SPECIFIC DRUGS Interaction ! Drug Interaction Comments -Adrenergic blocking High-dose agents (e.g.

, phentolamine) epinephrine vasoconstriction and hypertension antagonized a Anesthetics, general Increased Use with caution, if at all; increased risk of (cyclopropane, halogenated cardiosensitivity to ventricular arrhythmias such as VPCs, VT, hydrocarbons) epinephrine a or VF; contraindicated with chloroform, trichloroethylene, or cyclopropane aMay not be absorbed rapidly enough with topical hemostatic use to present a problem in short procedures aPropylactic lidocaine or procainamide may provide some protection aIV propranolol may reverse arrhythmias a Antidepressants, MAO MAO is one enzyme Marked potentiation of epinephrine effects inhibitors involved in by MAO inhibitors does not occur epinephrine metabolism a Antidepressants, tricyclic Potentiation of epinephrine effects (especially on heart rate and rhythm) a Antidiabetic agents (e.g., Epinephrine-induced May require increased antidiabetic dosage a insulin, oral hypoglycemics) hyperglycemia a Antihistamines, first Potentiation of generation (especially epinephrine effects diphenhydramine, (especially on heart dexchlorpheniramine, rate and rhythm) a tripelennamine) -Adrenergic blocking Antagonism of agents cardiac and bronchodilating effects a Digoxin Increased Avoid epinephrine with high digoxin cardiosensitivity to dosages epinephrine a Ergot alkaloids -Adrenergic Possible reversal of pressor response a antagonism a Phenothiazines Reversal of Do not use to treat phenothiazine-induced epinephrine's hypotension vasopressor effect a Sympathomimetic amines Additive effects and Avoid concomitant use a toxicity a Actions:

An endogenous catecholamine. a Acts directly on both - and -adrenergic receptors of tissues innervated by sympathetic nerves except the sweat glands and arteries of the face. a Main effects of therapeutic parenteral doses are relaxation of smooth muscle of the bronchial tree, cardiac stimulation, and dilation of skeletal muscle vasculature. a Relaxes bronchial smooth muscle by stimulation of 2-adrenergic receptors and constricts bronchial arterioles by stimulation of -adrenergic receptors. a Relieves bronchospasm, reduces congestion and edema, and increases tidal volume and vital capacity. a Inhibits histamine release and antagonizes the effect of the mediator on end organs. a As a result, may reverse histamine-induced bronchiolar constriction, vasodilation, and edema. a Acts on 1-adrenergic receptors in the heart, producing a positive chronotropic effect through the SA node and a positive inotropic effect on the myocardium. a d Cardiac output, oxygen consumption, and the work of the heart are increased. a Constricts arterioles in the skin, mucous membranes, and viscera by its effect on adrenergic receptors and reduces cutaneous blood flow, especially in the hands and feet. a Produces local vasoconstriction and hemostasis in bleeding from small vessels when applied topically but does not control bleeding from larger vessels. a Increases glycogenolysis in the liver, reduces glucose uptake by tissues, and inhibits insulin release in the pancreas, resulting in hyperglycemia. a

Tables of preparation

Epinephrine Routes Bulk Oral Inhalation Dosage Forms Strengths Powder* Aerosol 220 mcg/metered spray Brand Names Manufacturer

Epinephrine Mist (with Alpharma alcohol 34%) Primatene Mist (with Wyeth alcohol 34% ascorbic acid and fluorocarbon propellants) * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Epinephrine Hydrochloride Routes Dosage Forms Strengths Brand Names Manufacturer Oral Solution, for 1% (1:100) (of Adrenalin Chloride Monarch Inhalation nebulization epinephrine) Solution (with benzethonium chloride and sodium bisulfite) Parenteral Injection 0.1 mg/mL Epinephrine Hydrochloride Hospira (1:10,000) (of Injection epinephrine)* EpiPen Jr. Auto-Injector Dey (with sodium metabisulfite; delivers a single 0.15-mg dose [0.3 mL]) 1 mg/mL (1:1000) Adrenalin Chloride Monarch (of epinephrine)* Solution (with sodium bisulfite) Epinephrine Injection American (preservative-free and Regent sulfite-free) EpiPen Auto-Injector (with Dey sodium metabisulfite; delivers a single 0.3-mg dose [0.3 mL]) * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name 0.5 mg/mL (1:2000) (of epinephrine)