Epinephrine Latin name. Properties, uses and contraindications of epinephrine

R01AA14 (Epinephrine)
N01BB53 (Mepivacaine in combination with other drugs)
A01AD01 (Epinephrine)
C01CA24 (Epinephrine)
N01BB58 (Articaine in combination with other drugs)
N01BB51 (Bupivacaine in combination with other drugs)

You should consult your doctor before using Epinephrine. These instructions for use are for informational purposes only. For more information, please refer to the manufacturer's annotation.

Clinical and pharmacological groups

21.006 (Local anesthetic with vasoconstrictor component)
01.010 (Alpha-, beta-agonist)
21.009 (Local anesthetic for dental use)
21.007 (Local anesthetic with vasoconstrictor component for dental use)

pharmachologic effect

Adrenomimetic, has a direct stimulating effect on α- and β-adrenergic receptors.

Under the action (adrenaline) due to stimulation of α-adrenergic receptors, an increase in the content of intracellular calcium in smooth muscles occurs. Activation of α1-adrenergic receptors increases the activity of phospholipase C (through G-protein stimulation) and the formation of inositol triphosphate and diacylglycerol. This promotes the release of calcium from the depot of the sarcoplasmic reticulum. Activation of α2-adrenergic receptors leads to the opening of calcium channels and an increase in calcium entry into cells.

Stimulation of β-adrenergic receptors causes G-protein-mediated activation of adenylate cyclase and an increase in cAMP production. This process is a trigger mechanism for the development of reactions from various target organs. As a result of stimulation of β1-adrenergic receptors in the tissues of the heart, an increase in intracellular calcium occurs. When β2-adrenergic receptors are stimulated, there is a decrease in free intracellular calcium in smooth muscles, due, on the one hand, to an increase in its transport from the cell, and, on the other hand, to its accumulation in the depot of the sarcoplasmic reticulum.

It has a pronounced effect on the cardiovascular system. Increases the frequency and strength of heart contractions, stroke and minute volume of the heart. Improves AV conduction, increases automatism. Increases myocardial oxygen demand. Causes constriction of blood vessels abdominal cavity, skin, mucous membranes, to a lesser extent - skeletal muscles. Increases blood pressure (mainly systolic), in high doses increases OPSS. The pressor effect can cause a short-term reflex slowing of the heart rate.

Epinephrine (adrenaline) relaxes the smooth muscles of the bronchi, lowers the tone and motility of the gastrointestinal tract, dilates the pupils, and contributes to a decrease in intraocular pressure. Causes hyperglycemia and increases plasma levels of free fatty acids.

Pharmacokinetics

Metabolized with the participation of MAO and COMT in the liver, kidneys, gastrointestinal tract. T1 / 2 is a few minutes. Excreted by the kidneys.

Penetrates through the placental barrier, does not penetrate the BBB.

It is allocated with breast milk.

EPINEFRINE: DOSAGE

Individual. Enter s / c, less often - in / m or / in (slowly). Depending on the clinical situation, a single dose for adults can range from 200 mcg to 1 mg; for children -100-500 mcg. The solution for injection can be used as eye drops.

Topically used to stop bleeding - use tampons moistened with a solution of epinephrine.

drug interaction

Epinephrine antagonists are α- and β-adrenergic blockers.

Non-selective beta-blockers potentiate the pressor effect of epinephrine.

When used simultaneously with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalation anesthesia (chloroform, enflurane, halothane, isoflurane, methoxyflurane), cocaine increases the risk of developing arrhythmias (simultaneous use is not recommended, except in cases of emergency); with other sympathomimetic agents - increased severity side effects from the cardiovascular system; with antihypertensive drugs (including diuretics) - a decrease in their effectiveness; with ergot alkaloids - an increase in the vasoconstrictor effect (up to severe ischemia and the development of gangrene).

MAO inhibitors, m-anticholinergics, ganglionic blockers, thyroid hormone preparations, reserpine, octadine potentiate the effects of epinephrine.

Epinephrine reduces the effects of hypoglycemic agents (including insulin), neuroleptics, cholinomimetics, muscle relaxants, opioid analgesics, hypnotics.

With simultaneous use with drugs that prolong the QT interval (including astemizole, cisapride, terfenadine), there is an increase in the duration of the QT interval.

Pregnancy and lactation

Epinephrine (adrenaline) crosses the placental barrier and is excreted in breast milk.

Adequate and strictly controlled clinical studies of the safety of the use of epinephrine have not been conducted. Use during pregnancy and lactation is possible only if the expected benefit of therapy for the mother outweighs the potential risk to the fetus or child.

EPINEFRINE: SIDE EFFECTS

From the side of the cardiovascular system: angina pectoris, bradycardia or tachycardia, palpitations, increase or decrease in blood pressure; when used in high doses - ventricular arrhythmias; rarely - arrhythmia, pain in chest.

From the nervous system: headache, anxiety, tremor, dizziness, nervousness, fatigue, psychoneurotic disorders (psychomotor agitation, disorientation, memory impairment, aggressive or panic behavior, schizophrenia-like disorders, paranoia), sleep disturbance, muscle twitching.

From the side digestive system: nausea, vomiting.

From the urinary system: rarely - difficult and painful urination (with prostatic hyperplasia).

Allergic reactions: angioedema, bronchospasm, skin rash, erythema multiforme.

Others: hypokalemia, increased sweating; local reactions - pain or burning at the site of the / m injection.

Indications

allergic reactions immediate type(including urticaria, angioedema, anaphylactic shock) that develop when used medicines, sera, blood transfusions, food intake, insect bites, or exposure to other allergens.

Bronchial asthma (stopping an attack), bronchospasm during anesthesia.

Asystole (including against the background of an acutely developed AV blockade of the III degree).

Bleeding from superficial vessels of the skin and mucous membranes (including from the gums).

Arterial hypotension, not amenable to adequate volumes of replacement fluids (including shock, trauma, bacteremia, open heart surgery, renal failure, chronic heart failure, drug overdose).

The need to prolong the action of local anesthetics.

Hypoglycemia (due to an overdose of insulin).

Open-angle glaucoma, with surgical operations on the eyes - swelling of the conjunctiva (treatment), to dilate the pupil, intraocular hypertension.

To stop bleeding.

Treatment of priapism.

Contraindications

Hypertrophic obstructive cardiomyopathy, pheochromocytoma, arterial hypertension, tachyarrhythmia, ischemic heart disease, ventricular fibrillation, pregnancy, lactation, hypersensitivity to epinephrine.

special instructions

Use with caution in metabolic acidosis, hypercapnia, hypoxia, atrial fibrillation, ventricular arrhythmia, pulmonary hypertension, hypovolemia, myocardial infarction, non-allergic shock (including cardiogenic, traumatic, hemorrhagic), thyrotoxicosis, occlusive vascular diseases (including h history - arterial embolism, atherosclerosis, Buerger's disease, cold injury, diabetic endarteritis, Raynaud's disease), cerebral atherosclerosis, angle-closure glaucoma, diabetes, Parkinson's disease, convulsive syndrome, prostatic hypertrophy; simultaneously with inhalation drugs for anesthesia (halothane, cyclopropane, chloroform), in elderly patients, in children.

Epinephrine should not be administered intra-arterially, since severe peripheral vasoconstriction can lead to the development of gangrene.

Epinephrine can be used intracoronary in cardiac arrest.

With arrhythmias caused by epinephrine, beta-blockers are prescribed.

Adrenomimetic, has a direct stimulating effect on - and -adrenergic receptors.
Under the action of epinephrine (adrenaline), due to stimulation of α-adrenergic receptors, an increase in the content of intracellular calcium in smooth muscles occurs. Activation of 1-adrenergic receptors increases the activity of phospholipase C (through G-protein stimulation) and the formation of inositol triphosphate and diacylglycerol. This promotes the release of calcium from the depot of the sarcoplasmic reticulum. Activation of 2-adrenergic receptors leads to the opening of calcium channels and an increase in calcium entry into cells.
Stimulation of α-adrenergic receptors causes G-protein-mediated activation of adenylate cyclase and an increase in cAMP production. This process is a trigger mechanism for the development of reactions from various target organs. As a result of stimulation of 1-adrenergic receptors in the tissues of the heart, an increase in intracellular calcium occurs. When 2-adrenergic receptors are stimulated, there is a decrease in free intracellular calcium in smooth muscles, due, on the one hand, to an increase in its transport from the cell, and, on the other hand, to its accumulation in the depot of the sarcoplasmic reticulum.
It has a pronounced effect on the cardiovascular system. Increases the frequency and strength of heart contractions, stroke and minute volume of the heart. Improves AV conduction, increases automatism. Increases myocardial oxygen demand. It causes vasoconstriction of the abdominal organs, skin, mucous membranes, and to a lesser extent, skeletal muscles. Increases blood pressure (mainly systolic), in high doses increases OPSS. The pressor effect can cause a short-term reflex slowing of the heart rate.
Epinephrine (adrenaline) relaxes the smooth muscles of the bronchi, lowers the tone and motility of the gastrointestinal tract, dilates the pupils, and helps to lower intraocular pressure. Causes hyperglycemia and increases plasma free fatty acids.

Pharmacokinetics of the drug.

Metabolized with the participation of MAO and COMT in the liver, kidneys, gastrointestinal tract. T1 / 2 is a few minutes. Excreted by the kidneys.
Penetrates through the placental barrier, does not penetrate the BBB.
It is allocated with breast milk.

Indications for use:

Allergic reactions of immediate type (including urticaria, angioedema, anaphylactic shock) that develop with the use of drugs, serums, blood transfusions, food intake, insect bites or the introduction of other allergens.
Bronchial asthma (stopping an attack), bronchospasm during anesthesia.
Asystole (including against the background of an acutely developed AV blockade of the III degree).
Bleeding from superficial vessels of the skin and mucous membranes (including from the gums).
Arterial hypotension, not amenable to adequate volumes of replacement fluids (including shock, trauma, bacteremia, open heart surgery, renal failure, chronic heart failure, drug overdose).
The need to prolong the action of local anesthetics.
Hypoglycemia (due to an overdose of insulin).
Open-angle glaucoma, during eye surgery - swelling of the conjunctiva (treatment), to dilate the pupil, intraocular hypertension.
To stop bleeding.
Treatment of priapism.

Dosage and method of application of the drug.

Individual. Enter s / c, less often - in / m or / in (slowly). Depending on the clinical situation, a single dose for adults can range from 200 mcg to 1 mg; for children -100-500 mcg. The solution for injection can be used as eye drops.
Locally used to stop bleeding - use tampons moistened with a solution of epinephrine.

Side effects of Epinephrine:

From the side of the cardiovascular system: angina pectoris, bradycardia or tachycardia, palpitations, increase or decrease in blood pressure; when used in high doses - ventricular arrhythmias; rarely - arrhythmia, chest pain.
From the nervous system: headache, anxiety, tremor, dizziness, nervousness, fatigue, psychoneurotic disorders (psychomotor agitation, disorientation, memory impairment, aggressive or panic behavior, schizophrenia-like disorders, paranoia), sleep disturbance, muscle twitching.
From the digestive system: nausea, vomiting.
From the urinary system: rarely - difficult and painful urination (with prostatic hyperplasia).
Allergic reactions: angioedema, bronchospasm, skin rash, erythema multiforme.
Others: hypokalemia, increased sweating; local reactions - pain or burning at the site of the / m injection.

Contraindications to the drug:

Hypertrophic obstructive cardiomyopathy, pheochromocytoma, arterial hypertension, tachyarrhythmia, ischemic heart disease, ventricular fibrillation, pregnancy, lactation, hypersensitivity to epinephrine.

Use during pregnancy and lactation.

Epinephrine (adrenaline) crosses the placental barrier and is excreted in breast milk.
Adequate and strictly controlled clinical studies of the safety of the use of epinephrine have not been conducted. Use during pregnancy and lactation is possible only if the expected benefit of therapy for the mother outweighs the potential risk to the fetus or child.

Special instructions for the use of Epinephrine.

Use with caution in metabolic acidosis, hypercapnia, hypoxia, atrial fibrillation, ventricular arrhythmia, pulmonary hypertension, hypovolemia, myocardial infarction, non-allergic shock (including cardiogenic, traumatic, hemorrhagic), thyrotoxicosis, occlusive vascular diseases (including h history - arterial embolism, atherosclerosis, Buerger's disease, cold injury, diabetic endarteritis, Raynaud's disease), cerebral atherosclerosis, angle-closure glaucoma, diabetes mellitus, Parkinson's disease, convulsive syndrome, prostatic hypertrophy; simultaneously with inhalation drugs for anesthesia (halothane, cyclopropane, chloroform), in elderly patients, in children.
Epinephrine should not be administered intra-arterially, since severe peripheral vasoconstriction can lead to the development of gangrene.
Epinephrine can be used intracoronary in cardiac arrest.
With arrhythmias caused by epinephrine, beta-blockers are prescribed.

Interactions of Epinephrine with other drugs.

Epinephrine antagonists are - and -adrenergic blockers.
Non-selective beta-blockers potentiate the pressor effect of epinephrine.
When used simultaneously with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalation anesthesia (chloroform, enflurane, halothane, isoflurane, methoxyflurane), cocaine increases the risk of developing arrhythmias (simultaneous use is not recommended, except in cases of emergency); with other sympathomimetic agents - increased severity of side effects from the cardiovascular system; with antihypertensive drugs (including diuretics) - a decrease in their effectiveness; with ergot alkaloids - increased vasoconstrictor effect (up to severe ischemia and the development of gangrene).
MAO inhibitors, m-anticholinergics, ganglionic blockers, thyroid hormone preparations, reserpine, octadine, potentiate the effects of epinephrine.
Epinephrine reduces the effects of hypoglycemic agents (including insulin), neuroleptics, cholinomimetics, muscle relaxants, opioid analgesics, hypnotics.
With simultaneous use with drugs that prolong the QT interval (including astemizole, cisapride, terfenadine), an increase in the duration of the QT interval occurs.

11264 0

Epinephrine
Adreno- and sympathomimetics (a-, b-), hypertensive drugs

Release form

Solution d / in. 0.1% (adrenaline hydrochloride) 0.18% (adrenaline hydrotartrate) Solution for nar. approx. 0.1% (adrenaline hydrochloride)

Solution for nar. approx. 0.18% (adrenaline hydrotartrate)

Mechanism of action

Epinephrine activates all types of adrenergic receptors. At the cellular level, the effects of adrenoreceptor activation lead to a series of biochemical processes and, ultimately, to an increase or decrease in the concentration of calcium ions in the cell. Accordingly, the functional activity of the cell is enhanced or weakened. In relation to smooth muscles, this is expressed in an increase or decrease in muscle tone.

What kind of biochemical processes will begin in the cell and how, consequently, the nature of cellular activity will change, depends on the type of receptor localized on the cell membrane. For example, the smooth muscle cells of the vessels of the internal organs carry a1-adrenergic receptors, the stimulation of which leads to cell contraction and vasoconstriction. On the smooth muscle cells of the bronchi there are β2-adrenergic receptors, the interaction of epinephrine with which causes relaxation of the cells and expansion of the bronchi.

Main Effects

The action of epinephrine is diverse, but it fits well into the picture of preparing the body for physical work.

The cardiovascular system is the main target of epinephrine:
■ increases the frequency and strength of heart contractions, stroke and minute blood volumes, improves atrioventricular conduction, increases the excitability and automatism of the heart muscle, increases myocardial oxygen demand;
■ under the action of epinephrine on a:-adrenergic receptors, the vessels of the abdominal organs, skin, mucous membranes narrow, the total peripheral vascular resistance increases, blood pressure rises (mainly systolic);
■ the pressor effect can cause a short-term reflex slowing of the heart rate;
■ vasoconstriction causes a decrease in the rate of absorption of local anesthetics, which increases the duration of local anesthesia and reduces the toxic effect of anesthetics;
■ excitation of B2-receptors of blood vessels (skeletal muscles, liver, heart, etc.) leads to their expansion.
Epinephrine relaxes the smooth muscles of the bronchi (stimulation of β2-adrenergic receptors), reduces renal blood flow, blood supply to internal organs, tone and motility of the gastrointestinal tract.

Under the action of epinephrine, the tone of the uterus decreases.

Epinephrine dilates the pupils, helps to reduce the production intraocular fluid and a decrease in intraocular pressure.

Causes hyperglycemia (increases glycogenolysis and gluconeogenesis) and the mobilization of fatty acids from fat depots, which increases the plasma content of free fatty acids.

Inhibits allergic reactions. It inhibits the release of histamine and leukotrienes induced by antigens, eliminates spasm of bronchioles, and prevents the development of edema of their mucosa. The therapeutic effect develops almost instantly with intravenous administration, after s / c injection - after 5-10 minutes (maximum effect - after 20 minutes), with intramuscular injection, the time of onset of the effect is variable. Epinephrine - LS short action: with a / in the introduction of its duration is 1-2 minutes.

Pharmacokinetics

With s / c and / m injections, it is well absorbed. It is well absorbed after endotracheal and conjunctival administration. The time to reach the maximum concentration of epinephrine in plasma with s / c and / m injections is 3-10 minutes. Penetrates through the placenta and into breast milk. Epinephrine is rapidly destroyed by monoamine oxidase and catechol-ortho-methyltransferase cells of the liver, kidneys, intestinal mucosa, nerve cells with the formation of inactive metabolites. Metabolites, as well as a small amount of unchanged epinephrine, are excreted by the kidneys. T1 / 2 with intravenous injections - 1-2 minutes.

Indications

Epinephrine is part of most local anesthetic solutions. Epinephrine is prescribed for:
■ anaphylactic shock, traumatic shock and shock caused by other causes;
■ bronchial asthma (stopping an attack), bronchospasm during anesthesia;
■ hypoglycemia, incl. due to an overdose of insulin;
■ bleeding from superficial vessels of the skin and mucous membranes (including from the gums);
■ arterial hypotension, not amenable to adequate volumes of replacement fluids (including shock, trauma, bacteremia, open heart surgery, renal failure, etc.);
■ the need to prolong the action of local anesthetics.

Dosage and administration

Ways of administration of epinephrine - s / c, / m, less often / in, intracardiac (with cardiac arrest), for topical application, in addition, tampons moistened with a solution of epinephrine (for bleeding) and eye drops are used. Sometimes administered endotracheally. Dosing regimen is individual. Epinephrine is used in the form of single injections of 0.3-1 ml of a 0.1% hydrochloride solution (if necessary, repeated administration is allowed after 10-20 minutes - up to 3 times), sometimes intravenously by drip at a rate of 1 μg / min (with possible increase to 2-10 µg/min). During resuscitation, it is possible to administer it in an increasing dose (increase the dose by 1 ml every 5 minutes).

Children with anaphylactic shock: s / c or / m 10 mcg / kg (maximum - up to 0.3 mg), if necessary, the introduction of these doses is repeated every 15 minutes (up to 3 times).

Children with bronchospasm: s / c 10 mcg / kg (maximum - up to 0.3 mg), injections of these doses, if necessary, repeat every 15 minutes (up to 3-4 times) or every 4 hours.

Contraindications

■ Hypersensitivity.
■ Arterial hypertension, pheochromocytoma.
■ Severe atherosclerosis.
■ Ischemic disease heart, ventricular fibrillation, tachyarrhythmia.
■ Thyrotoxicosis, diabetes mellitus.
■ Angle-closure glaucoma.
■ Pregnancy, lactation.
■ Simultaneous use with means for inhalation anesthesia (halothane, cyclopropane, chloroform) is unacceptable.
■ Use to correct hypotension during labor is not recommended as it may delay the second stage of labor; when administered in high doses to weaken uterine contractions, it can cause prolonged atony of the uterus with bleeding.

Precautions, therapy control

For the prevention and treatment of arrhythmias that have arisen against the background of epinephrine, β-blockers are indicated.
Intracardiac epinephrine is administered if other methods are not available, because. there is a risk of cardiac tamponade and pneumothorax.

Epinephrine should not be administered intra-arterially due to the possible development of gangrene with vasospasm.
During the treatment period, it is recommended to determine the concentration of potassium ions in the blood serum, measure arterial and central venous pressure, diuresis, hemodynamic parameters, and take an electrocardiogram.

With endotracheal administration, the absorption and final plasma concentration of epinephrine can be unpredictable.

It is not advisable to use for a long time.

Strictly controlled studies of the use of epinephrine in pregnant women have not been conducted. A statistically regular relationship was established between the occurrence of malformations and inguinal hernia in children whose mothers used epinephrine during the first trimester or throughout pregnancy, and one case of anoxia in the fetus after intravenous administration of epinephrine to the mother was also reported. Epinephrine should not be used in pregnant women with blood pressure above 130/80 mm Hg. Art.

When stopping treatment, the dose should be reduced gradually, because. abrupt discontinuation of therapy may lead to severe hypotension.

Epinephrine is easily destroyed by alkalis and oxidizing agents.

Prescribe with caution:
■ with metabolic acidosis, hypercapnia, hypoxia;
■ with pulmonary hypertension;
■ with hypovolemia;
■ in case of non-allergic shock (including cardiogenic, traumatic, hemorrhagic);
■ with cerebral atherosclerosis;
■ with prostatic hypertrophy;
■ in the elderly and children.

Side effects

From the side of the cardiovascular system:
■ possible heart rhythm disturbances, increased blood pressure;
■ at high doses - ventricular arrhythmias, pain in the heart.

From the nervous system:
■ often - headache, anxiety, tremor;
■ less often - dizziness, nervousness, fatigue, psychoneurotic disorders (psychomotor agitation, disorientation, memory impairment, aggressive or panic behavior, schizophrenia-like disorders, paranoia), sleep disturbance, muscle twitching.

From the digestive system:
■ often - nausea, vomiting.

From the urinary system:
■ rarely - difficult and painful urination (with prostatic hyperplasia).

Local reactions:
■ pain or burning at the IM injection site.

Other effects:
■ rarely - hypokalemia;
■ very rarely - increased sweating. Animal studies have shown that the drug is teratogenic when administered at doses up to 25 times the recommended human dose.

Overdose

Symptoms: excessive increase in blood pressure, tachycardia, followed by bradycardia, rhythm disturbances (atrial and ventricular fibrillation), coldness and pallor of the skin, vomiting, headache, metabolic acidosis, myocardial infarction, craniocerebral hemorrhage (especially in elderly patients), pulmonary edema , possibly fatal.

Treatment: immediate cessation of administration, to reduce blood pressure, injections of a-blockers (phentolamine), for arrhythmias - b-blockers (propranolol), in the future - symptomatic therapy.

Epinephrine is a synthetic epinephrine. Instructions for use indicate that the drug has cardiostimulating, vasoconstrictive, hyperglycemic, hypertensive properties. The drug acts on the smooth muscles of the internal organs, cardiovascular and respiratory system, activates fat and carbohydrate metabolism. The tool is used for bronchial asthma, allergies, shock conditions.

Composition and form of release

There are various forms of release of Epinephrine. The compound is sold in the form of homeopathic granules or drops for oral administration, solutions for injections of various dosages, solutions for topical use, in the form of a powder substance or tincture substance.

The active substance is epinephrine in the form of hydrotartrate.

Pharmacological properties

Epinephrine - what is it? One of the most important neurotransmitters, the main hormone produced by the adrenal medulla. Another name for the remedy is adrenaline. According to the entire chemical structure, the substance can be attributed to catecholamines. Epinephrine is a synthetic adrenaline.

The drug creates a cardiostimulating, vasoconstrictive, hyperglycemic, hypertensive effect. Stimulates alpha and beta adrenoceptors. Entered parenterally, it is very quickly destroyed by monoamine oxidase and catechol-O-methyltransferase of liver cells, kidneys, intestinal mucosa, axons. T_1/2 is 1-2 min. Excretion of metabolites (vanillylmandelic acid) is carried out by the kidneys.

Instructions for use of Epinephrine explains that the drug has a pronounced effect on the smooth muscles of internal organs, the cardiovascular and respiratory systems, activates fat and carbohydrate metabolism. At the cellular level, the action is due to the activation of adenylate cyclase of the inner surface cell membrane, an increase in the level of intracellular cAMP and the entry of calcium ions into the cell.

The first phase of action is primarily due to stimulation of beta-adrenergic receptors of various organs and is manifested by tachycardia, an increase cardiac output, increased excitability and conduction of the myocardium, arteriolo- and bronchodilation, as well as a decrease in uterine tone, inhibition allergic reactions and mobilization of glycogen from the liver and fatty acids from fat depots.

Then, alpha-adrenergic receptors are excited and the vessels of the abdominal organs, skin, mucous membranes, and, to a lesser extent, skeletal muscles narrow, and blood pressure rises (mainly systolic).

Epinephrine medicine: what helps

Indications for use are as follows:

• to eliminate immediate allergic reactions (Quincke's edema, anaphylactic shock, urticaria) that have developed as a result of drug allergies, blood transfusions, food intake, the introduction of other allergens or insect bites;
• with asystole, including against the background of AV blockade of the 3rd degree;
• if it is necessary to prolong the action of local anesthetics;
• to stop an attack bronchial asthma;
• in the treatment of priapism;
• with open-angle glaucoma, if surgery is required on the eyes, in order to expand the pupil, relieve intraocular pressure;
• with bronchospasm that occurred during the use of anesthesia;
• in patients with hypoglycemia caused by an overdose of insulin;
• to stop bleeding;
• with arterial hypotension that cannot be treated with replacement fluids (after trauma, in a state of shock, with bacteremia, open heart surgery, with kidney failure, drug overdose, heart failure).

Contraindications

Instructions for the use of the drug Epinephrine prohibits when:

• pheochromocytoma;
• ventricular fibrillation;
• hypersensitivity to epinephrine;
• arterial hypertension;
• breastfeeding;
• hypertrophic obstructive cardiomyopathy;
• pregnancy;
• tachyarrhythmias.

Side effects

The medicine can cause negative reactions from the following body systems:

• local reactions: burning and pain at the injection site;
• nervous system: headache, tremor, anxiety, dizziness, fatigue, nervousness, psychoneurotic disorders (disorientation, psychomotor agitation, memory impairment, panic and aggressive behavior, paranoia, schizophrenia-like disorders), muscle twitching, sleep disturbance;
• digestive system: nausea, vomiting;
• circulatory system: angina pectoris, tachycardia or bradycardia, palpitations, decrease or increase in blood pressure, arrhythmia, ventricular arrhythmias, chest pain;
• allergic reactions: bronchospasm, angioedema, erythema multiforme, skin rash;
• genitourinary system: painful and difficult urination (with prostate hyperplasia);
• hypokalemia;
• increased sweating.

Medicine Epinephrine: instructions for use

Most often, the drug is prescribed subcutaneously or intramuscularly. Less commonly, it is administered intravenously by drip. As a vasoconstrictor, the drug is recommended to be administered intravenously, drip. The infusion rate is 1 mcg per minute, with the possibility of further increase to 10 mcg per minute.

Application for the treatment of diseases

To stop an attack of bronchial asthma, it is recommended to inject 0.3-0.5 mg of diluted or undiluted Epinephrine solution subcutaneously. If necessary, after 20 minutes, you can enter an additional dose (up to 3 times). Also shown are intravenous injections of the drug at 0.1-0.25 mg in a solution with sodium chloride, a concentration of 0.1 mg per 1 ml.

In anaphylactic shock, the drug is administered slowly intravenously. 0.1-0.25 mg of the substance is diluted in 0.9% solution of sodium chloride. If necessary, you can continue the introduction of the drug at a concentration of 0.1 m per ml.

If the patient's condition is more stable, then intramuscular or subcutaneous administration of 0.3-0.5 mg of the drug is recommended during. If necessary, you can make a second injection after 10-20 minutes and another one after the same period of time.

To prolong the duration of the local anesthetic, 5 mcg per ml is prescribed. As spinal anesthesia, 0.2-0.4 mg of the drug is used. To stop bleeding, the substance is used topically. A swab moistened with a solution of the drug is placed on the bleeding area.

With asystole, intracardiac injections of Epinephrine diluted with 0.9% solution of sodium chloride in a ratio of 0.5 mg of the substance per 10 ml of solvent are prescribed. During resuscitation, intravenous injections of the drug are used in a diluted form, every 3-5 minutes.

With endotracheal instillation, the optimal dosage is determined by the doctor, it should be 2-2.5 times higher than the dosage for intravenous injection.

Application instruction of Epinephrine for children

With asystole in newborns, the drug is slowly injected intravenously at 10-30 mcg per kg of the child's weight. The frequency of injections is every 3-5 minutes. If the child is more than 1 month old, use higher dosages of the drug. You can also enter the drug endotracheally.

To eliminate anaphylactic shock in children, the substance is used subcutaneously or intramuscularly at 10 mg per kg of the child's weight. The maximum dosage is 0.3 mg. If necessary, the drug can be administered every 15 minutes, no more than 3 times.

With bronchospasm in children, up to 0.3 mg of the drug is used subcutaneously. Injections can be repeated every 15 minutes up to 4 times. Treatment of open-angle glaucoma is carried out by instillation of one drop of a 1-2% solution of Epinephrine into the affected eye, 2 times a day. The duration of treatment is determined by the doctor.

During pregnancy and breastfeeding

Epinephrine (adrenaline) crosses the placental barrier and is excreted in breast milk. Adequate and strictly controlled clinical studies of the safety of the use of epinephrine have not been conducted.

Use during pregnancy and lactation is possible only if the expected benefit of therapy for the mother outweighs the potential risk to the fetus or child. The drug should not be administered to pregnant women if the pressure is more than 130 to 80 mm. It is best to stop breastfeeding.

Drug Interactions

Beta and alpha adrenergic blockers are epinephrine antagonists. Epinephrine reduces the effects of sleeping pills and narcotic analgesics. When using epinephrine together:

• with quinidine, cardiac glycosides, tricyclic antidepressants, drugs for inhalation anesthesia (enflurane, chloroform, isoflurane, halothane, methoxyflurane), dopamine increases the likelihood of developing arrhythmias (do not use together or use very carefully);
• with other sympathomimetic drugs - increased severity adverse reactions from the circulatory system;
• with antihypertensive drugs (including diuretics) - a decrease in their effectiveness.

Concurrent use of epinephrine:

• with MAO inhibitors (including procarbazine, furazolidone, selegiline) can cause a pronounced and sudden increase in blood pressure, headache, hyperpyretic crisis, arrhythmias, vomiting;
• with phenoxybenzamine - tachycardia and increased hypotensive effect; with nitrates - weakening of their therapeutic effect;
• with phenytoin - bradycardia and a sudden decrease in blood pressure; with drugs that prolong the QT interval (including cisapride, astemizole, terfenadine), prolongation of the QT interval;
• with preparations of thyroid hormones - mutual enhancement of action; with ergot alkaloids - increased vasoconstrictor effect (severe ischemia and development of gangrene are possible);
• with diatrizoates, ioxaglic or iothalamic acids - increased neurological effects.

Epinephrine reduces the effects of insulin and other hypoglycemic drugs.

special instructions

Use the drug with caution when:

• convulsive syndrome;
• non-allergic shock
• metabolic acidosis;
• myocardial infarction;
• Parkinson's disease;
• diabetes mellitus;
• pulmonary hypertension;
• ventricular arrhythmias;
• hypercapnia; hypoxia;
• hypovolemia;
• angle-closure glaucoma;
• prostatic hypertrophy;
• atrial fibrillation;
• cerebral atherosclerosis;
• simultaneously with inhalation drugs for anesthesia (halothane, cyclopropane, chloroform), in elderly patients, in children.

Epinephrine should not be administered intra-arterially, since severe peripheral vasoconstriction can lead to the development of gangrene. Permissible use intracoronary in cardiac arrest. With arrhythmias caused by epinephrine, beta-blockers are prescribed.

Analogues of the drug Epinephrine

You can replace the tool with the following analogues:

• epinephrine hydrotartrate.
• Adrenalin.
• Adrenaline hydrotartrate injection 0.18%.
• Adrenaline-Hydrochloride-Vial.
• Adrenaline tartrate.

Eye drops Epinephrine is essential for the treatment of open-angle glaucoma. This drug is rarely used in ophthalmic practice, but has a good effect in patients with this disease. Considering the strong effect of active substance Please read the instructions carefully before using.

Epinephrine is a foreign name, when in domestic medicine the definition of the drug as Adrenaline is more common.

It is a white or slightly pinkish crystalline powder. Undergoes change under the influence of light and air. Finds medical use in the form of a 0.1% solution.

Directly, a solution of Epinephrine is prepared with the addition of 0.01 N. hydrochloric acid. The resulting substance is colorless and transparent, it can not be subjected to heat.

Pharmacological action of epinephrine

Epinephrine is able to have the following effects on the body:

• Decrease. Epinephrine helps to normalize the circulation of intraocular fluid, which effectively reduces pressure inside the eyeball.
• Constricts blood vessels. Active substances this drug has a narrowing effect on the vessels of the skin and mucous membranes. This results in an increase in systolic arterial pressure, pulse rate and heart rate.
• Antiallergic. Epinephrine reduces the production of histamine and various inflammatory mediators, which helps eliminate the effects of allergic reactions: itching, inflammation, irritation, burning.
• Bronchodilator. This effect is manifested in the elimination of the spasmodic state of the bronchi, relaxation of the smooth bronchial muscles.

The complex action of epinephrine provides its irreplaceable effect, which helps to provide effective necessary treatment.

In what cases is it used?

The drug has the following indications for use:

1. Open-angle. This disease is associated with an increase in intraocular pressure, sometimes damage to the optic nerve is also observed.
2. Allergic reactions resulting from improper use of medicines, the use of certain foods, insect bites, transfusion of blood and its components.
3. Low blood pressure, provoked by various operations, injuries, heart failure.
4. Nosebleeds - as a topical use.

Epinephrine may be used in some other special cases as directed by a doctor.

Dosage and method of application

The instillation technique should be performed step by step, thereby minimizing the risk of adverse reactions.

Epinephrine eye drops are instilled alternately in each eye, 1-2 drops.

To minimize side effects follow the correct method of instillation:

• It is necessary to pull the lower eyelid down with the index finger, as a result, a kind of pocket will appear between the eyelid and the sclera.
• The gaze must be directed upward.
• Lightly press the medicine bottle until one drop appears from the dispenser, it should fall into the resulting pocket from top to bottom.
• Close your eye and hold it in this position for 2-3 minutes. Do not do this with excessive zeal, or blinking, as this will contribute to the expiration of the medicine.
• To prevent the drug from entering the nasal cavity, you need to hold your finger at the inner corner of the eye for 5 minutes, gently pressing.

The duration of the course of treatment with the drug depends on the indication for use and is prescribed directly by the doctor.

Contraindications

The drug is mainly used not in ophthalmology, and belongs to the list of potent medicines. The drug should not be used in the following cases:

• Individual intolerance to the components of the drug.
• The period of pregnancy and lactation.
• Increased blood pressure.
• Fibrillation of the ventricles of the heart.
• Various types of cardiomyopathies.

Before using Epinephrine, it is imperative to consult with a specialist who will identify the presence of contraindications.

side effects of epinephrine

At the first signs of local or systemic side effects, you should immediately notify your doctor

Taking the drug may be accompanied by the following side effects:

1. Drops in blood pressure.
2. Decrease or increase in pulse, heart rate.
3. Feeling tired, irritable.
4. Problems with the digestive system.
5. Seizures.
6. Allergic reactions: itching, rashes, irritation.

The doctor should definitely advise the patient about possible side effects.

Interaction with other drugs

The drug can not be combined with various drugs for the treatment of heart diseases, as well as with anesthetic agents, which is administered through inhalation, as this can cause a strong manifestation of side effects from the heart and circulatory system.

If you need to take Epinephrine in conjunction with other drops, then you need to pause between instillations of various drugs for at least 30 minutes.

It should also be noted that epinephrine contains epinephrine, which is a contrainsular hormone and reduces the effects of insulin and other drugs aimed at lowering blood glucose levels, thus it can provoke hyperglycemia.

Similar drugs

The most common analogues of Epinephrine are Vial and Adrenaline. They contain similar active ingredients.

Thus, Epinephrine is an indispensable drug for people with diseases of the visual apparatus, namely open-angle glaucoma. Particular attention should be paid to contraindications for the use and side effects drug.

Before you start taking it, you must always consult with your doctor, who will decide whether to take the medicine and determine the necessary dosage.

interesting information about modern methods glaucoma treatment, see the video:

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