Composition:
Each ampoule (1 ml ) contains Adrenaline ……………. 1 mg.

Pharmacological Properties:
Adrenaline ( Epinephrine ) is a direct acting sympathomimetic agent, with marked effect on beta-adrenoreceptors than on alpha-adrenoreceptors, its actions vary considerably according to the dose given, and the consequent reflex compensating responses of the body. In practice, major effects of adrenaline include increased speed and force of cardiac contraction (with lowered doses this causes increased systolic pressure yet reduced diastolic pressure since overall peripheral resistance is lowered, but with higher doses both systolic and diastolic pressure are increased as stimulation of peripheral alpha-receptors increases peripheral resistance); blood flow to skeletal muscle is increased ( reduced with higher doses).
Metabolic effects include increased oxygen consumption, blood flow in the kidneys, mucosa, and skin is reduced; there is a little direct effect on cerebral blood flow.
The strong vasoconstrictor actions of adrenaline acts quickly to counter vasodilatation and resulting increased capillary permeability. By its effect on smooth muscle, adrenaline relaxes the bronchioles, thereby relieving wheezing and dyspnoea. Its action also relieves angioedema or hives (urticaria).
Indications:
– In general, the most common uses of Adrenaline are to relieve respiratory distress due to bronchospasm, to provide rapid relief of hypersensitivity reactions to drugs and other allergens, and to prolong the action of infiltration anaesthetics.
– Adrenaline is used in cardiopulmonary resuscitation, and its cardiac effects may be of use in restoring cardiac rhythm in cardiac arrest due to various causes and it is similarly indicated for cardiovascular resuscitation procedures, specially in cardiac failure, or in hemorrhagic, or cardiogenic shock, although very hazardous.
– Adrenaline is used as a hemostatic agent. To relieve bronchial asthmatic paroxysms; or symptomatic relief of serum sickness, urticaria, angioneurotic edema; for resuscitation in cardiac arrest following anaesthetic accidents.
– Adrenalin can be utilized to prolong the action of intraspinal and local anaesthetics.
– Major clinical application of Adrenaline include the emergency management of severe allergic reactions (type 1)( anaphylaxis) to hymenoptera stings, foods, and anaphylatic shock to drugs and other allergens.
– In ventricular fibrillation, Adrenaline is the first pharmacological agent to be used if three attempts of electro defibrillation failed.
Contra Indications:
– Narrow angle glaucoma. – Brain damage.
– Pheochromocytoma – Prostatomegaly.
– Severe renal failure. – Coronary insufficiency.
– Adrenaline should not be used in cardiac failure or in haemorrhagic, traumatic, or cardiogenic shock.
Precautions:
– Adrenaline should be administered with extreme caution to patients who have developed ischaemic heart disease.
-Use of Adrenaline with drugs that sensitize the heart to arrhythmias is not recommended.
– Anginal pain may be induced by Adrenaline in patients with coronary insufficiency.
– Administer with caution to hyperthyroid individuals, psychoneurotic individuals, subjects with cardiovascular disease, hypertension, or diabetes, elderly individuals, pregnant women, and children under 30 kg (66 Lbs ) body weight.
– Great care is also needed in patients with arrhythmia or tachycardia, occlusive vascular disorders including arteriosclerosis, or aneurysms.
– Sympathomimetics should be avoided or used with cation in patients undergoing anaesthesia with cyclopropane, halothane, or other halogenated anasthetics, as they may induce ventricular fibrillation.
Pregnancy (Category C) : There are no adequate and well-controlled studies in pregnant women. However, Adrenaline should be used during pregnancy only if potential benefits justifies the potential risks to the fetus.
Pediatric Use : Safety and effectiveness in children has not been established.
Drug Interactions:
Many sympathomimetic drugs interact with monoamine oxidase inhibitors, and should not be given to patients receiving such treatment, or within 14 days of its termination.
– An increased risk of arrhythmias may also occur if sympathomimetic agents are given to patients receiving cardiac glycosides, quinidine, or tricyclic antidepressants.
– Use of Adrenaline with excessive doses of digitalis, diuretics, or other drugs that sensitize the heart to arrhythmias is not recommended.
– The effect of Adrenaline may be potentiated by tricyclic antidepressants, certain antihistamines e.g. Diphenhydramine, tripelennamine, and sodium L-thyroxine.
Side Effects:
– Use of Adrenaline ( Epinephrine) injection may cause transient and minor side effects include anxiety, headache, respiratory difficulty, pallor, dizziness, weakness, tremor, throbbing, restlessness, tenseness, fear and palpitation often occur with therapeutic doses, especially in hyperthyroid individuals.
– Repeated local injection can result in necrosis at sites of injection from vascular constriction.
Dosage And Administration:
Subcutaneously or Intramuscularly : 0.2 to 1 ml ( mg) start with small dose and increase if required.
– For bronchial asthma and certain allergic manifestations: Including angioedema, urticaria, serum sickness, anaphylactic shock, use Adrenaline subctuaneously. The adult dose (100-500mg) (0.1 to 0.5 ml) of a 1 in 1000 aqueous solution. Children have received 0.01 mg/kg body weight (10 mg per kg) to a maximum total dose of 0.5 ml (500 mg) administered subcutaneously, repeated every four hours if required.
– For cardiac resuscitation:
* A dose of 0.5 ml (0.5 mg) diluted to 10 ml with sodium chloride injection can be administered intravenously or intracardially to restore myocardial contractility.
* External cardiac massage should follow intracardial administration to permit the drug to enter coronary circulation. The drug should be used secondarily to unsuccessful attempt with physical or electromechanical methods.
– In ventricular fibrillation: 1 mg administerd intravenously, if an intravenous line can not be established a dose of 2 mg via an endotrachial tube can be considered.
In ophthalmic use: ( for producing conjuctival decongestions, to control hemorrhage, produce mydriasis and reduce intraocular pressure). Use a concentration of 1 : 10.000 (0.1 mg/ml) to 1 : 1.000 ( 1 mg/ml ).
Note:
– Adrenaline injection should be protected from exposure to light.
– Do not remove ampoules or vials from carton until ready to use.
Packing: Box containing ( 5-100) ampoules x 1 ml.
Storage: store between (15-30)° C , protect from light and freezing.