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin lactobionateepinephrine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin stearateepinephrine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.etherether increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.etomidateetomidate increases levels of epinephrine by decreasing metabolism. Contraindicated.fluconazoleepinephrine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.fluphenazineepinephrine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.formoterolepinephrine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.haloperidolepinephrine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.imipramineepinephrine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.imipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.iobenguane I 131epinephrine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.isofluraneisoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.ketamineketamine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of epinephrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding).ketoconazoleepinephrine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.levoketoconazoleepinephrine and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.levomilnacipranlevomilnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.lofepramineepinephrine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.lofepramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.lumefantrineepinephrine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.maprotilineepinephrine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.maprotiline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.methoxyfluranemethoxyflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.methylergonovinemethylergonovine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.milnacipranmilnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.moxifloxacinepinephrine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.nadololnadolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).nortriptylineepinephrine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.nortriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.octreotideepinephrine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.octreotide (Antidote)epinephrine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.ozanimodozanimod increases toxicity of epinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.perphenazineepinephrine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.pindololpindolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).procarbazineprocarbazine increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.prochlorperazineepinephrine and prochlorperazine both increase QTc interval. Avoid or Use Alternate Drug.promazineepinephrine and promazine both increase QTc interval. Avoid or Use Alternate Drug.promethazineepinephrine