epinephrine (adrenaline)

Adult Dosing .

Dosage forms:  INJ (auto-injector): 0.15 mg, 0.3 mg; INJ (pre-filled syringe): 0.1 mg per mL; INJ (vial): 0.1 mg per mL, 1 mg per mL

septic shock

[0.05-2 mcg/kg/min IV]

Info: titrate dose by 0.05-0.2 mcg/kg/min q10-15min to target mean arterial pressure; taper dose gradually to D/C

anaphylaxis

[auto-injector form, 15-30 kg]

Dose: 0.15 mg SC/IM x1; Info: may repeat dose x1 after 5-15min; may consider 0.3 mg SC/IM x1 if wt >25 kg

[auto-injector form, >30 kg]

Dose: 0.3 mg SC/IM x1; Info: may repeat dose x1 after 5-15min

[pre-filled syringe or vial form]

Dose: 0.3-0.5 mg (1 mg per mL) SC/IM q5-10min prn; Max: 0.5 mg/dose

asthma exacerbation, severe

[0.3-0.5 mg (1 mg per mL) SC/IM q20min x3 doses prn]

Max: 1 mg/dose

ACLS, asystole/PEA

[1 mg (0.1 mg per mL) IV/IO q3-5min prn]

Alt: 2-2.5 mg (1 mg per mL) ETT q3-5min prn; Info: give as soon as feasible during CPR; dilute ETT dose w/ sterile water or NS to total volume 5-10 mL; IV/IO preferred to ETT route; optimal ETT dose unknown; see ACLS: Asystole/PEA table

ACLS, VF/pulseless VT

[1 mg (0.1 mg per mL) IV/IO q3-5min prn]

Alt: 2-2.5 mg (1 mg per mL) ETT q3-5min prn; Info: give during CPR; dilute ETT dose w/ sterile water or NS to total volume 5-10 mL; IV/IO preferred to ETT route; optimal ETT dose unknown; see ACLS: VF/Pulseless VT table

ACLS, bradycardia

[2-10 mcg/min IV]

Info: for pts unresponsive to atropine or if atropine use inappropriate; see ACLS: Bradycardia table

post-resuscitation stabilization (off-label)

[0.1-0.5 mcg/kg/min IV]

Info: refer to ACLS guidelines

rapid sequence intubation adjunct (off-label)

[5-20 mcg IV x1]

Info: for pts w/ shock or s/sx hypotension during intubation; see Rapid Sequence Intubation (RSI), Adult table

renal dosing

[see below]

renal impairment: no adjustment

HD/PD: not defined

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  INJ (auto-injector): 0.15 mg, 0.3 mg; INJ (pre-filled syringe): 0.1 mg per mL; INJ (vial): 0.1 mg per mL, 1 mg per mL

anaphylaxis

[auto-injector form, 15-30 kg]

Dose: 0.15 mg SC/IM x1; Info: may repeat dose x1 after 5-15min; may consider 0.3 mg SC/IM x1 if wt >25 kg

[auto-injector form, >30 kg]

Dose: 0.3 mg SC/IM x1; Info: may repeat dose x1 after 5-15min

[pre-filled syringe or vial form, <30 kg]

Dose: 0.01 mg/kg/dose (1 mg per mL) SC/IM q5-10min prn; Max: 0.3 mg/dose

[pre-filled syringe or vial form, >30 kg]

Dose: 0.3-0.5 mg (1 mg per mL) SC/IM q5-10min prn; Max: 0.5 mg/dose

asthma exacerbation, severe

[infants/children]

Dose: 0.01 mg/kg/dose (1 mg per mL) SC/IM q20min x3 doses prn; Max: 0.5 mg/dose

NALS/NRP

[0.01-0.03 mg/kg/dose (0.1 mg per mL) IV/IO q3-5min prn]

Alt: 0.05-0.1 mg/kg/dose (0.1 mg per mL) ETT q3-5min prn; Info: give during CPR; IV route preferred; optimal ETT dose unknown; see NALS/NRP: Neonatal Resuscitation table

PALS, asystole/PEA

[0.01 mg/kg/dose (0.1 mg per mL) IV/IO q3-5min prn]

Max: 1 mg/dose IV/IO, 2.5 mg/dose ETT; Alt: 0.1 mg/kg/dose (1 mg per mL) ETT q3-5min prn; Info: give w/in 5min CPR start; IV/IO preferred to ETT route; optimal ETT dose unknown; see PALS: Asystole/PEA table

PALS, VF/pulseless VT

[0.01 mg/kg/dose (0.1 mg per mL) IV/IO q3-5min prn]

Max: 1 mg/dose IV/IO, 2.5 mg/dose ETT; Alt: 0.1 mg/kg/dose (1 mg per mL) ETT q3-5min prn; Info: give during CPR; IV/IO preferred to ETT route; optimal ETT dose unknown; see PALS: VF/Pulseless VT table

PALS, bradycardia

[0.01 mg/kg/dose (0.1 mg per mL) IV/IO q3-5min prn]

Max: 1 mg/dose IV/IO, 2.5 mg/dose ETT; Alt: 0.1 mg/kg/dose (1 mg per mL) ETT q3-5min prn; Info: for pts w/ persistent bradycardia; IV/IO preferred to ETT route; optimal ETT dose unknown; see PALS: Bradycardia table

post-resuscitation stabilization (off-label)

[0.1-1 mcg/kg/min IV/IO]

Info: refer to PALS guidelines

renal dosing

[see below]

renal impairment: no adjustment

HD/PD: not defined

hepatic dosing

[not defined]