manner in pregnant and non-pregnant patients In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated; delaying treatment in pregnant women with hypotension associated with septic shock may increase risk of maternal and fetal morbidity and mortality Life-sustaining therapy for pregnant woman should not be withheld due to potential concerns regarding effects of epinephrine on fetus Labor and delivery Epinephrine usually inhibits spontaneous or oxytocin-induced contractions of the pregnant human uterus and may delay second stage of labor; avoid epinephrine during second stage of labor; in dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg; although epinephrine may improve maternal hypotension associated with septic shock and anaphylaxis, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia Lactation There is no information regarding presence of epinephrine in human milk or effects on the breastfed infant or on milk production However, due to poor oral bioavailability and short half-life, epinephrine exposure is expected to be very low in breastfed infant Epinephrine is first-line medication of choice for treatment of anaphylaxis; it should be used in same manner for anaphylaxis in breastfeeding and non-breastfeeding patientsPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Strong alpha-adrenergic effects, which cause an increase in cardio output and HR, a decrease in renal perfusion and PVR, and a variable effect on BP, resulting in systemic vasoconstriction and increased vascular permeability Strong beta1- and moderate beta2-adrenergic effects, resulting in bronchial smooth muscle relaxation Secondary relaxation effect on smooth muscle of stomach, intestine, uterus, and urinary bladder Absorption Onset: 5-10 min (SC); 1 min (inhalation) Duration: 4 hr Metabolism Metabolized by MAO and COMT in adrenergic neuron Metabolites: Metadrenaline, sulfate conjugates, and hydroxy derivatives of mandelic acid (inactive) Elimination Excretion: Urine IV Incompatibilities Solution: Na-bicarbonate 5%, Ionosol PSL, Ionosol T/D5 Additive: Aminophylline, hyaluronidase, mephentermine, Na-bicarbonate Syringe: Na-bicarbonate(?) Y-site: Ampicillin, thiopental Not specified: Atropine, carbenicillin, diazepam, erythromycin, lidocaine IV Compatibilities Solution: D5W, D10W, dextrose-Ringer's, dextrose-saline, NS, LR, Ringer's Additive: Amikacin, cimetidine, dobutamine, floxacillin, furosemide, metaraminol, ranitidine, verapamil Syringe: Caffeine, doxapram, heparin, milrinone Y-site: Amiodarone, atracurium, bivalirudin, CaCl2, Ca gluconate, cefpirome, cisatracurium, dexmedetomidine, diltiazem, dobutamine, dopamine, famotidine, fenoldopam, fentanyl, furosemide, heparin, Hextend, hydrocortisone Na succinate, hydromorphone, inamrinone, labetalol, levofloxacin, lorazepam, midazolam, milrinone, morphine SO4, nicardipine, nitroglycerin, norepinephrine, pancuronium, phytonadione, KCl, propofol, ranitidine, remifentanil, nitroprusside, tirofiban, vasopressin, vecuronium, vitamin B/C, warfarin Not specified: Meperidine IV Preparation Dilute epinephrine in D5W or D5W 0.9% NaCl Administration in saline solution alone is not recommended Add 1 mL (1 mg) of epinephrine from its ampule to 1000 mL of a D5W containing solution Each mL of this dilution contains 1 mcg of epinephrine Solution: 1 mg in 250 mL D5W or NS (4 mcg/mL) to make up concentration of 15-60 mL/hr (1-4 mcg/min) IV Administration Correct blood volume depletion as fully as possible prior to administering any vasopressor When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, epinephrine can be administered before and concurrently with blood volume replacement Whenever possible, administer epinephrine infusions into a large vein Avoid using a catheter tie-in technique, because the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug Central line; infusion pump required Do not mix with alkaline solutions Discard after 24 hours or if solution is discolored or contains precipitate Store in light-resistant container Intraocular Preparation Epinephrine must be diluted prior to intraocular use Dilute 1 mL of epinephrine 1 mg/mL (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to create an epinephrine concentration of 1:100,000 to 1:1,000,000 (10-1 mcg/mL) Use the irrigating solution as needed for the surgical procedure Intraocular Administration After dilution in an ophthalmic irrigating fluid, inject intracamerally SC/IM Administration SC or IM administration only Inject IM or SC into the anterolateral aspect of the thigh, through clothing if necessary Do not administer autoinjector IV; administer only in outer thigh to ensure SC or IM administration Do not inject into buttock, or into digits, hands, or feet To minimize the risk of injection-related injury, instruct caregivers to hold the child's leg firmly in place and limit movement prior to and during injection when administering to young children Discard remaining volume after dose has been administered In conjunction with use, seek immediate medical or hospital care Storage Injection Unused vials Store at room temperature, 20-25°C (68-77°F) Protect from light until ready to use; do not refrigerate; protect from freezing Protect from alkalis and oxidizing agents Diluted solutions Store at room temperature (25°C) or refrigeration (4°C) is 24 hr Autoinjector Store at room temperature 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F; do not refrigerator The trainer for AUVI-Q should not be used at temperatures <50ºF (10ºC) or >104ºF (40ºC) Store the trainer for AUVI-Q in its outer case; keep away from dirt, chemicals, and water BRAND FORM. UNIT PRICE PILL IMAGE Epinephine Professional EMS injection- 1 mg/mL kitEpinephrine Professional injection- 1 mg/mL kitAdrenalin injection- 1 mg/mL (1 mL) vialAdrenalin injection- 1 mg/mL vialEpinephrineSnap-V injection- 1 mg/mL kitEpinephrineSnap-EMS injection- 1 mg/mL kitEpiPen Jr injection- 0.15 mg/0.3 mL deviceEpiPen Jr 2-Pak injection- 0.15 mg/0.3 mL deviceEpiPen 2-Pak injection- 0.3 mg/0.3 mL deviceAuvi-Q injection- 0.3 mg/0.3 mL deviceAuvi-Q injection- 0.15 mg/0.15 mL deviceEpiPen injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.15 mg/0.3 mL deviceepinephrine injection- 1 mg/mL (1 mL) solutionepinephrine injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.15 mg/0.3 mL deviceepinephrine injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.15 mg/0.3 mL deviceepinephrine injection- 0.15 mg/0.15 mL deviceepinephrine injection- 0.1 mg/mL solutionepinephrine injection- 0.1 mg/mL solutionepinephrine injection- 0.3 mg/0.3 mL deviceepinephrine injection- 0.15 mg/0.3 mL deviceCopyright © 2010 First DataBank, Inc.Select a drug:epinephrine inhalationepinephrine injectionPrint Patient Educationepinephrine inhalation EPINEPHRINE INHALER - ORAL INHALATION (EP-i-NEF-rin) COMMON BRAND NAME(S): Primatene Mist USES: Epinephrine is used to treat wheezing and shortness of breath that commonly occur with asthma. Controlling these symptoms can decrease time lost from work or school. Epinephrine belongs to a class of drugs known as bronchodilators. It works by relaxing the muscles around the airways so that they open up and you can breathe more easily. Use this medication only if you have been told by your doctor that you have asthma. HOW TO USE: Read the Patient Information Leaflet for instructions on proper use of this medication and the proper cleaning of the mouthpiece. Consult your doctor or pharmacist if you have any questions.Shake the canister well before each inhalation. Follow all directions on the product package. If you have any questions, ask your doctor or pharmacist. If you take other asthma drugs by mouth or with inhaling devices, ask your doctor about how to correctly take this medication with your other asthma medicines.Use this medication exactly as directed in the product package. Inhale by mouth as needed. Take the cap off the mouthpiece. Place the mouthpiece near your mouth and exhale. Place the mouthpiece fully into your mouth and press the inhaler as you breathe in deeply. Hold your breath for as long as comfortable to allow the drug to be absorbed. If more than one inhalation is needed, wait at least 1 full minute between inhalations. Do not use again for at least 4 hours. If your breathing does not get better within 20 minutes after using this medication, or if your breathing gets worse, get medical help right away.Rinse your mouth after using this medication to help prevent dryness and throat irritation. Do not use more of this medication or use it more often than recommended by the product package or your doctor.Clean the mouthpiece after each day of use as directed. The mouthpiece should also be cleaned if it is clogged or not working properly.Try to keep track of the number of inhalations used from each canister. Discard the canister after you have used the number of inhalations marked on the product package. Do not float the inhaler in water to test if any more drug is left in it. SIDE EFFECTS: Headache, nausea, vomiting, nervousness, dizziness, shaking (tremor), trouble sleeping, stomach upset, sweating, dry mouth, bad taste, cough, or sore throat may occur. If any of these effects last or get worse, notify your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: fast/pounding/irregular heartbeat, muscle cramps, weakness, mental/mood changes (such as anxiety, hallucinations).Get medical help right away if you have any very serious side effects, including: chest pain.Rarely, this medication has caused severe (rarely fatal), sudden worsening of breathing problems/asthma (paradoxical bronchospasm). If you experience sudden wheezing, get medical help right away.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before taking epinephrine, tell your doctor or pharmacist if you are allergic to it; or to similar bronchodilators (such as albuterol, levalbuterol, salmeterol); or to sympathomimetic drugs (such as pseudoephedrine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have any of the following health problems, consult your doctor or pharmacist before using this product: heart disease (such as high blood pressure, abnormal heart rhythm, coronary insufficiency), seizures, overactive thyroid (hyperthyroidism), diabetes, low blood potassium level (hypokalemia), glaucoma (narrow-angle), Parkinson's disease, urination problems (such as trouble urinating due to enlarged prostate).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially the effects on the heart.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (such as prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: some beta blockers (such as propranolol), other sympathomimetic drugs (such