Adrenaline injection








Indications:


Adrenaline is used for its sympathomimetic properties, such as relief of bronchial spasm, acute allergy and for cardiovascular resucitation as well as anaphylactic shock.


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Contra-indications:


Hypertension, arteriosclerosis, aneurysms, cardiovascular diseases such as ischaemic heart disease, arrhythmia or tachycardia and hyperthyroidism. Anginal pain may be precipitated in patients with angina pectoris. Care is also required in patients with diabetes mellitus or closed-angle glaucoma. It should be avoided or used with caution in patients undergoing anaesthesia with cyclopropane, halothane or other halogenated anaestethics, as they may induce ventricular fibrillation. An increased risk of arrhythmias may also occur if sympathomimetic agents are given to patients receiving cardiac glycosides, quinidine or tricyclic antidepressants.


Adrenaline interacts with monoamine oxidase inhibitors and should not be given to patients receiving such treatment or within 14 days of its termination.


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Warnings:


The injection is not to be used if its colour is pinkish or darker than slightly yellow or if it contains a precipitate.


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Dosage and directions for use:


Bronchial spasm:


By subcutaneous injection


Adults:


0,1 mL to 0,5 mL of a 1 in 1000 aqueous solution (100 to 500 micrograms).


Children:


0,01 mL per kg body-mass (10 micrograms per kg body-mass) to a maximum total dose of 0,5 mL (500 micrograms).


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Acute allergy and anaphylactic shock:


By subcutaneuous or preferably intramuscular injection.


Adults:


0,2 mL to 0,5 mL as a 1 in 1000 solution. Up to 1 mL may be given and more than one dose may be required.


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Cardiovascular resuscitation:


In emergencies a diluted solution is given slowly intravenously. The recommended dose is 0,5 mL to 1 mL (0,5 mg to 1 mg) diluted 10 times to 5 to 10 mL (1 in 10 000 solutions). Doses may be given every 5 minutes during the prolonged resuscitation effort.


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Side effects and special precautions:


Central adverse effects may be fear, anxiety, restlessness, tremors, insomnia, irritability, confusion, weakness and psychotic states. Cardiac effects are palpitations, cardiac arrest, rapid pulse, anginal pain, hypotension with dizziness and flushing. Appetite may be reduced and nausea and vomiting may occur.?


Weakness and coldness of the extremities, even with small doses and especially when given in conjunction with local anaesthetics may occur. Gangrene may follow infiltration into the fingers and toes. Other effects may be difficulty in micturition, urinary retention, dyspnoea, disturbances of glucose metabolism, sweating and hypersalivation.?


Headache is also common.


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Known symptoms of overdosage and it’s treatment:


For symptoms see "Side effects and special precautions".


Because of the rapid onset and short duration of adrenaline action, the treatment is primarily supportive. Severe toxic reactions should be treated with an immediate injection of rapidly acting alpha-adrenergic blocking agent, such as phentolamine followed by a betablocker such as propranolol. Rapid acting vasodilators, such as glyceryl trinitrate have also been used.


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