Adrinor

Indications

Adrenaline (also called epinephrine) is an emergency medicine. It is the first treatment for anaphylaxis, a severe and life-threatening allergic reaction (for example to insect stings, foods or medicines). In hospital it is also used in cardiac arrest (when the heart stops), for some cases of very low blood pressure or shock, and in small amounts with local anaesthetics to reduce bleeding and make numbing last longer.

How It Works

Adrenaline is a natural hormone. It tightens blood vessels to raise blood pressure, makes the heart beat more strongly, opens the airways, and reduces swelling of the throat and skin caused by allergy.

Dosage and Administration

Adrenaline injection is given by a doctor or nurse, or with an auto-injector by a person who has been trained to use it. For anaphylaxis in adults, the usual dose is 0.5 mg (0.5 ml of the 1 mg/ml solution) injected into the muscle of the outer thigh; it can be repeated after 5 minutes if there is no improvement. Children receive a smaller dose based on age or weight, as prescribed. Doses for cardiac arrest, shock or use into a vein are given only by trained hospital staff. After any emergency use, the person must be taken to hospital, because the reaction can come back.

Interactions

• Beta blockers (such as Propranolol) can reduce its effect and cause a sharp rise in blood pressure.
• Tricyclic antidepressants (such as Amitriptyline) and MAO inhibitors can increase its effect on the heart and blood pressure.
• Some anaesthetic gases (such as Halothane), Digoxin and Levothyroxine increase the risk of irregular heartbeat.
• It can raise blood sugar, so diabetes medicines may need adjusting.

Contraindications

In a life-threatening allergic reaction there is no reason not to use it. Outside emergencies, it is used with caution or avoided in people with serious heart rhythm problems, some types of glaucoma (narrow angle), and in local anaesthetic injections for fingers, toes, ears, nose or penis.

Side Effects

Common: fast or pounding heartbeat, shaking, anxiety, sweating, pale skin, headache, dizziness and nausea. These usually pass quickly. Get urgent medical help (call emergency services or go to hospital) after any use for anaphylaxis, and especially if there is chest pain, an irregular heartbeat, a severe headache, breathlessness, or the allergic symptoms return.

Pregnancy and Lactation

In a life-threatening emergency, adrenaline should be used in pregnancy and breastfeeding, because the benefit is far greater than any risk. Outside emergencies, use only if the doctor advises.

Precautions and Warnings

Use with care in people with heart disease, high blood pressure, an overactive thyroid, diabetes, or older age. Do not inject into the buttock, hands or feet. People at risk of anaphylaxis who are given an auto-injector should carry it at all times, know how to use it, and check the expiry date. Do not use the solution if it has turned pink or brown or contains particles.

Overdose

Overdose can cause a dangerous rise in blood pressure, irregular heartbeat, fluid in the lungs and stroke. It is an emergency and must be treated in hospital.

Therapeutic Class

Sympathomimetic (catecholamine); emergency treatment for anaphylaxis and cardiac arrest.

Storage

Store below 30°C, protected from light (keep in the outer carton). Do not refrigerate or freeze. Keep out of the reach of children.