Information about Epinephrine (Adrenaline)
Epinephrine (Adrenaline) is a natural hormone and neurotransmitter produced by the adrenal glands. It is used as a medication for the treatment of severe allergic reactions, cardiac arrest, and severe bronchospasm.
Active ingredients: epinephrine bitartrate
Therapeutic category: Sympathomimetic, Adrenergic agonist
Chemical structure: C9H13NO3
Mechanism of action: Epinephrine acts on alpha and beta adrenergic receptors, causing vasoconstriction, bronchodilation, and increased heart rate.
History of the drug
Epinephrine was first isolated from the adrenal glands in the early 20th century. Its discovery opened new horizons in understanding the nervous system and hormones. Today, epinephrine is one of the most important drugs in emergency medicine.
According to research by Srisawat and Pipitpreecha, epinephrine can be administered through various routes, including intramuscular and intranasal, with different levels of systemic absorption.
Epinephrine is marketed under various trade names in many countries around the world, and research continues with great scientific interest.
Usage Instructions/Indications
Epinephrine (adrenaline) is used in emergency medical situations and is mainly administered:
- For the treatment of anaphylactic shock
- In cardiac arrest as part of cardiopulmonary resuscitation
- For the treatment of severe bronchospasm
- In cases of severe hypotension
Administration can be done:
- Intramuscularly
- Intravenously (in a hospital setting)
- Subcutaneously
- By inhalation (in special cases)
Contraindications and Precautions
The use of epinephrine is contraindicated in:
- Patients with known hypersensitivity to the drug
- Cases of local anesthesia in extremities
- Combination with certain antidepressants
Special caution is required in patients with:
- Cardiovascular diseases
- Hyperthyroidism
- Diabetes mellitus
- Hypertension
- Glaucoma
Special warnings for the elderly, children, and pregnant women
Elderly
Careful titration of the dose is required due to the increased risk of cardiovascular complications. Close monitoring of blood pressure and heart rate is recommended.
Children
The dosage should be adjusted based on body weight. Special caution is required when administering to neonates and infants.
Pregnant and breastfeeding women
Administered only when the expected benefit outweighs the potential risks. It crosses the placenta and may affect uterine blood flow.
As highlighted in a study by Yoon, Gianturco, Pavlech, and Storm, the use of epinephrine requires careful assessment of the clinical situation and individualization of treatment for each patient.
Dosage and administration
The dosage of epinephrine (adrenaline) depends on the clinical indication and the route of administration:
- For anaphylaxis: 0.3-0.5 mg intramuscularly, with the possibility of repetition after 5-15 minutes
- For cardiac arrest: 1 mg intravenously every 3-5 minutes
- For bronchospasm: 0.3-0.5 mg subcutaneously or intramuscularly
In a study conducted by Pansiritanachot, Vathanavalun, and Chakorn, different dosing regimens of epinephrine in post-resuscitation situations were investigated.
What to do if I miss a dose of epinephrine?
Epinephrine (adrenaline) is mainly used in emergency situations and does not follow a regular dosing schedule. In case of self-administered epinephrine for anaphylaxis, if symptoms persist, contact a doctor immediately.
Overdose
Epinephrine overdose can cause:
- Severe hypertension
- Arrhythmias
- Pulmonary edema
- Cerebral hemorrhage
- Renal failure
Immediate medical intervention and hospitalization are required.
Side effects
Common side effects:
- Tachycardia
- Arrhythmias
- Increased blood pressure
- Tremor
- Anxiety
- Headache
- Nausea
Rare side effects:
- Angina
- Pulmonary edema
- Hemorrhagic stroke
- Heart failure
- Necrosis at the injection site
In case of severe side effects, immediate discontinuation of administration and medical monitoring are required.
Interactions
Epinephrine (adrenaline) significantly interacts with many drugs and substances, which requires special attention during its administration. As emphasized in the works of a series of researchers, including Vathanavalun, understanding these interactions is critical for the safe use of the drug.
Drug-drug interactions
The simultaneous administration of epinephrine with monoamine oxidase inhibitors (MAOIs) can cause severe and prolonged hypertension. Interaction with beta-blockers can lead to severe hypertension and bradycardia. Tricyclic antidepressants enhance the action of epinephrine, increasing the risk of arrhythmias. According to the study by Chakorn and colleagues, co-administration with certain anesthetics can cause ventricular arrhythmias.
Drug-food interactions
Consumption of foods and drinks containing caffeine can enhance the stimulatory effect of epinephrine on the cardiovascular system. Simultaneous intake of alcohol can alter the body’s response to epinephrine. Foods rich in tyramine, such as certain cheeses and wines, may interact with epinephrine causing a dangerous increase in blood pressure. It is recommended to avoid consuming large amounts of salt as it may affect the drug’s effectiveness in regulating blood pressure.
Additional important information
Epinephrine (adrenaline) requires special attention in its storage and handling. The drug should be stored at room temperature, away from light and moisture. Exposure to high temperatures can reduce its effectiveness. In the case of self-administered epinephrine, it is important to regularly check the expiration date and the appearance of the solution. As emphasized by Storm, the effectiveness of the drug can be significantly affected by storage conditions.
Special attention is required when using epinephrine in combination with local anesthetics. Research by Pipitpreecha has demonstrated the importance of the correct ratio between the two substances. Keeping a record of administrations and patient reactions can help in better management of future incidents.
Development of resistance
Frequent use of epinephrine can lead to reduced receptor response to the drug. As noted by Gianturco, the development of resistance is particularly important in patients who require regular use of the drug. Dosage adjustment should be done carefully and always under medical supervision. Maintaining adequate intervals between doses can help prevent the development of resistance.
Preclinical and Clinical Studies
Preclinical studies of epinephrine (adrenaline) have focused on understanding its mechanisms of action in various tissues and organs. Studies in experimental animals have demonstrated its effects on the cardiovascular and respiratory systems. Toxicity and safety data have confirmed the favorable profile of the drug when used according to indications. The work of Srisawat and colleagues has significantly contributed to understanding the absorption of epinephrine through different routes of administration.
Post-marketing studies, Pharmacovigilance, and Pharmacokinetic characteristics
The pharmacokinetics of epinephrine are characterized by rapid onset of action and relatively short duration. In his research, Pavlech thoroughly analyzes the relationship between the route of administration and the bioavailability of the drug. Post-marketing data from the long-term use of epinephrine have confirmed its effectiveness in managing emergency situations. As noted by Yoon in her analysis, continuous pharmacovigilance has contributed to the development of improved delivery devices and a better understanding of the long-term effects of the drug.
Preclinical and Clinical Studies
Epinephrine (adrenaline) has been the subject of extensive laboratory and clinical studies. Preclinical research has focused on understanding the molecular mechanisms and pharmacological properties of the substance at the cellular level. Particular emphasis has been placed on studying the receptors and intracellular pathways activated by epinephrine. The results of a study by Pansiritanachot have shed light on the relationship between plasma drug concentration and clinical response.
Post-marketing studies, Pharmacovigilance, and Pharmacokinetic characteristics
Post-marketing studies have focused on evaluating the long-term safety and effectiveness of epinephrine in various patient populations. According to the analysis by SL Gianturco, the pharmacokinetic characteristics of epinephrine significantly depend on the route of administration and the patient’s condition. Pharmacovigilance systems have contributed to identifying rare adverse effects and optimizing administration protocols. The analysis of data from long-term use in real-world conditions has led to the development of personalized therapeutic approaches for different patient groups.
Comparative effectiveness
Epinephrine (adrenaline) has been proven particularly effective compared to other sympathomimetic agents in managing emergency situations. Conducting comparative studies has demonstrated its superiority in cases of anaphylaxis and cardiac arrest. Research work by LL Pavlech documents the faster onset of action of epinephrine compared to alternative therapeutic options.
Systematic reviews and meta-analyses
Data from systematic reviews support the use of epinephrine as a first-line treatment in life-threatening situations. A comprehensive analysis by R Pipitpreecha highlights the importance of timely administration of the drug in the outcome of incidents.
Current research directions and future prospects
Current research efforts focus on developing new forms of administration and optimizing existing formulations. Innovative approaches are being examined to extend the duration of action and reduce adverse effects. Of particular interest is research on personalized dosing regimens based on genetic and environmental factors. According to KD Storm, future research will focus on developing targeted therapeutic approaches with an improved safety profile.
Summary
Epinephrine bitartrate is a vital drug in emergency medicine. Its therapeutic value is indisputable in life-threatening situations such as anaphylaxis and cardiac arrest. However, its use requires caution due to potential interactions with other drugs and contraindications in certain conditions. Adverse effects include cardiovascular complications, and special attention is required when administering to special population groups.
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WARNING: Never take medication without consulting a doctor. Always read the medication leaflet. This encyclopedic article refers to the specific active substance and does not replace the instructions of your doctor or pharmacist.
Bibliography
Asian Pacific Journal – Srisawat C, Pipitpreecha R (2022). Systemic absorption of epinephrine compared between the intranasal and intramuscular routes of administration in healthy adults.
Resuscitation Plus – Pansiritanachot W, Vathanavalun O, Chakorn T (2024). Early post-resuscitation outcomes in patients receiving norepinephrine versus epinephrine for post-resuscitation shock.
University of Maryland Archive – Yoon SJ, Gianturco SL, Pavlech LL, Storm KD (2021). Epinephrine bitartrate: Summary Report.
