Description
EPINEPHRINE
Indications and Usage
Hypotension in Septic Shock: Epinephrine Injection USP (1 mg/10 mL, 0.1 mg/mL) is used to increase blood pressure in adults experiencing low blood pressure due to septic shock.
Dosage & Administration
General Guidelines:
- Check the epinephrine solution for particles or discoloration before use.
- Do not use if the solution is cloudy, colored, or has particles. Discard any unused medication.
Dosage for Hypotension in Septic Shock:
- Dilute 10 mL (1 mg) of epinephrine in 1,000 mL of a 5% dextrose solution or a mixture of 5% dextrose and sodium chloride to make a 1 mcg/mL solution.
- The diluted solution is stable for up to 4 hours at room temperature or up to 24 hours if refrigerated.
- Do not use saline solution alone for dilution. Administer whole blood or plasma separately if needed.
Infusion Tips:
- Use a large vein for infusion to prevent local concentration build-up.
- Avoid using veins in the legs for elderly patients or those with vascular disease.
Dosing Rate:
- The infusion rate should be between 0.05 mcg/kg/min and 2 mcg/kg/min.
- Adjust the dose every 10–15 minutes by 0.05 to 0.2 mcg/kg/min to reach the target mean arterial pressure (MAP).
- Once the patient is stable, reduce the dose gradually every 30 minutes over a 12-24 hour period.
Dosage Forms and Strengths
Injection Solution:
- Available in a 10 mL glass vial containing 1 mg/10 mL (0.1 mg/mL) of epinephrine in a clear, sterile solution. Each vial comes with an injector for single-dose use.
Contraindications
- There are no specific contraindications for Epinephrine Injection.
Warnings and Precautions
Hypertension:
- Monitor blood pressure carefully as epinephrine responses can vary. Adjust the dose to avoid high blood pressure. Patients on MAOIs or certain antidepressants may experience severe, prolonged hypertension with epinephrine.
Pulmonary Edema:
- Epinephrine can increase heart output and constrict blood vessels, potentially leading to fluid buildup in the lungs.
Cardiac Risks:
- Epinephrine may cause heart arrhythmias or damage the heart muscle, especially in those with heart disease or cardiomyopathy.
Extravasation and Tissue Damage:
- Avoid leakage of epinephrine into tissues to prevent damage. Regularly check the infusion site. If signs of tissue damage appear, move the infusion site to prevent tissue necrosis. There is a risk of gangrene if the drug is infused in a lower extremity vein.
- Antidote for Tissue Damage: If leakage occurs, inject 10-15 mL of saline with 5-10 mg of phentolamine into the affected area using a fine needle within 12 hours to help reverse the damage.
Renal Impairment:
- Epinephrine may reduce blood flow to the kidneys, which can lead to decreased urine output or kidney issues.
Allergic Reactions to Sulfites:
- Epinephrine contains sodium metabisulfite, which can cause allergic reactions, especially in those sensitive to sulfites. In life-threatening situations, use epinephrine if necessary, but consider an alternative formulation without sodium metabisulfite if possible.
Adverse Reactions
Common Side Effects:
- Cardiovascular: Rapid heart rate, irregular heart rhythms, heart attack, high blood pressure.
- Gastrointestinal: Nausea, vomiting.
- General: Reactions at the injection site, such as leakage.
- Metabolic: Insulin resistance, low potassium levels, lactic acidosis.
- Nervous System: Headache, tremors, stroke, dizziness, confusion, agitation.
- Psychiatric: Anxiety, restlessness.
- Renal: Reduced kidney function.
- Respiratory: Abnormal lung sounds (rales).
- Skin: Sweating, pallor, skin damage at the infusion site.
- More information on EPINEPHRINE
- https://familydrugmartkenya.com/product/nivolunix-nivolumab-40mg-injection-1s/
