Sympathomimetics.

Generic - cardiovascular system

Adrenaline (Epinephrine) USP 0.1mg per ml.

Sterile aqueous solution for parenteral administration.

Adjunctive use in the management of cardiac arrest. In cardiopulmonary resuscitation. Intracardiac puncture and intramyocardial injection of adrenaline may be effective when external cardiac compression and attempts to restore the circulation by electrical defibrillation or use of a pacemaker fail.

Ventricular fibrillation (pulseless ventricular tachycardia)

Adults:

Intravenous injection: 10ml (1mg) by intravenous injection repeated every 2-3 minutes as necessary.

Endotracheal: 20-30ml (2-3mg) via an endotracheal tube, repeated as necessary.

Intracardiac injection: 1 to 10ml (0.1 to 1mg), direct into the atrium of the heart.

Intracardiac injection should only be considered if there is no other access available. It should be undertaken by personnel trained in the technique.

Children:

Intravenous injection: Initially 0.1ml/kg body weight (10mcg/kg); e.g. 2kg infant would receive 0.2ml of Adrenaline 1:10,000. Subsequent doses should be 1ml/kg (100mcg/kg).

Intraosseous: 0.1ml/kg body weight (10mcg/kg).

Endotracheal: A dose has not been established; 10 times the intravenous dose may be appropriate.

Asystole

Adults:

Intravenous: 10ml (1mg) by intravenous injection repeated every 2-3 minutes as necessary. If there is no response after three cycles, consider injections of adrenaline 5mg.

Endotracheal: 20-30 ml (2-3mg) via an endotracheal tube, repeated as necessary.

Children:

Intravenous: 0.1ml/kg initially (10mcg/kg). If no response give 1ml/kg (100mcg/kg). After 3 cycles consider alkalising or antiarrhytmic agents.

Intraosseus: 0.1 ml/kg initially (10mcg/kg). If no response give 1ml/kg (100mcg/kg). After 3 cycles consider alkalising or antiarrhythmic agents.

Electromechanical Dissociation (EMD)

Adults:

Intravenous: 10ml (1mg) by intravenous injection repeated every 2-3 minutes as necessary. If normal rhythm does not return after standard measures, consider adrenaline 5mg intravenous.

Children:

Intravenous: 0.1ml/kg initially (10mcg/kg) every 3 minutes, until underlying cause identified. Subsequent doses should be 1ml/kg (100mcg/kg).

THE UTMOST CARE SHOULD BE EXERCISED AT ALL TIMES DURING THE DILUTION AND CALCULATION PROCESS. Childrens dose of 10micrograms/ kg (0.1mL/kg of the 1 in 10,000 adrenaline injection) by SLOW IV over several minutes.

Contraindications are relative as this product is intended for use in life-threatening emergencies.

Other than in the emergency situation, the following contraindications should be considered: hyperthyroidism, hypertension, ischaemic heart disease, diabetes mellitus and closed angle glaucoma.

These special warnings and precautions are relative as this product is intended for use in life-threatening situations.

Administer slowly with caution to elderly patients and to patients with ischaemic heart disease, hypertension, diabetes mellitus, hyperthyroidism or psychoneurosis. Use with extreme caution in patients with long-standing bronchial asthma and emphysema who have developed degenerative heart disease. Anginal pain may be induced when coronary insufficiency is present.

The effects of adrenaline may be potentiated by tricyclic antidepressants. Volatile liquid anaesthetics such as halothane increase the risk of adrenaline-induced ventricular arrhythmias and acute pulmonary oedema if hypoxia is present. Severe hypertension and bradycardia may occur with non-selective beta-blocking drugs such as propranolol. Propranolol also inhibits the bronchodilator effect of adrenaline. The risk of cardiac arrhythmias is higher when adrenaline is given to patients receiving digoxin or quinidine. Adrenaline -induced hyperglycaemia may lead to loss of blood-sugar control in diabetic patients treated with hypoglycaemic agents.

The vasoconstrictor and pressor effects of adrenaline, mediated by its alpha-adrenergic action, may be enhanced by concomitant administration of drugs with similar effects, such as ergot alkaloids or oxytocin. Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine with the risk of severe hypertension.

The potentially severe adverse effects of adrenaline arise from its effect upon blood pressure and cardiac rhythm. Ventricular fibrillation may occur and severe hypertension may lead to cerebral haemorrhage and pulmonary oedema. Symptomatic adverse effects are anxiety, dyspnoea, restlessness, palpitations, tachycardia, anginal pain, tremor, weakness, dizziness, headache and cold extremities.

Biochemical effects include inhibition of insulin secretion, stimulation of growth hormone secretion, hyperglycaemia (even with low doses), gluconeogenesis, glycolysis, lipolysis and ketogenesis.

International Medication Systems (UK) Ltd

(POM)

04 June 2009