EPINEPHRINE BITARTRATE IN 0.9% SODIUM CHLORIDE
Clinical safety rating: safe
No significant drug interactions Can cause hypernatremia and fluid overload.
Epinephrine is a direct-acting sympathomimetic amine that stimulates alpha- and beta-adrenergic receptors. Alpha-adrenergic effects increase peripheral vascular resistance and blood pressure. Beta1-adrenergic effects increase heart rate and contractility. Beta2-adrenergic effects cause bronchodilation and vasodilation in skeletal muscle.
| Metabolism | Epinephrine is metabolized primarily by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) to metanephrine, normetanephrine, and other metabolites. Hepatic metabolism also occurs. |
| Excretion | Primarily renal; 90% as metabolites (metanephrine, vanillylmandelic acid) and unchanged drug; biliary/fecal <5%. |
| Half-life | Terminal elimination half-life: ~2 minutes following intravenous administration; clinical context: ultrashort duration necessitates continuous infusion or repeated boluses for sustained effect. |
| Protein binding | ~50% bound, primarily to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | 0.3-0.5 L/kg; reflects distribution into highly perfused tissues and minimal plasma binding; clinical meaning: rapid distribution to target organs (heart, lungs, skeletal muscle). |
| Bioavailability | Intravenous: 100%; Subcutaneous: variable (20-40%) due to vasoconstriction; Intramuscular: 80-100% (deltoid site); Endotracheal: <10% (inconsistent). |
| Onset of Action | Intravenous: rapid (<1 minute); Endotracheal: 2-3 minutes; Intramuscular: 5-10 minutes; Subcutaneous: 5-15 minutes. |
| Duration of Action | Intravenous: 1-2 minutes; Subcutaneous/Intramuscular: 20-30 minutes; Clinical notes: duration is dose-dependent and limited by rapid metabolism; repeated dosing or infusion required for prolonged effect. |
Intravenous infusion: 0.1 to 1 mcg/kg/min, titrated to effect. Intravenous bolus: 1 mg every 3-5 minutes as needed for cardiac arrest. Intramuscular: 0.3 to 0.5 mg (1:1000 solution) for anaphylaxis, repeat every 5-15 minutes if necessary.
| Dosage form | SOLUTION |
| Renal impairment | No specific dose adjustment required for renal impairment. Use caution in patients with severe renal insufficiency due to potential for increased sensitivity. |
| Liver impairment | No specific dose adjustment required for hepatic impairment. Use caution in patients with severe hepatic insufficiency. |
| Pediatric use | Intravenous infusion: 0.1 to 1 mcg/kg/min, titrated to effect. Intravenous bolus: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) every 3-5 minutes for cardiac arrest. Intramuscular: 0.01 mg/kg (up to 0.3 mg) of 1:1000 solution for anaphylaxis. |
| Geriatric use | Initiate at lower end of dosing range (e.g., 0.1 mcg/kg/min IV infusion) and titrate slowly due to increased sensitivity and risk of adverse effects such as hypertension and tachycardia. Monitor closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Excreted into breast milk in minimal amounts. M/P ratio unknown. Oral bioavailability is low, so infant exposure is negligible. Use with caution in nursing mothers; theoretical risk of cardiovascular effects in infant. |
| Teratogenic Risk | FDA Pregnancy Category C. Epinephrine crosses the placenta. First trimester: Potential for teratogenicity based on animal studies (fetal hypoxia, malformations). Second and third trimesters: Uterine vasoconstriction may reduce placental perfusion, causing fetal hypoxia, bradycardia, or acidosis. High doses may delay labor due to β2-mediated tocolysis. |
■ FDA Black Box Warning
Epinephrine injection should not be used in patients with known hypersensitivity to sympathomimetic amines or any component of the product. Do not administer via the intravenous route unless diluted and under constant monitoring due to risk of cardiac arrhythmias and cerebral hemorrhage.
| Common Effects | fluid replacement |
| Serious Effects |
["Hypersensitivity to epinephrine or any component of the formulation","Narrow-angle glaucoma","Shock (other than anaphylactic shock)","In cardiovascular disease with coronary insufficiency","In patients with organic heart disease or cardiac dilatation"]
| Precautions | ["May exacerbate angina, myocardial infarction, or cardiac arrhythmias","Use caution in patients with hypertension, hyperthyroidism, diabetes, or cerebrovascular disease","May cause transient increase in blood glucose","May worsen symptoms of prostate enlargement or obstructive uropathy","Rapid IV injection may cause cerebral hemorrhage due to severe hypertension"] |
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| Fetal Monitoring | Continuous maternal heart rate, blood pressure, ECG, and oxygen saturation. Fetal heart rate monitoring (e.g., cardiotocography) for signs of distress. Monitor uterine activity for tocolysis or hyperstimulation. |
| Fertility Effects | Animal studies show no significant impairment of fertility. In humans, no well-controlled studies; theoretical risk of reduced uterine blood flow affecting implantation. |