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.

Primary Characterstics

Indications

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Pharmacokinetics

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Contraindications

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Drug Interactions

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

Severity N/A

Pseudoephedrine (HCl)

Interaction of Pseudoephedrine (HCl) with Adrenaline

Phenylephrine (HCl)

Interaction of Phenylephrine (HCl) with Adrenaline

Phentolamine (Mesylate)

Interaction of Phentolamine (Mesylate) with Adrenaline

Phenoxybenzamine (HCl)

Interaction of Phenoxybenzamine (HCl) with Adrenaline

Oxytocin

Interaction of Oxytocin with Adrenaline

Ephedrine

Interaction of Ephedrine with Adrenaline

Methylphenidate (HCl)

Interaction of Methylphenidate (HCl) with Adrenaline

Dexamphetamine (Sulphate)

Interaction of Dexamphetamine (Sulphate) with Adrenaline

Amitriptyline (HCl)

Interaction of Amitriptyline (HCl) with Adrenaline

Bethanechol (Cl)

Interaction of Bethanechol (Cl) with Adrenaline

Bethanidine (Sulphate)

Interaction of Bethanidine (Sulphate) with Adrenaline

Bovine Insulin

Interaction of Bovine Insulin with Adrenaline

Clomipramine (HCl)

Interaction of Clomipramine (HCl) with Adrenaline

Debrisoquine (Sulphate)

Interaction of Debrisoquine (Sulphate) with Adrenaline

Dothiepin (HCl)

Interaction of Dothiepin (HCl) with Adrenaline

Doxepin (HCl)

Interaction of Doxepin (HCl) with Adrenaline

Droperidol

Interaction of Droperidol with Adrenaline

Human Insulin

Interaction of Human Insulin with Adrenaline

Isoetharine

Interaction of Isoetharine with Adrenaline

Isoflurane

Interaction of Isoflurane with Adrenaline

Isoproterenol

Interaction of Isoproterenol with Adrenaline

Levodopa

Interaction of Levodopa with Adrenaline

Maprotiline (HCl)

Interaction of Maprotiline (HCl) with Adrenaline

Methotrimeprazine (Maleate)

Interaction of Methotrimeprazine (Maleate) with Adrenaline

Nadolol

Interaction of Nadolol with Adrenaline

Oxprenolol (HCl)

Interaction of Oxprenolol (HCl) with Adrenaline

Phentolamine (Mesylate)

Interaction of Phentolamine (Mesylate) with Adrenaline

Pindolol

Interaction of Pindolol with Adrenaline

Porcine Insulin

Interaction of Porcine Insulin with Adrenaline

Protriptyline (HCl)

Interaction of Protriptyline (HCl) with Adrenaline

Thioridazine (HCl)

Interaction of Thioridazine (HCl) with Adrenaline

Timolol (Maleate)

Interaction of Timolol (Maleate) with Adrenaline

Tolazoline (HCl)

Interaction of Tolazoline (HCl) with Adrenaline

Tolbutamide

Interaction of Tolbutamide with Adrenaline

Trifluoperazine (HCl)

Interaction of Trifluoperazine (HCl) with Adrenaline

Trimipramine (Maleate)

Interaction of Trimipramine (Maleate) with Adrenaline

Phenoxybenzamine (HCl)

Interaction of Phenoxybenzamine (HCl) with Adrenaline

Carteolol (HCl)

Interaction of Carteolol (HCl) with Adrenaline

Carvedilol

Interaction of Carvedilol with Adrenaline

Levobunolol (HCl)

Interaction of Levobunolol (HCl) with Adrenaline

Amoxapine

Interaction of Amoxapine with Adrenaline

Dopexamine (HCl)

Interaction of Dopexamine (HCl) with Adrenaline

Sevoflurane

Interaction of Sevoflurane with Adrenaline

Penbutolol

Interaction of Penbutolol with Adrenaline

Zotepine

Interaction of Zotepine with Adrenaline

Piretanide

Interaction of Piretanide with Adrenaline

Pioglitazone

Interaction of Pioglitazone with Adrenaline

Quinidine

Interaction of Quinidine with Adrenaline

Details: Coadministration increase risk of Cardiac Arrythmias
Imipramine (HCl)

Interaction of Imipramine (HCl) with Adrenaline

Details: Coadministration increase pressure response to adrenaline and cardiac arrythmias.
Management: imipramine should be coadminister with great care.
Benperidol

Interaction of Benperidol with Adrenaline

Details: Antipsychotics (e.g Benperidol) antagonizes hypertensive effects of Sympathomimetics (e.g Adrenaline).
Bisoprolol (Fumarate)

Interaction of Bisoprolol (Fumarate) with Adrenaline

Details: Severe hypertension when beta-blockers given with Adrenaline.
Guanethidine

Interaction of Guanethidine with Adrenaline

Methotrimeprazine(HCl)

Interaction of Methotrimeprazine(HCl) with Adrenaline

Details: Monoamino oxidase inhibitor hypertensive agents anticholinergics CNS depresants.
Linezolid

Interaction of Linezolid with Adrenaline

Metipranolol

Interaction of Metipranolol with Adrenaline

Details: Likely interaction of METIPRANOLOL [EYE] increasing the HYPERTENSIVE effect of ADRENALINE

Major

Halothane

Interaction of Halothane with Adrenaline

Details: Coadministration result in ventricular arrhythmias and acute pulmonary edema or death.
Management: This combination should be avoided or used cautiously.If used together than dose adjustment of adrenaline is necessary.
Cocaine

Interaction of Cocaine with Adrenaline

Details: Coadministration can result in life threatening cardiac arrhythmias.
Management: Use this combination with extreme caution.
Propranolol (HCl)

Interaction of Propranolol (HCl) with Adrenaline

Details: Coadministration of these drugs leads to hypertension,then bradycardia and stroke may also be reported due to blockade of beta effects of adrenaline.
Management: Strict monitoring of patient blood pressure is required if this combination is used or selective beta blockers can be a better alternative.
Betaxolol (HCl)

Interaction of Betaxolol (HCl) with Adrenaline

Details: Severe hypertension when beta-blockers (e.g Betaoxolol) given with Adrenaline.
Lofepramine (HCl)

Interaction of Lofepramine (HCl) with Adrenaline

Details: Likely interaction of LOFEPRAMINE increasing the HYPERTENSIVE effect of ADRENALINE.
Iprindole

Interaction of Iprindole with Adrenaline

Details: Likely interaction of IPRINDOLE increasing the HYPERTENSIVE effect of ADRENALINE.

Minor

Haloperidol

Interaction of Haloperidol with Adrenaline

Details: vasopressor effect of adrenaline is reversed by haloperidol.
Management: Phenylephrine or noradrenaline or other vasopressor agents can be a good alternative.

Moderate

Acebutolol

Interaction of Acebutolol with Adrenaline

Details: Acebutolol may enhance the vasopressor effect of Adrenaline.Epinephrine used as a local anesthetic for dental procedures will not likely cause clinically relevant problems.
Onset: Immediate
Management: 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.
Furazolidone

Interaction of Furazolidone with Adrenaline

Details: Increased heart rate and blood pressure has been reported in some cases when adrenaline is used with furazolidne.
Management: monitor patient heart rate and blood pressure on coadministration.
Ergotamine (Tartrate)

Interaction of Ergotamine (Tartrate) with Adrenaline

Details: Additive vasoconstriction result due to alpha adrenergic agonist activity of ergotamine and hence increases blood pressure when given with adrenaline.
Management: Excessive vasoconstriction,patient response and tolerance should be monitor.
Guanethidine

Interaction of Guanethidine with Adrenaline

Details: Catecholamine stores are depleted from adrenergic nerve endings by guanethidine result in hypertension and cardiovascular adverse effects when coadministered with adrenaline.
Management: Monitor patient blood pressure and heart rate.In hypertensive patient adrenaline is used with caution.
Digoxin

Interaction of Digoxin with Adrenaline

Details: 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.
Onset: Immediate
Management: 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.
Atenolol

Interaction of Atenolol with Adrenaline

Details: Atenolol may enhance the vasopressor effect of Adrenaline.Adrenaline used as a local anesthetic for dental procedures will not likely cause clinically relevant problems.
Onset: Immediate
Management: 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.
Ergometrine (Maleate)

Interaction of Ergometrine (Maleate) with Adrenaline

Details: Coadministration increases blood pressure by vasoconstriction due to alpha adrenergic agonist activity of ergot alkaloids.
Management: Coadministration is not recommended. If use then close clinical monitoring of response, tolerance and excessive vasoconstriction is recommended.
Iproniazid Phosphate

Interaction of Iproniazid Phosphate with Adrenaline

Details: Likely interaction of ADRENALINE increasing the VASOCONSTRICTOR effect of IPRONIAZID.

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.

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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 Cerebral hemorrhage, Pulmonary edema, Cardiac arrhythmias, 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.

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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 (20kg)
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 (3kg)
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.

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Warning / Precautions

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Storage Conditions

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Interference in Pathology

No data regarding the pathological interferences produced by Adrenaline is available.

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Brands / Trade Names of Adrenaline

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Manufacturers of Adrenaline in Pakistan

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