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====== Adrenaline (Treatment) ======

===== - Overview =====
Adrenaline is an endogenous catecholamine, and is used pharmacologically as a sympathomimetic agent. It acts on the β and α adrenoreceptors with dose-dependent selectivity. It is used to treat anaphylaxis, symptomatic bradycardia (e.g. in β-blocker toxicity), and cardiac arrest.

===== - Toxicologic Indications & Dosing =====

==== - Anaphylaxis ====

  * Also see: [[anaphylaxis]].
  * **Adult:**
    * 💊 **Adrenaline 0.5 mg IM** (0.5 mL of 1:1,000), q5min PRN.
  * **Child:**
    * 💊👶 **Adrenaline 10 micrograms/kg IM** (0.01 mL/kg of 1:1,000), q5min PRN. Min dose 0.1 mL, max dose 0.5 mL.
  * IV adrenaline may be given only by experienced specialists in an appropriate setting, as the dose requirements are different.


==== - Bradycardia ====
  * Also see: [[:beta_blocker_toxicity|Beta Blocker Toxicity]].
  * **Adult:**
    * 💊 **Adrenaline 5-20 microgram IV**, q3min PRN.
    * 💊 **Adrenaline 2-10 microgram/min IV infusion**, titrate to response.
  * **Child:**
    * 💊👶 **Adrenaline 10 microgram/kg IV** (0.1 mL/kg of 1:10,000), q3min PRN.
    * 💊👶 **Adrenaline 0.1-1.5 microgram/kg/min IV infusion**, titrate to response.
==== - Cardiac Arrest ====

  * Also see: [[cardiac arrest]].
  * **Adult:** 💊 **Adrenaline 1 mg IV**, every 2 cycles.
  * **Child:** 💊👶 **Adrenaline 10 microgram/kg IV**, every 2 cycles.


===== - Cautions & Contraindications =====
There are no absolute contraindications to the use of adrenaline in a life-threatening situation.
  * Overtreatment may result in hypertension and tachyarrhythmias.
  * ↑ serum lactate.
  * Myocardial ischemia.

===== - Special Populations =====
**Pregnancy rating:** A (AU/NZ)

**Lactation:** Excreted in breast milk, but potential effects on breastfed infant is unknown.

===== - Adverse Effects =====
  * **CVS:** hypertension, tachyarrhythmias, myocardial ischemia.
  * **CNS:** anxiety, tremor.
  * **Skin:** tissue necrosis if extravasates.
  * **Metabolic:** hyperglycemia, hyperlactatemia.

===== - Pharmacology =====

==== - Pharmacodynamics ====
**Mechanism of action:** Dose-dependent adrenoceptor activity, with β-agonist effects predominate at low doses, and added α-agonist effects at higher doses.

==== - Pharmacokinetics ====

**Absorption:**
  * Oral bioavailability: 0%.

**Distribution:**
  * Vd: 0.1-0.2 L/kg.
  * Lipid solubility:
    * Does not cross BBB
    * Crosses placenta
    * Excreted in breast milk
  * Protein binding: 50%


**Metabolism:** Rapidly metabolized by COMT and MAO into metanephrine and 3,4-dihydroxymandelic acid, then ultimately into vanillylmandelic acid.

**Excretion:**
  * Elimination t½: 2-3 mins.
  * Renal clearance: Renally excreted, mostly as inactive metabolites.

==== - Pharmaceutics ====
**Formulation:**
  * Ampoules containing 1000 microgram/1 mL or 1000 microgram/10 mL.
  * Autoinjector with varying doses (commonly 0.15 mg, 0.3 mg, 0.5 mg). Various brands exist, e.g. EpiPen, Emerade, Auvi-Q.
===== - References =====
Useful general references:

~~REFNOTES~~