Adrenalin

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 13.09.2021

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Synonym(s)

Epinephrine

Definition
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Biogenic hormone of the adrenal medulla, neurotransmitter of adrenergic neurons in the CNS, catecholamine which belongs to the sympathomimetics.

Half-life
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1-3 minutes.

Indication
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Acute bronchial asthma, anaphylactic shock. Additive to local anaesthetics (to reduce their absorption and thus toxicity and prolong their effect), haemostasis on skin and mucous membrane.

Remember! Do not use local anaesthetics containing adrenaline and tampons in the acral area. Risk of necrosis!

Limited indication
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Pregnancy, Cave! Sulphite hypersensitivity, cor pulmonale, diabetes mellitus, hypercalcemia, hypokalemia, Parkinson's disease (increased tremor), severe renal insufficiency.

Dosage and method of use
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  • Acute bronchial asthma: 0.2-0.5 mg s.c. or by inhalation.
  • Anaphylactic shock: dilute 1 ml ampoule (1:1000) with 9 ml NaCl 0.9% (1 ml = 0.1 mg), adults 1 ml of the diluted solution slowly i.v., if necessary equal dose after approx. 5 min.; children 0.1 ml of the diluted solution/10 kg bw i.v.
  • Local anaesthesia: Procaine 0.05 ml of solution 1:1000 per 10 ml, half of the diluted solution for lidocaine.
  • Hemostasis: Press the tampon onto the wound with max. 10 drops of the solution diluted 10 times (0.01%).

Undesirable effects
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Angina pectoris, cardiac arrhythmia, anaphylaxis (sulfite content of the solution), anxiety, insomnia, danger of cerebral hemorrhage due to abrupt rise in blood pressure, hyperglycemia, hypokalemia, hyperhidrosis.

Interactions
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s. Table 1.

Contraindication
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Narrow-angle glaucoma, pheochromocytoma, prostate hypertrophy, hyperthyroidism, arteriosclerosis, coronary insufficiency, heart muscle damage, absolute arrhythmia, severe hypertension, anaesthesia with inhalation narcotics (cyclopan, halothane), local anaesthesia of the acra (fingers, hands, feet, nose, chin, tongue, etc.).

Preparations
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Adrenalin 1:1000, Fastject injection solution with autoinjector, Suprarenin 1:1000; Anapen autoinjector 150 µg or 300 µg.

Tables
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Major interactions of adrenaline

Alimemazine

RR drop, adrenaline reversal

Amantadine

Reciprocal toxicity ↑, enhanced central effects.

Antidepressants, tricyclic.

Blood pressure crisis, avoid combination

Appetite inhibitors

RR increase, reciprocal toxicity ↑

Acetazolamide

Adreanlin effect ↓

Bromocriptine

reciprocal toxicity ↑

Clozapine

RR drop, reversal of effect

Diclofenamide

Adrenaline effect ↓

Dihydralazine

Angina pectoris, tachycardia, dihydralazine effect ↓

L-dopa

sympathomimetic effect ↑

Enflurane

Cardiac arrhythmias

Guanethidine

RR increase, guanethidine effect ↓

Guanfacine

Guanfacine effect ↓

Halothane

Cardiac arrhythmia, death

Cardiac glycosides

ventricular arrhythmias

Insulin

Hyperglycemia

Isoflurane

Cardiac arrhythmias

Metformin

Hyperglycemia

Metoclopramide

Avoid combination

Mianserin

sympathomimetic effect ↑

Neuroleptics

RR drop, adrenal reversal

Procarbazine

Hypertensive crisis

α -receptor blockers

RR drop, reversal of effect

β-Receptor blockers

Bradycardia, hypertension

Thyroid hormones

Coronary insufficiency

β-sympathomimetics

Reciprocal toxicity ↑

Authors

Last updated on: 13.09.2021