AUVI-Q
Clinical safety rating: caution
Comprehensive clinical and safety monograph for AUVI-Q (AUVI-Q).
Epinephrine is a direct-acting sympathomimetic amine that acts on alpha- and beta-adrenergic receptors. Alpha-adrenergic stimulation increases peripheral vascular resistance, reversing hypotension and improving coronary perfusion. Beta-adrenergic stimulation causes bronchodilation, positive chronotropic and inotropic effects, and vasodilation.
| Metabolism | Metabolized primarily by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) in the liver and other tissues. Major metabolites include metanephrine and vanillylmandelic acid (VMA). |
| Excretion | Epinephrine is rapidly metabolized in the liver and other tissues by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO). Renal excretion of metabolites accounts for the majority of elimination; less than 5% is excreted unchanged in urine. |
| Half-life | The terminal elimination half-life of epinephrine is approximately 2–3 minutes when administered intravenously. After intramuscular injection, the half-life is extended to about 20–30 minutes due to slower absorption, providing a longer duration of therapeutic effect. |
| Protein binding | Epinephrine is weakly bound to plasma proteins, primarily albumin and alpha-1-acid glycoprotein, with protein binding around 10–20%. |
| Volume of Distribution | The volume of distribution (Vd) for epinephrine is approximately 0.2–0.4 L/kg, indicating distribution primarily into extracellular fluid and minimal tissue binding. |
| Bioavailability | Intramuscular injection into the vastus lateralis muscle yields near-complete absorption with an absolute bioavailability of approximately 100% due to its high water solubility and extensive vascularization of the injection site. |
| Onset of Action | Intramuscular injection (auto-injector) leads to peak plasma concentrations within 5–10 minutes, with onset of clinical effects (e.g., increased blood pressure, heart rate) occurring within 1–5 minutes. |
| Duration of Action | The duration of action following intramuscular epinephrine is approximately 20–30 minutes for hemodynamic effects, though clinical response (e.g., reversal of anaphylaxis) may persist longer. Repeat dosing may be required if symptoms recur. |
0.3 mg intramuscularly into anterolateral thigh, repeated every 5-15 minutes as needed.
| Dosage form | SOLUTION |
| Renal impairment | No dosage adjustment required for renal impairment. |
| Liver impairment | No dosage adjustment required for hepatic impairment. |
| Pediatric use | Weight 15-30 kg: 0.15 mg IM; weight >30 kg: 0.3 mg IM; repeat every 5-15 minutes as needed. |
| Geriatric use | No specific dose adjustment; use standard adult dosing with caution for comorbidities. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for AUVI-Q (AUVI-Q).
| Breastfeeding | Epinephrine is excreted into breast milk in very small amounts; oral bioavailability is negligible. The M/P ratio is not reported. Use with caution; minimal risk to the infant due to poor oral absorption and rapid maternal metabolism. |
| Teratogenic Risk | Epinephrine is pregnancy category C. There are no adequate and well-controlled studies in pregnant women. Case reports and observational studies suggest no increased risk of major congenital anomalies. However, epinephrine may cause fetal hypoxia and decreased uterine blood flow due to vasoconstriction, particularly in the first trimester. Theoretical risk of uterine contractions may occur in later trimesters. |
■ FDA Black Box Warning
Epinephrine is indicated for emergency treatment of severe allergic reactions. In conjunction with epinephrine use, the patient should seek immediate medical or hospital care.
| Serious Effects |
["Hypersensitivity to epinephrine or any component of the product.","No absolute contraindications in life-threatening allergic reactions."]
| Precautions | ["Administer only via intramuscular or subcutaneous injection into the anterolateral aspect of the thigh; do not inject intravenously.","Use with caution in patients with cardiovascular disease, hypertension, diabetes, hyperthyroidism, parkinsonism, or elderly patients.","May cause transient hypertension, cardiac arrhythmias, and pulmonary edema.","Accidental intravascular injection may result in cerebral hemorrhage or cardiac arrhythmias."] |
| Food/Dietary | No specific food interactions are known for epinephrine. However, food allergens that trigger anaphylaxis should be strictly avoided. Alcohol may increase the risk of hypotension and should be avoided during treatment. No restrictions on food intake after administration. |
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| Fetal Monitoring | Monitor maternal blood pressure, heart rate, and fetal heart rate during administration. In emergencies, risk of anaphylaxis outweighs risks. Observe for signs of maternal or fetal distress. |
| Fertility Effects | No known adverse effects on fertility. Epinephrine is not expected to impair reproductive function. |
| Clinical Pearls | AUVI-Q is an epinephrine auto-injector for anaphylaxis. Key pearls: (1) The device has a distinct voice-guided instruction system; ensure patient/family are trained on its use. (2) The needle is shorter than some other auto-injectors (0.5 inches vs 0.6 inches for EpiPen), but still delivers intramuscularly. (3) It is temperature-sensitive; store at 25°C (77°F) with excursions permitted to 15-30°C (59-86°F). (4) Injection site: anterolateral thigh, can be through clothing. (5) Do not reuse; each device is a single dose. (6) After use, seek emergency medical treatment immediately. |
| Patient Advice | Always carry two AUVI-Q devices at all times in case a second dose is needed. · Familiarize yourself with the device's voice instructions before an emergency occurs. · Inject into the outer middle thigh; it can be administered through clothing if necessary. · After injection, hold in place for 3 seconds to deliver the full dose. · Seek emergency medical care immediately after using AUVI-Q. · Check expiration dates regularly and replace expired devices. · Store at room temperature away from light and moisture; do not refrigerate or freeze. · If a second dose is needed, use the second device in the other thigh. |