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Manufacturer(s) of Adrenaline in Pakistan.

BarrettDosacoElite
HSCMBLOphth-Pharma
OrientPDHShifa
Venus

Adrenaline

Overview

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.

Category:

Primary Characterstics

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.

Pharmacokinetics

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.

Indications

Adrenaline is primarily indicated in conditions like Acute allergic reactions, Anaphylactic shock, Angioedema, Capillary bleeding in palliative care, Cardiac arrest, Folate-deficient megaloblastic anaemia, 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.

Contraindications

Drug Interactions

Adrenaline is known to interact with other drugs, the details of drug interactions is as follows:

DrugDetailsSeverityOnsetManagement
AcebutololAcebutolol may enhance the vasopressor effect of Adrenaline.Epinephrine used as a local anesthetic for dental procedures will not likely cause clinically relevant problems. ModerateImmediateMonitor 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
AtenololAtenolol may enhance the vasopressor effect of Adrenaline.Adrenaline used as a local anesthetic for dental procedures will not likely cause clinically relevant problems.ModerateImmediateMonitor 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.
BenperidolAntipsychotics (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)
CocaineCoadministration can result in life threatening cardiac arrhythmias.MajorUse this combination with extreme caution.
Debrisoquine (Sulphate)
Dexamphetamine (Sulphate)
DigoxinCoadministration 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.ModerateImmediateMonitor 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.ModerateCoadministration 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. ModerateExcessive vasoconstriction,patient response and tolerance should be monitor.
FurazolidoneIncreased heart rate and blood pressure has been reported in some cases when adrenaline is used with furazolidne.Moderatemonitor patient heart rate and blood pressure on coadministration.
GuanethidineCatecholamine stores are depleted from adrenergic nerve endings by guanethidine result in hypertension and cardiovascular adverse effects when coadministered with adrenaline.ModerateMonitor patient blood pressure and heart rate.In hypertensive patient adrenaline is used with caution.
Haloperidolvasopressor effect of adrenaline is reversed by haloperidol.MinorPhenylephrine or noradrenaline or other vasopressor agents can be a good alternative.
HalothaneCoadministration result in ventricular arrhythmias and acute pulmonary edema or death.MajorThis 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.
IprindoleLikely interaction of IPRINDOLE increasing the HYPERTENSIVE effect of ADRENALINE. Major
Iproniazid PhosphateLikely interaction of ADRENALINE increasing the VASOCONSTRICTOR effect of IPRONIAZID.Moderate
Isoetharine
Isoflurane
Isoproterenol
Levobunolol (HCl)
Levodopa
Lofepramine (HCl)Likely interaction of LOFEPRAMINE increasing the HYPERTENSIVE effect of ADRENALINE. Major
Maprotiline (HCl)
Methotrimeprazine (Maleate)
Methylphenidate (HCl)
MetipranololLikely 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.MajorStrict 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)
QuinidineCoadministration 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.

Side Effects

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.

Available Brands

Click on the appropriate strength of the dosage form to view its available brands.

Single Ingredient

Inj: 1 mg/ml,

Multi ingredient

Inj: 5 mcg/ml, 0.001 %w/v,

Dosage

Adrenaline's dosage details are as follows:
Dose Single Dose Frequency Route Instructions

Adult Dosage

0.5 to 2 %1.2 (1.25)As recommended.Eye Dropsuse in 5-10 mintues after administration of a mitotic eye drop For open angle Glaucoma
500 to 1000 mcg750 (750)As recommended.IMAdrenaline should be given every 5 minutes For Anaphylaxis, Bronchospam and allergy.
200 to 500 mcg350 (350)As recommended.SCEvery 20-25 minutes
2 to 20 ug/min11 (11)As recommended.Slow-IVor 1 mg for 2-3 minutes upto 1 hour for Cardiac Arrest
2 to 20 ug/min11 (11)As recommended.Solution1:1,000 Solution. for bleeding forocal anesthesia : minimum : 1:80,000 , maximum 1:200000
2 to 3 mg2.5 (2.5)As recommended.Via ETTEvery 15-30 Minutes, As Required

Paedriatic Dosage ( 20 Kg. )

100 to 0 mcg/kg50 (50)As recommended.ETTdose may increase upto 100mcg/kg for advance cardiace life support
120 to 250 mcg/kg180 (185)As recommended.Intra MuscularSingle Dose
10 to 0 mcg/kg5 (5)As recommended.IVdose may increase upto 100mcg/kg for advance cardiace life support

Neonatal Dosage ( 3 Kg. )

0.006 to 0.012 mg/kg0.009 (0.009)As recommended.IntramuscularSingle 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.

Storage Conditions

Inj (soln), Inhalation Soln, Inhalation Aerosol, Eye Soln

Store Below 40°C. Do not Freeze. Protect from Sunlight and Moisture.

Inj (susp)

Store in refrigerator. Do not Freeze.

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