Adrenaline is a sympathomimetic amine, alpha-and beta-adrenoreceptor agonist, synthesized from tyrosine in the adrenal medulla and released along with small quantities of nor-it into blood stream, upon stimulation by the central nervous system in response to stress, anger or fear, acting to increase heart rate, blood pressure, cardiac output and carbohydrate metabolism. Adrenaline is a very potent vasoconstrictor and cardiac stimualnt. It also acts as a bronchodialator (dilates the bronchi i.e. air passage) and relieves respiratory discomfort in bronchial asthma and emphysema.
Adrenaline also known as Epinephrine. . It is of Natural origin and belongs to Catecholamine. It belongs to Alpha & Beta adrenergic agonist pharmacological group on the basis of mechanism of action and also classified in Drugs used in Shock and Syumpathomimetic pharmacological group.The Molecular Weight of Adrenaline is 183.20. It is weakly acidic drug, 4.24% solution of the drug is isotonic and Its pKa is 8.7, 10.2, 12.
Oral absorption of Adrenaline is found to be 75% ±5. Plasma protien binding is 50%. Presystemic metabolism is noted to be 75% ±5 and metabolism is reported 99% via liver. Renal Excretion accounts for 70-95% and plasma half life is 3-10 min.
Adrenaline is primarily indicated in conditions like
Acute allergic reactions, Anaphylactic shock, Angioedema, Capillary bleeding in palliative care, Cardiac arrest, Life-threatening angioedema, Metastatic colorectal cancer, Open-angle glaucoma, and can also be given in adjunctive therapy as an alternative drug of choice in Anesthesia, Cardiopulmonary resuscitation, Priapism.
Adrenaline is known to interact with other drugs, the details of drug interactions is as follows:
Drug Details Severity Onset Management Acebutolol Acebutolol may enhance the vasopressor effect of Adrenaline.Epinephrine used as a local anesthetic for dental procedures will not likely cause clinically relevant problems. Moderate Immediate Monitor for increases in pressor effects of Adrenaline if used in patients receiving Acebutolol therapy. Beta1-selective agents should pose limited risk (if used in doses that allow them to retain their selectivity).The amount of Adrenaline used in dental procedures as part of local anesthetic administration is not likely to be of clinical concern.Infiltrating larger volumes of local anesthetics for other surgical procedures (eg, >0.06 mg Adrenaline) may cause clinically-relevant problems. Amitriptyline (HCl) Amoxapine Atenolol Atenolol may enhance the vasopressor effect of Adrenaline.Adrenaline used as a local anesthetic for dental procedures will not likely cause clinically relevant problems. Moderate Immediate Monitor increased pressor effects of Adrenaline if used in patients receiving Atenolol. The amount of Adrenaline in dental procedures as part of local anesthetic administration is not likely to be of clinical concern. Infiltrating larger volumes of local anesthetics for other surgical procedures (eg, >0.06 mg Adrenaline) may cause clinically-relevant problems. Benperidol Antipsychotics (e.g Benperidol) antagonizes hypertensive effects of Sympathomimetics (e.g Adrenaline). Betaxolol (HCl) Severe hypertension when beta-blockers (e.g Betaoxolol) given with Adrenaline. Major Bethanechol (Cl) Bethanidine (Sulphate) Bisoprolol (Fumarate) Severe hypertension when beta-blockers given with Adrenaline. Bovine Insulin Carteolol (HCl) Carvedilol Clomipramine (HCl) Cocaine Coadministration can result in life threatening cardiac arrhythmias. Major Use this combination with extreme caution. Debrisoquine (Sulphate) Dexamphetamine (Sulphate) Digoxin Coadministration increase risk of Cardiac Arrythmias
Atenolol may enhance the vasopressor effect of Adrenaline.Adrenaline used as a local anesthetic for dental procedures will not likely cause clinically relevant problems. Moderate Immediate Monitor increased pressor effects of Adrenaline if used in patients receiving Atenolol. The amount of Adrenaline in dental procedures as part of local anesthetic administration is not likely to be of clinical concern. Infiltrating larger volumes of local anesthetics for other surgical procedures (eg, >0.06 mg Adrenaline) may cause clinically-relevant problems. Dopexamine (HCl) Dothiepin (HCl) Doxepin (HCl) Droperidol Ephedrine Ergometrine (Maleate) Coadministration increases blood pressure by vasoconstriction due to alpha adrenergic agonist activity of ergot alkaloids. Moderate Coadministration is not recommended. If use then close clinical monitoring of response, tolerance and excessive vasoconstriction is recommended. Ergotamine (Tartrate) Additive vasoconstriction result due to alpha adrenergic agonist activity of ergotamine and hence increases blood pressure when given with adrenaline. Moderate Excessive vasoconstriction,patient response and tolerance should be monitor. Furazolidone Increased heart rate and blood pressure has been reported in some cases when adrenaline is used with furazolidne. Moderate monitor patient heart rate and blood pressure on coadministration. Guanethidine Catecholamine stores are depleted from adrenergic nerve endings by guanethidine result in hypertension and cardiovascular adverse effects when coadministered with adrenaline. Moderate Monitor patient blood pressure and heart rate.In hypertensive patient adrenaline is used with caution. Guanethidine Haloperidol vasopressor effect of adrenaline is reversed by haloperidol. Minor Phenylephrine or noradrenaline or other vasopressor agents can be a good alternative. Halothane Coadministration result in ventricular arrhythmias and acute pulmonary edema or death. Major This combination should be avoided or used cautiously.If used together than dose adjustment of adrenaline is necessary. Human Insulin Imipramine (HCl) Coadministration increase pressure response to adrenaline and cardiac arrythmias. imipramine should be coadminister with great care. Iprindole Likely interaction of IPRINDOLE increasing the HYPERTENSIVE effect of ADRENALINE. Major Iproniazid Phosphate Likely interaction of ADRENALINE increasing the VASOCONSTRICTOR effect of IPRONIAZID. Moderate Isoetharine Isoflurane Isoproterenol Levobunolol (HCl) Levodopa Linezolid Lofepramine (HCl) Likely interaction of LOFEPRAMINE increasing the HYPERTENSIVE effect of ADRENALINE. Major Maprotiline (HCl) Methotrimeprazine (Maleate) Methotrimeprazine(HCl) Monoamino oxidase inhibitor hypertensive agents anticholinergics CNS depresants. Methylphenidate (HCl) Metipranolol Likely interaction of METIPRANOLOL [EYE] increasing the HYPERTENSIVE effect of ADRENALINE Nadolol Oxprenolol (HCl) Oxytocin Penbutolol Phenoxybenzamine (HCl) Phenoxybenzamine (HCl) Phentolamine (Mesylate) Phentolamine (Mesylate) Phenylephrine (HCl) Pindolol Pioglitazone Piretanide Porcine Insulin Propranolol (HCl) Coadministration of these drugs leads to hypertension,then bradycardia and stroke may also be reported due to blockade of beta effects of adrenaline. Major Strict monitoring of patient blood pressure is required if this combination is used or selective beta blockers can be a better alternative. Protriptyline (HCl) Pseudoephedrine (HCl) Quinidine Coadministration increase risk of Cardiac Arrythmias Sevoflurane Thioridazine (HCl) Timolol (Maleate) Tolazoline (HCl) Tolbutamide Trifluoperazine (HCl) Trimipramine (Maleate) Zotepine
These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.
Interference in Pathology
No data regarding the pathological interferences produced by Adrenaline is available.
The severe or irreversible adverse effects of Adrenaline, which give rise to further complications include Local ischemic necrosis.
Adrenaline produces potentially life-threatening effects which include Ventricular fibrillation, Cerebral hemorrhage, Pulmonary edema. which are responsible for the discontinuation of Adrenaline therapy.
The signs and symptoms that are produced after the acute overdosage of Adrenaline include Cardiac arrhythmias, Cerebral hemorrhage, Pulmonary edema, Rise in B.P..
The symptomatic adverse reactions produced by Adrenaline are more or less tolerable and if they become severe, they can be treated symptomatically, these include Weakness, Dizziness, Headache, Anxiety, Dyspnea, Restlessness, Palpitation, Tachycardia, Tremors, Cold extremities, Stinging, Redness of eye.
Adrenaline's dosage details are as follows:
0.5 to 2 % 1.2 (1.25) As recommended. Eye Drops use in 5-10 mintues after administration of a mitotic eye drop For open angle Glaucoma 500 to 1000 mcg 750 (750) As recommended. IM Adrenaline should be given every 5 minutes
For Anaphylaxis, Bronchospam and allergy. 200 to 500 mcg 350 (350) As recommended. SC Every 20-25 minutes 2 to 20 ug/min 11 (11) As recommended. Slow-IV or 1 mg for 2-3 minutes upto 1 hour for Cardiac Arrest 2 to 20 ug/min 11 (11) As recommended. Solution 1:1,000 Solution. for bleeding
forocal anesthesia : minimum : 1:80,000 , maximum 1:200000
2 to 3 mg 2.5 (2.5) As recommended. Via ETT Every 15-30 Minutes, As Required
Paedriatic Dosage ( 20 Kg. )
100 to 0 mcg/kg 50 (50) As recommended. ETT dose may increase upto 100mcg/kg for advance cardiace life support 120 to 250 mcg/kg 180 (185) As recommended. Intra Muscular Single Dose
10 to 0 mcg/kg 5 (5) As recommended. IV dose may increase upto 100mcg/kg for advance cardiace life support
Neonatal Dosage ( 3 Kg. )
0.006 to 0.012 mg/kg 0.009 (0.009) As recommended. Intramuscular Single dose
High Risk Groups
Drug should not be given to Paediatrics, Pregnant Mothers, and Neonates.
If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.
Warning / Precautions
Care should be excercised in elderly as they are more sensitive to the effects of epinephrine. Use with caution in patients with ventricular fibrillation. Administer with great caution and in carefully circumscribed quantities in area of body served by end arteries (e.g. fingers, toes etc. because it can cause severe tissue necrosis). The use of epinephrine in children requires that the body weight of patient be known.
Care should be instituted when adrenaline is administered to diabetic patients
Arenaline Delays the second stage of labor.
Inj (soln), Inhalation Soln, Inhalation Aerosol, Eye Soln
Store Below 40°C. Do not Freeze. Protect from Sunlight and Moisture.
Store in refrigerator. Do not Freeze.
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