Adrenaline (Treatment)

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.

• 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.

• Also see: 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.

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

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.

Pregnancy rating: A (AU/NZ)

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

• CVS: hypertension, tachyarrhythmias, myocardial ischemia.
• CNS: anxiety, tremor.
• Skin: tissue necrosis if extravasates.
• Metabolic: hyperglycemia, hyperlactatemia.

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

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.

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.

Useful general references: