ADRENACLICK
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ADRENACLICK (ADRENACLICK).
Epinephrine is a direct-acting sympathomimetic amine that acts on alpha- and beta-adrenergic receptors. Alpha-1 receptor activation causes vasoconstriction, increasing blood pressure and reducing mucosal edema. Beta-1 receptor activation increases heart rate and contractility. Beta-2 receptor activation causes bronchodilation and vasodilation.
| Metabolism | Metabolized by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) in the liver and tissues. |
| Excretion | Primarily renal (80-90% as unchanged drug via glomerular filtration and active tubular secretion), with 10-20% fecal via biliary elimination. |
| Half-life | 2.0-2.5 hours in adults with normal renal function; prolonged in renal impairment (up to 24 hours in anuria). |
| Protein binding | 85-90% bound primarily to albumin, with minor binding to alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.5-1.0 L/kg, indicating moderate tissue distribution; clinical meaning: dose adjustments required in obesity or edema. |
| Bioavailability | Oral: 30-40% due to extensive first-pass metabolism; Sublingual: 50-60%. |
| Onset of Action | Intravenous: 5-10 minutes; Oral: 30-60 minutes; Sublingual: 10-15 minutes. |
| Duration of Action | Intravenous: 30-60 minutes; Oral: 4-6 hours; Sublingual: 2-4 hours. |
100 to 200 mcg sublingually as needed for severe allergic reaction, may repeat every 5-15 minutes.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required for renal impairment; creatinine clearance does not affect elimination. |
| Liver impairment | No specific guidelines; use with caution in severe hepatic impairment due to risk of reduced drug clearance. |
| Pediatric use | Weight 7.5-15 kg: 100 mcg sublingually; 15-30 kg: 200 mcg sublingually; >30 kg: 200-300 mcg sublingually; repeat every 5-15 minutes as needed. |
| Geriatric use | No specific dose adjustment; use cautiously due to increased prevalence of cardiovascular disease and potential for hypertension or arrhythmias. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ADRENACLICK (ADRENACLICK).
| Breastfeeding | Excreted into breast milk; M/P ratio approximately 0.9 for epinephrine. Limited human data; use with caution as infant may experience tachycardia and hypertension. |
| Teratogenic Risk | Pregnancy Category C. First trimester: limited human data; animal studies show no consistent teratogenic effects but increased fetal resorption at high doses. Second trimester: potential for reduced uterine blood flow. Third trimester: risk of fetal tachycardia, hypoglycemia, and maternal uterine relaxation delaying labor. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to epinephrine or any component","Coronary insufficiency","Narrow-angle glaucoma","Shock (other than anaphylactic)","During general anesthesia with halogenated hydrocarbons or cyclopropane","Do not use in patients with brain damage or organic heart disease"]
| Precautions | ["May cause cardiac arrhythmias, hypertension, and myocardial ischemia","Use with caution in patients with cardiovascular disease, diabetes, hyperthyroidism, or hypertension","May cause pulmonary edema if given in excessive doses","Risk of injection site necrosis with repeated injections"] |
| Food/Dietary | No food interactions are known for epinephrine; however, during anaphylaxis, avoid food intake until airway patency is established. No dietary restrictions are required for the medication itself. |
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| Fetal Monitoring |
| Monitor maternal blood pressure, heart rate, and uterine activity during administration. Fetal heart rate monitoring recommended due to risk of tachycardia. Assess for signs of maternal hypertension or arrhythmias. |
| Fertility Effects | No known adverse effects on fertility in animal studies. Human data not available. |
| Clinical Pearls | Adrenaclick (epinephrine auto-injector) is indicated for emergency treatment of anaphylaxis. Administer intramuscularly into the anterolateral thigh; the needle is designed to penetrate clothing if necessary. Do not inject into the gluteal muscle or vein. After injection, massage the site for 10 seconds to enhance absorption. Patients should carry two devices as a single dose may be insufficient. Monitor for biphasic anaphylaxis and arrange immediate transport to an emergency facility. |
| Patient Advice | Use the auto-injector at the first sign of a severe allergic reaction (e.g., hives, swelling, difficulty breathing, wheezing, throat tightness). · Inject into the outer thigh only; do not inject into a vein, buttock, or hands/feet. · Hold the device in place for 3 seconds after activation, then massage the injection site for 10 seconds. · Seek emergency medical care immediately after injection, even if symptoms improve. · Carry two auto-injectors at all times, as a repeat dose may be needed. |