Adrenaline in injection ampoules is a drug that affects the heart and the entire vascular system. The substance can increase blood pressure. The remedy is classified as special type hormone, it is also called the emergency hormone. Adrenaline can give a sharp jolt to the body and helps in extreme or critical situations.
In the medical field, an injection of adrenaline is used in cardiac arrest or other situations that may threaten human life. Adrenaline for injection is sold at any pharmacy, but it must be used carefully and only on the recommendation of a doctor.
Types and composition of solution
In the medical field, the solution is also called epinephrine. The main component of the substance is also the same. For injection, epinephrine hydrochloride and epinephrine hydrotartrate are produced. The characteristic feature of the first substance is that it changes upon contact with daylight and air. The liquid for the main component is 0.01% hydrochloric acid.
The second type of drug is characterized by the fact that it is mixed with water, since it does not change upon contact with water or air. Sometimes you have to take a higher dose for an injection, due to the difference in the molecular weight of the two substances.
The package with the medicinal substance contains 1 ml of a solution of 0.1% hydrochloride concentrate or 0.18% hydrogen tartrate.
There is also another form of the product - reddish-orange capsules, which contain 30 ml of ready-to-use solution. This solution is used for intramuscular and intravenous injections. Tablets of the drug are also available for purchase.
How do adrenaline injections work?
Pharmacodynamics. The effect of the injection lies in its effect on alpha and beta adrenaline receptors. What will happen if you inject with such a substance?
The body's response to the use of epinephrine is to constrict blood vessels. abdominal cavity, on the skin or mucous membranes. Vascular system muscles react much less to hormone changes. The body can react to injections like this:
- adrenaline receptors of the heart react to the drug, thereby causing an increase in the rate of contraction of the ventricular muscles;
- there is an increase in glucose in the blood system;
- enrichment of the body with glucose is significantly accelerated, which allows you to obtain a large amount of necessary energy in a short time;
- the respiratory tract expands, the body receives more necessary oxygen;
- blood pressure increases significantly in a short time;
- The body stops responding to possible pathogens for a certain period of time.
Adrenaline can also suppress the production of fat deposits, improve muscle activity, and activate the central nervous system. It also stimulates the production of hormones, improves the functioning of the adrenal cortex (which improves the functioning of hormones), enzymes are activated, and the functioning of the blood system is significantly improved.
Application in medicine
Many patients find that their doctor prescribes epinephrine injections for them. But why it should be used is worth examining in more detail.
The instructions that are attached to each package have clear instructions for using the drug:
- Complex cases of low blood pressure, if other substances have failed (heart surgery, shock from injury, cardiac or renal failure);
- During an overdose of various medications;
- With severe spasms of the bronchi during surgery;
- A sudden and severe asthma attack;
- Severe bleeding from the vessels of the mucous membranes or skin;
- To suppress different types bleeding that does not stop with other drugs;
- For quick fix allergies;
- With a sharp weakening of contractions of the heart muscle;
- Low glucose levels;
- Medicine for ophthalmic surgical operations, for various types of glaucoma.
- The substance can increase the duration of anesthesia, which is used for prolonged surgical interventions.
Patients should under no circumstances self-prescribe the drug. It is prohibited to use the drug for injection on your own. Violation of such rules can lead to undesirable consequences and serious complications.
Contraindications for use
Since the drug has a serious effect on the body, it also has a number of contraindications. If we talk about older people, the drug is prescribed for them only if there is a real threat to life. But, even in such cases, a low dosage of the drug is used. The drug may be contraindicated in the following circumstances:
- if the patient has symptoms of atherosclerosis;
- high blood pressure;
- when the vessels dilate more than 2 times (aneurysm);
- various stages of diabetes mellitus (due to the fact that glucose levels increase, which can lead to death);
- when thyroid hormones are produced too much;
- with bleeding;
- while carrying a child (the period does not matter);
- in some forms of glaucoma;
- if there is severe intolerance to the components of the product.
In some cases, epinephrine may be used to prolong a patient's anesthesia. But they do this with extreme caution, since adrenaline may enhance the effect of not every anesthetic. During such use of two or more drugs, it is important to maintain compatibility.
Dosage
Parenterally: during a state of shock, hypoglycemia - by dropper, less often - intramuscularly, but slowly;
For adults - 0.5 – 0.75 ml,
Children - 0.2 – 0.5 ml;
High doses are administered using a dropper: single - 1 ml, daily norm- 5 ml.
During an asthmatic attack (adults) - droppers of 0.3–0.7 ml.
Cardiac arrest - intracardial 1 ml.
Possible overdose
There are cases of overdose of a substance, even if it was prescribed by a doctor. This is due to incorrect dosage calculations or other possible health problems.
Symptoms of an overdose can be: a sharp rise in blood pressure much higher than normal, an excessively rapid pulse that quickly turns into bradycardia, pale skin. Then the body suddenly becomes cold, a strong headache, poor orientation in space.
Severe manifestations of overdose: heart attack, cerebral hemorrhage, breathing problems and bad condition lungs. There are cases of overdose that cause death.
Overdose rarely occurs if the injections are administered by a doctor in a medical facility. It is for this reason that it is very important to carry out injections in a hospital. After all, if an adverse reaction or overdose occurs, there is access to defibrillators, and doctors will be able to quickly take anti-shock measures.
If the first signs of an overdose appear or adverse reactions occur, you must stop using the drug.
To lower blood pressure, alpha-blockers are used, and to restore normal heart rhythm, beta-blockers are used:
- Non-selective: nadolol, timolol;
- Selective: atenolol;
- Non-selective: labetalol;
- B1 – selective: nebivolol.
Adverse reactions
The drug not only combines all human powers to protect against possible danger or stress. Since use increases blood pressure, heart rate increases, headaches may occur, and a distorted perception of reality may appear. In such situations, it is difficult for a person to breathe; the feeling of suffocation and lack of oxygen accompanies the person for several more hours. Sometimes hallucinations occur, which can affect future mental and emotional health. The patient may not control his actions and emotions.
If an uncontrolled release of a hormone occurs, the person will clearly feel severe irritability and state of anxiety. This is influenced by the rapid processing of glucose, increased by adrenaline, with the release of additional energy that is not required at the moment.
The substance does not always act for the benefit of the body. When its amount increases greatly, and it is used for a long period, the hormone complicates the functioning of the cardiac system. This can cause heart problems that need to be treated in a hospital. High content Epinephrine in the blood affects the occurrence of various signs of psychological disorders, lack of sleep and vigor. Typically, such a reaction negatively affects well-being and subsequently affects the patient’s health.
Adverse reactions include:
- A sharp increase in blood pressure and deterioration in health;
- Increased heart rate;
- If the patient has coronary heart disease, there is a risk of angina pectoris;
- There is pressure in the area of the heart and strong pain, which hinders movement;
- A person suffers from nausea, which turns into vomiting;
- The patient feels dizzy and disoriented, spasms in the temples;
- May happen mental disorders, as well as panic attacks;
- A rash may appear on the skin, itching, and other allergic reactions;
- From the outside genitourinary system Possible disturbances or difficulty urinating;
- Increased sweating is possible (extremely rare cases).
If the patient experiences an adverse reaction from using the medication, it is necessary to stop using the substance and consult a doctor about further use. medicines. Even if injections are given regularly, adverse reactions may also occur.
How to combine
Adrenaline antagonists include α- and β-adrenergic receptor blockers. Non-selective beta-blockers cause a pressor effect of adrenaline.
- Use simultaneously with cardiac glycosides increases the risk of arrhythmia. It is prohibited to use the drugs at the same time. Allowed only in extreme cases;
- with drugs whose action is aimed at eliminating certain symptoms, adverse reactions affecting the state of the cardiac or vascular system may increase;
- with medications for hypertension – their effect noticeably decreases;
- with alkaloids – increases the effect, which negatively affects the patient’s condition (Development coronary disease, can cause the development of gangrene);
- Thyroid hormone products – increase the effect of the drug;
- adrenaline reduces the effectiveness of the use of hypoglycemic drugs (this also includes insulin), opioids, and sleeping pills. If we talk about diabetes, the use of adrenaline is prohibited and can only be used in extreme cases;
- combination with drugs that prolong the QT interval results in a sharp duration of action of the drug.
Directions for using the medicine
Adrenaline should be taken with caution for: heart disease, hypertension and arrhythmia. It is very rare now that doctors prescribe the drug after a heart attack; more often they replace it with weaker substances that do not have a strong effect on the cardiac system.
Used in small doses for diseases associated with blood vessels, as there is a risk of complications and side effects.
The substance is rarely used for serious chronic diseases, such as atherosclerosis, glaucoma, diabetes mellitus, prostate hypertrophy.
Weak doses are used for the elderly, children, if anesthesia is used.
Adrenaline is not recommended for use arterially, as a sharp narrowing of blood vessels may occur, which often causes gangrene. If the patient is in cardiac arrest, intracoronary epinephrine may be used. In cases of arrhythmia in a patient, in addition to the drug, the doctor must use beta-blockers.
Pregnancy
Carrying a baby is considered a special period, and the use of Epinephrine (adrenaline) is not recommended. This is due to the fact that it penetrates the placenta and is excreted through breast milk, which can negatively affect the baby’s health.
And even though qualitative research safe use the substance has not been tested, doctors usually replace it with safer means.
Use medicinal substance Pregnant and nursing mothers are allowed only if the result of treatment outweighs the possible risk to the child.
When therapy is carried out, various tests are first performed to identify a negative reaction.
How to store the substance
The product should be stored in a dark room or in dark packaging. Temperature from 15 to 25°C. Avoid contact with children.
If the packaging of the drug was damaged during storage or transportation, the substance is not recommended for use.
Adrenomimetic, has a direct stimulating effect on α- and β-adrenergic receptors.
Under the influence of epinephrine (adrenaline), due to stimulation of α-adrenergic receptors, an increase in the content of intracellular calcium in smooth muscles occurs. Activation of α 1 -adrenergic receptors increases the activity of phospholipase C (via stimulation of G-protein) and the formation of inositol triphosphate and diacylglycerol. This promotes the release of calcium from the sarcoplasmic reticulum store. Activation of α 2 -adrenergic receptors leads to the opening of calcium channels and an increase in calcium entry into cells.
Stimulation of β-adrenergic receptors causes G protein-mediated activation of adenylate cyclase and an increase in cAMP production. This process is a trigger for the development of reactions on the part of various organs-targets. As a result of stimulation of β 1 -adrenergic receptors in the tissues of the heart, an increase in intracellular calcium occurs. When β 2 -adrenergic receptors are stimulated, free intracellular calcium in smooth muscles decreases, caused, on the one hand, by an increase in its transport from the cell, and on the other, by its accumulation in the sarcoplasmic reticulum depot.
Has a pronounced effect on the cardiovascular system. Increases the frequency and strength of heart contractions, stroke and minute volume of the heart. Improves AV conduction, increases automaticity. Increases myocardial oxygen demand. Causes vasoconstriction of the abdominal organs, skin, mucous membranes, and, to a lesser extent, skeletal muscles. Increases blood pressure (mainly systolic), and in high doses increases peripheral vascular resistance. The pressor effect can cause a short-term reflex slowdown in heart rate.
Epinephrine ( adrenalin ) relaxes the smooth muscles of the bronchi, reduces the tone and motility of the gastrointestinal tract, dilates the pupils, and helps lower intraocular pressure. Causes hyperglycemia and increases plasma levels of free fatty acids.
Pharmacokinetics
Metabolized with the participation of MAO and COMT in the liver, kidneys, and gastrointestinal tract. T 1/2 is several minutes. Excreted by the kidneys.
Penetrates the placental barrier, does not penetrate the BBB.
Excreted in breast milk.
Indications
Allergic reactions of immediate type (including urticaria, angioedema, anaphylactic shock), developing when using drugs, serums, blood transfusions, food products, insect bites or the introduction of other allergens.
Bronchial asthma (relief of attack), bronchospasm during anesthesia.
Asystole (including against the background of acutely developed AV block of the third degree).
Bleeding from superficial vessels of the skin and mucous membranes (including from the gums).
Arterial hypotension that is not amenable to adequate volumes of replacement fluids (including shock, trauma, bacteremia, open heart surgery, renal failure, chronic heart failure, drug overdose).
The need to lengthen the action local anesthetics.
Hypoglycemia (due to insulin overdose).
Open-angle glaucoma, during eye surgery - swelling of the conjunctiva (treatment), for pupil dilation, intraocular hypertension.
To stop bleeding.
Treatment of priapism.
Dosage regimen
Individual. Injected subcutaneously, less often - intramuscularly or intravenously (slowly). Depending on the clinical situation single dose for adults can range from 200 mcg to 1 mg; for children - 100-500 mcg. The injection solution can be used as eye drops.
Used locally to stop bleeding - use tampons moistened with epinephrine solution.
Side effect
From the outside of cardio-vascular system: angina pectoris, bradycardia or tachycardia, palpitations, increased or decreased blood pressure; when used in high doses - ventricular arrhythmias; rarely - arrhythmia, pain in chest.
From the nervous system: headache, anxiety, tremor, dizziness, nervousness, fatigue, psychoneurotic disorders (psychomotor agitation, disorientation, memory impairment, aggressive or panic behavior, schizophrenia-like disorders, paranoia), sleep disturbance, muscle twitching.
From the outside digestive system: nausea, vomiting.
From the urinary system: rarely - difficult and painful urination (with hyperplasia prostate gland).
Allergic reactions: angioedema, bronchospasm, skin rash, erythema multiforme.
Others: hypokalemia, increased sweating; local reactions - pain or burning at the site of intramuscular injection.
Contraindications
Hypertrophic obstructive cardiomyopathy, pheochromocytoma, arterial hypertension, tachyarrhythmia, ischemic heart disease, ventricular fibrillation, pregnancy, lactation, increased sensitivity to epinephrine.
Use during pregnancy and breastfeeding
Epinephrine ( adrenalin ) penetrates the placental barrier and is excreted in breast milk.
Adequate and strictly controlled clinical trials The safety of the use of epinephrine has not been studied. Use during pregnancy and lactation is possible only in cases where the expected benefit of therapy for the mother outweighs the potential risk for the fetus or child.
special instructions
Use with caution in metabolic acidosis, hypercapnia, hypoxia, atrial fibrillation, ventricular arrhythmia, pulmonary hypertension, hypovolemia, myocardial infarction, shock of non-allergic origin (including cardiogenic, traumatic, hemorrhagic), thyrotoxicosis, occlusive vascular diseases (including including a history of arterial embolism, atherosclerosis, Buerger's disease, cold injury, diabetic endarteritis, Raynaud's disease), cerebral atherosclerosis, angle-closure glaucoma, diabetes mellitus, Parkinson's disease, convulsive syndrome, prostate hypertrophy; simultaneously with inhalation drugs for anesthesia (fluorothane, cyclopropane, chloroform), in elderly patients, in children.
Epinephrine should not be administered intra-arterially, since severe peripheral vasoconstriction can lead to the development of gangrene.
Epinephrine can be used intracoronarily for cardiac arrest.
For arrhythmias caused by epinephrine, beta-blockers are prescribed.
Drug interactions
Epinephrine antagonists are α- and β-adrenergic receptor blockers.
Non-selective beta-blockers potentiate the pressor effect of epinephrine.
When used simultaneously with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalational anesthetics (chloroform, enflurane, halothane, isoflurane, methoxyflurane), cocaine, the risk of developing arrhythmias increases (simultaneous use is not recommended unless absolutely necessary); with other sympathomimetic drugs - increased severity of side effects from the cardiovascular system; with antihypertensive drugs (including diuretics) - a decrease in their effectiveness; with ergot alkaloids - increased vasoconstrictor effect (up to severe ischemia and development of gangrene).
MAO inhibitors, m-anticholinergics, ganglion blockers, hormone preparations thyroid gland, reserpine, octadine potentiate the effects of epinephrine.
Epinephrine reduces the effects of hypoglycemic agents (including insulin), antipsychotics, cholinomimetics, muscle relaxants, opioid analgesics, and hypnotics.
When used simultaneously with drugs that prolong the QT interval (including astemizole, cisapride, terfenadine), the duration of the QT interval increases.
Instructions for medical use
medicine
ADRENALINE-HEALTH
Tradename
Adrenaline-Health
International nonproprietary name
Epinephrine
Dosage form
Solution for injection 0.18%, 1 ml
Compound
1 ml of solution contains
active substance - adrenaline hydrotartrate 1.82 mg
Excipients: sodium metabisulfite (E 223), sodium chloride, water for injections
Description
Transparent colorless solution
Pharmacotherapeutic group
Drugs for the treatment of heart diseases. Cardiotonic drugs of non-glycoside origin. Adrenergic and dopamine stimulants. Epinephrine.
ATX code C01CA24.
Pharmacological properties
Pharmacokinetics
After intramuscular or subcutaneous administration, epinephrine is rapidly absorbed; the maximum concentration in the blood is reached after 3-10 minutes.
The therapeutic effect develops almost instantly with intravenous administration (duration of action - 1-2 minutes), 5-10 minutes after subcutaneous administration (maximum effect - after 20 minutes), with intramuscular injection the time of onset of the effect is variable.
Penetrates the placental barrier into breast milk, does not penetrate the blood-brain barrier.
Metabolized by monoamine oxidase (to vanillylmandelic acid) and catechol-O-methyltransferase (to metanephrine) in the cells of the liver, kidneys, intestinal mucosa, and axons.
The half-life when administered intravenously is 1-2 minutes. Excretion of metabolites is carried out by the kidneys. Excreted in breast milk.
Pharmacodynamics
Adrenaline-Health is a cardiac stimulant, vasoconstrictor, hypertensive, antihypoglycemic agent. Stimulates α- and β-adrenergic receptors various localizations. Shows a pronounced effect on the smooth muscles of internal organs, cardiovascular and respiratory system, activates carbohydrate and lipid metabolism.
The mechanism of action is due to the activation of adenylate cyclase on the inner surface of cell membranes, an increase in the intracellular concentration of cAMP and Ca 2+. The first phase of action is primarily due to stimulation of β-adrenergic receptors in various organs and is manifested by tachycardia, increased cardiac output, myocardial excitability and conductivity, arteriolo- and bronchodilation, decreased uterine tone, mobilization of glycogen from the liver and fatty acids from fat depots. In the second phase, α-adrenergic receptors are excited, which leads to vasoconstriction of the abdominal organs, skin, mucous membranes (skeletal muscles to a lesser extent), an increase in blood pressure (mainly systolic), and general peripheral vascular resistance.
The effectiveness of the drug depends on the dose. In very low doses, at a rate of administration less than 0.01 mcg/kg/min, it may reduce arterial pressure due to dilation of blood vessels in skeletal muscles. At an injection rate of 0.04-0.1 mcg/kg/min, it increases the frequency and strength of heart contractions, stroke volume and minute blood volume, and reduces total peripheral vascular resistance; above 0.2 mcg/kg/min – constricts blood vessels, increases blood pressure (mainly systolic) and total peripheral vascular resistance. The pressor effect can cause a short-term reflex slowing of the heart rate. Relaxes the smooth muscles of the bronchi. Doses above 0.3 mcg/kg/min reduce renal blood flow, blood supply to internal organs, tone and motility gastrointestinal tract.
Increases conductivity, excitability and automatism of the myocardium. Increases myocardial oxygen demand. Inhibits the release of histamine and leukotrienes induced by antigens, eliminates spasm of bronchioles, and prevents the development of edema of their mucous membrane. Acting on α-adrenergic receptors of the skin, mucous membranes and internal organs, it causes vasoconstriction, reduces the rate of absorption of local anesthetics, increases the duration of action and reduces the toxic effect of local anesthesia. Stimulation of β 2 -adrenergic receptors is accompanied by increased excretion of potassium from the cell and can lead to hypokalemia. When administered intracavernosally, it reduces the blood supply to the cavernous bodies.
Dilates pupils, helps reduce production intraocular fluid and intraocular pressure. Causes hyperglycemia (increases glycogenolysis and gluconeogenesis) and increases the content of free fatty acids in the blood plasma, improves tissue metabolism. Weakly stimulates the central nervous system, exhibits antiallergic and anti-inflammatory effects.
Indications for use
- immediate allergic reactions: anaphylactic shock that develops from the use of drugs, serums, blood transfusions, insect bites or contact with allergens
- relief of acute attacks of bronchial asthma
- arterial hypotension of various origins (posthemorrhagic, intoxication, infectious)
- hypokalemia, including due to insulin overdose
- asystole, cardiac arrest
- prolongation of the action of local anesthetics
- AV block of the third degree, acutely developed
Directions for use and doses
Prescribed intramuscularly, subcutaneously, intravenously (drip), intracardially (resuscitation in case of cardiac arrest). When administered intramuscularly, the effect of the drug develops faster than when administered subcutaneously. The dosage regimen is individual.
Adults.
Anaphylactic shock: inject slowly intravenously 0.5 ml, diluted in 20 ml of 40% glucose solution. Subsequently, if necessary, intravenous drip administration is continued at a rate of 1 mcg/min, for which 1 ml of adrenaline solution is dissolved in 400 ml isotonic sodium chloride or 5% glucose. If the patient's condition allows it, it is better to administer intramuscular or subcutaneous injection of 0.3-0.5 ml in a diluted or undiluted form.
Bronchial asthma: 0.3-0.5 ml is administered subcutaneously, diluted or undiluted. If repeated administration is necessary, this dose can be administered every 20 minutes (up to 3 times). Intravenous administration of 0.3-0.5 ml in diluted form is possible.
As a vasoconstrictor administered intravenously at a rate of 1 mcg/min (with a possible increase to 2-10 mcg/min).
Asystole: 0.5 ml diluted in 10 ml of 0.9% sodium chloride solution is administered intracardially. During resuscitation measures - 1 ml (diluted) intravenously slowly every 3-5 minutes.
Children.
Asystole in newborns: administered intravenously at 0.01 ml/kg body weight every 3-5 minutes, slowly.
Anaphylactic shock: administered subcutaneously or intramuscularly to children under the age of 1 year - 0.05 ml, at the age of 1 year - 0.1 ml, 2 years - 0.2 ml, 3-4 years - 0.3 ml, 5 years - 0. 4 ml, 6-12 years - 0.5 ml. If necessary, administration is repeated every 15 minutes (up to 3 times).
Bronchospasm: 0.01 ml/kg body weight is administered subcutaneously (maximum - up to 0.3 ml). If necessary, administration is repeated every 15 minutes (up to 3-4 times) or every 4 hours.
Side effects
Often:
- headache
- anxiety
- tremor
- nausea, vomiting
- anorexia
- hyperglycemia
Infrequently:
- angina, bradycardia or tachycardia, palpitations, decreased or increased blood pressure (even with subcutaneous administration in normal doses, subarachnoid hemorrhage and hemiplegia are possible due to increased blood pressure)
- dyspnea
- nervousness, dizziness, fatigue, sleep disturbance
- muscle twitching
- psychoneurotic disorders (psychomotor agitation, disorientation)
- memory impairment
- aggressive or panicky behavior
- schizophrenia-like disorders, paranoia
- increased rigidity and tremors (in patients with Parkinson's disease)
- angioedema, bronchospasm
- skin rash, erythema multiforme
- increased sweating, impaired thermoregulation, cold extremities
Rarely:
- ventricular arrhythmias, chest pain
- ECG changes (including decreased T wave amplitude)
- Difficulty and painful urination (with prostatic hyperplasia)
- hypokalemia
- pulmonary edema
- pain or burning in the area intramuscular injection, with repeated injections of adrenaline, necrosis may occur due to the vasoconstrictor effect of adrenaline
Contraindications
- increased individual sensitivity to the components of the drug
- hypertrophic obstructive cardiomyopathy
- severe aortic stenosis
- tachyarrhythmia, ventricular fibrillation
- arterial or pulmonary hypertension
- ischemic pulmonary disease
- severe atherosclerosis
- occlusive vascular diseases
- pheochromocytoma
- angle-closure glaucoma
- non-allergenic shock
- convulsive syndrome
- thyrotoxicosis
- diabetes
- general anesthesia using inhalation agents: fluorothane, cyclopropane, chloroform
- period of pregnancy and lactation, second stage of childbirth
- application on areas of fingers and toes, on areas of the nose, genitals
Drug interactions
Epinephrine antagonists are α- and β-adrenergic receptor blockers.
When using the drug Adrenaline-Zdorovye simultaneously with other drugs, it is possible:
- with narcotic analgesics and hypnotics - weakening of their effects;
- with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalation anesthetics (chloroform, enflurane, halothane, isoflurane, methoxyflurane), cocaine - increased risk of arrhythmias;
- with other sympathomimetic drugs - increased severity of side effects from the cardiovascular system;
- with antihypertensive drugs (including diuretics) - decrease in their effectiveness;
- with monoamine oxidase inhibitors (including furazolidone, procarbazine, selegiline) - sudden and severe increase in blood pressure, hyperpyretic crisis, headache, cardiac arrhythmias, vomiting;
- with nitrates - weakening of their therapeutic effect;
- with phenoxybenzamine - increased hypotensive effect and tachycardia;
- with phenytoin - a sudden decrease in blood pressure and bradycardia, depending on the dose and rate of administration of adrenaline;
- with thyroid hormone preparations - mutual enhancement of action;
− with astemizole, cisapride, terfenadine - prolongation of the QT interval on the ECG;
- with diatrizoatams, iothalamic or ioxaglic acids - increased neurological effects;
- with ergot alkaloids - increased vasoconstrictor effect up to severe ischemia and the development of gangrene;
- with hypoglycemic drugs (including insulin) - decreased hypoglycemic effect;
With non-depolarizing muscle relaxants, the muscle relaxant effect may be reduced;
WITH hormonal contraceptives- may reduce effectiveness.
special instructions
It is administered intracardially during asystole, if other methods of eliminating it are not available, and there is increased risk development of cardiac tamponade and pneumothorax.
If infusion is necessary, a device with a measuring device should be used to regulate the rate of infusion. The infusion should be carried out into a large, preferably central, vein. When carrying out an infusion, it is recommended to monitor the concentration of potassium in the blood serum, blood pressure, diuresis, ECG, central venous pressure, pressure in the pulmonary artery.
Use of the drug in patients diabetes mellitus increases glycemia, which requires higher doses of insulin or sulfonylurea derivatives.
It is undesirable to use adrenaline for a long time, since narrowing of peripheral vessels can lead to the development of necrosis or gangrene.
When discontinuing treatment, the dose of epinephrine should be reduced gradually, since sudden discontinuation of therapy can lead to severe hypotension.
Carefully prescribed to patients with ventricular arrhythmia, coronary heart disease, atrial fibrillation, arterial hypertension, pulmonary hypertension, in case of myocardial infarction (if it becomes necessary to use the drug during myocardial infarction, it should be remembered that adrenaline can increase ischemia by increasing the myocardial oxygen demand), metabolic acidosis, hypercapnia, hypoxia, hypovolemia, thyrotoxicosis, in patients with occlusive vascular diseases (arterial embolism, atherosclerosis, Buerger's disease, cold injury, diabetic endarteritis, Raynaud's disease, with cerebral atherosclerosis, Parkinson's disease, with convulsive syndrome, with prostatic hypertrophy.
In cases of hypovolemia, patients should be adequately hydrated before using sympathomimetics.
Use in pediatrics.
Particular care should be taken when administering the drug to children (dosage varies). Recommendations on dosing of the drug for children are given in the section "Method of administration and dosage".
Use during pregnancy and lactation
Not used during childbirth to correct hypotension, since the drug can delay the second stage of labor by relaxing the uterine muscles. When administered in large doses to weaken uterine contractions, it can cause prolonged uterine atony with bleeding.
If it is necessary to use the drug, you should stop breastfeeding, as there is a high probability of side effects in the child.
Features of the effect of the drug on the ability to drive vehicles and work with complex mechanisms.
Overdose
Symptoms: excessive increase in blood pressure, mydriasis, tachyarrhythmia followed by bradycardia, violation heart rate(including atrial and ventricular fibrillation), coldness and pallor skin, vomiting, fear, anxiety, tremor, headache, metabolic acidosis, myocardial infarction, cerebral hemorrhage (especially in elderly patients), pulmonary edema, renal failure.
Treatment: cessation of drug administration. Symptomatic therapy, the use of α- and β-blockers, fast-acting nitrates. For arrhythmia, parenteral administration of β-blockers (propranolol) is prescribed.
Release form and packaging
1 ml of the drug is poured into glass ampoules.
A marking text is applied to the ampoule with paint or a label is pasted.
5 or 10 ampoules together with instructions for medical use in the state and Russian languages and a ceramic cutting disc are placed in cardboard box with partitions.
5 ampoules are placed in a blister pack made of polyvinyl chloride film and aluminum foil.
Racepinephrine, Adrenaline, Hydrochloride adrenaline, Adnephrine, Adrenamin, Adrenin, Epirenan, Epirinamine, Eppi, Glaucon, Glauconin, Glaucosan, Hypernephrine, Levorenin, Nephridia, Paranephrine, Renostiptycin, Stiptyrenal, Suprarenin, Suprarenalin, Tonogen
Recipe (international)
Rp.: Sol.Adrenalini hydrochloridi 0.1% - 1 ml
D.t.d. No. 10 in amp.
S.: subcutaneously, 1 time per day
Recipe (Russia)
Rp.: Sol. Epinephrini 0.1% - 1 ml
D.t.d. No. 10 in amp.
S.: subcutaneously
Prescription form - 107-1/у (Russia)
Active substance
Epinephrine
pharmachologic effect
Sympathomimetic acting on alpha and beta adrenergic receptors. The action is due to the activation of adenylate cyclase on the inner surface cell membrane, increasing the intracellular concentration of cyclic adenosine monophosphate (cAMP) and calcium ions.
In very low doses, at an administration rate of less than 0.01 mcg/kg/min, it can reduce blood pressure (BP) due to vasodilation of skeletal muscles. At an injection rate of 0.04-0.1 mcg/kg/min, it increases the frequency and strength of heart contractions, stroke volume and minute blood volume, and reduces total peripheral vascular resistance (TPVR); above 0.02 mcg/kg/min constricts blood vessels, increases blood pressure (mainly systolic) and peripheral vascular resistance. The pressor effect can cause a short-term reflex slowing of the heart rate.
Relaxes the smooth muscles of the bronchi, being a bronchodilator. Doses above 0.3 mcg/kg/min reduce renal blood flow, blood supply to internal organs, tone and motility of the gastrointestinal tract (GIT).
Dilates the pupils, helps reduce the production of intraocular fluid and intraocular pressure. Causes hyperglycemia (increases glycogenolysis and gluconeogenesis) and increases plasma levels of free fatty acids.
Increases conductivity, excitability and automatism of the myocardium. Increases myocardial oxygen demand.
Inhibits the antigen-induced release of histamine and the slow-reacting substance of anaphylaxis, eliminates spasm of bronchioles, and prevents the development of edema of their mucosa. Acting on alpha adrenergic receptors located in the skin, mucous membranes and internal organs, causes vasoconstriction, reduces the rate of absorption of local anesthetics, increases the duration and reduces the toxic effect of local anesthesia.
Stimulation of beta2-adrenergic receptors is accompanied by increased excretion of potassium ions from the cell and can lead to hypokalemia.
When administered intracavernosally, it reduces the blood supply to the cavernous bodies. The therapeutic effect develops almost instantly with intravenous (i.v.) administration (duration of action - 1-2 minutes), 5-10 minutes after subcutaneous (s.c.) administration (maximum effect - after 20 minutes), with intramuscular (i.v.) l) administration - the time of onset of the effect is variable.
Pharmacokinetics
When administered intramuscularly or subcutaneously, it is well absorbed. It is also absorbed after endotracheal and conjunctival administration. The time to reach maximum concentration in plasma (TC max) with subcutaneous and intramuscular administration is 3-10 minutes. Penetrates through the placenta, into breast milk, does not penetrate the blood-brain barrier.
Metabolized mainly by monoamine oxidase and catechol-O-methyltransferase in the endings of sympathetic nerves and other tissues, as well as in the liver with the formation of inactive metabolites. The half-life for intravenous administration is 1-2 minutes.
Excreted by the kidneys in the main form of metabolites (about 90%): vanillylmandelic acid, sulfates, glucuronides; and also in small quantities - unchanged.
Mode of application
For adults:
Subcutaneously, intramuscularly, sometimes intravenously.
Anaphylactic shock: slowly intravenously 0.1-0.25 mg, diluted in 10 ml of 0.9% sodium chloride solution, if necessary continue intravenous drip administration at a concentration of 1:10000. If the patient's condition allows, intramuscular or subcutaneous administration of 0.3-0.5 mg in diluted or undiluted form is preferable, if necessary, repeated administration - after 10-20 minutes up to 3 times.
Bronchial asthma: subcutaneously 0.3-0.5 mg diluted or undiluted, if necessary, repeated doses can be administered every 20 minutes up to 3 times, or intravenously 0.1-0.25 mg diluted in a concentration of 1:10000 .
To prolong the action of local anesthetics: at a concentration of 0.005 mg/ml (the dose depends on the type of anesthetic used), for spinal anesthesia - 0.2-0.4 mg.
For children:
For children with anaphylactic shock: subcutaneously or intramuscularly - 10 mcg/kg (maximum - up to 0.3 mg), if necessary, these doses are repeated every 15 minutes (up to 3 times).
For children with bronchospasm: subcutaneously 0.01 mg/kg (maximum - up to 0.3 mg), doses, if necessary, repeated every 15 minutes up to 3-4 times or every 4 hours.
For intravenous drip administration, an infusion pump should be used to accurately regulate the rate of administration. Infusions should be carried out into a large (preferably central) vein.
Indications
Attacks of bronchial asthma
- hypoglycemia due to insulin overdose
- acute drug allergic reactions
- simple open-angle glaucoma, etc.;
- as a vasoconstrictor and anti-inflammatory agent in otorhinolaryngological and ophthalmological practice.
Contraindications
Arterial hypertension
- widespread atherosclerosis
- thyrotoxicosis
- diabetes
- angle-closure glaucoma
- pregnancy.
Adrenaline should not be used during anesthesia with fluorotane or cyclopropane (due to the development of arrhythmias).
Side effects
Tachycardia
- heart rhythm disturbance
- increased blood pressure;
- with coronary heart disease, angina attacks are possible.
Release form
0.1% solution in ampoules of 1 ml in a package of 6 pieces; in bottles of 30 ml.
ATTENTION!
The information on the page you are viewing is created for informational purposes only and does not in any way promote self-medication. The resource is intended to provide healthcare workers with additional information about certain medications, thereby increasing their level of professionalism. The use of the drug "" necessarily requires consultation with a specialist, as well as his recommendations on the method of use and dosage of the medicine you have chosen.
There are a huge number of diseases that can lead to dangerous complications and even to death. Such ailments include disturbances in the functioning of the heart and blood vessels.
One of the medications used in the treatment of dangerous diseases is Adrenaline. The medicine has a large list of prescriptions.
"Adrenaline" has only one release form - solution for injection. The drug is produced by the Federal State Unitary Enterprise Moscow Endocrine Plant.
The drug has a hypertensive, bronchodilator, antiallergic effect. There is no "adrenaline" in tablets.
The drug is produced in liquid form:
- The injection solution is presented in the form of a slightly colored or colorless liquid with a specific aroma. It is produced in ampoules of one milliliter, which are placed in contour cells of five pieces. In total, the package contains one or two contour cells.
- Solution for local application also presented in the form of a clear liquid with a specific aroma. Available in glass bottles of thirty milliliters. There is only one bottle in the package.
When can the drug be used?
We remind you that the drug is not available in tablets. Indications for the use of "Adrenaline" are the following diseases:
- Quincke's edema (a reaction to various biological and chemical factors, often of an allergic nature).
- Nettle rash.
- Anaphylaxis.
- Asthma.
- Asystole (one of the types of circulatory arrest, which is characterized by cessation of contractions different departments hearts).
- Bronchial asthma.
- Bronchospastic syndrome.
- Reduction in blood pressure by more than twenty percent of standard values.
In addition, the use of the drug is indicated as a vasoconstrictor to stop bleeding and prolong the duration of action of local anesthetic tablets.
"Adrenaline": contraindications
The following diseases are prohibited from using the drug:
- Cardiac ischemia (a disease in which blood flows to the heart in small quantities, resulting in oxygen starvation of the heart muscle).
- Tachyarrhythmia (excessively fast heart rate).
- Ventricular fibrillation.
- Lactation (the process of accumulation and excretion of milk).
- Hypertrophic obstructive cardiomyopathy (an autosomal dominant disease characterized by hypertrophy of the wall of the left and/or occasionally the right ventricle).
- Pregnancy.
- Individual intolerance to drug substances.
Additional prohibitions
According to the instructions for use for "Adrenaline", it is known that contraindications to the use of the injection solution are:
- A disruption of the normal rhythm of heart contractions, in which extraordinary premature contraction of the ventricles is observed.
- Atrial fibrillation (a type of supraventricular tachyarrhythmia with chaotic atrial activity with a pulse frequency of three hundred fifty to seven hundred beats per minute).
- Myocardial infarction (cardiac ischemia, which occurs with the death of a section of the myocardium due to insufficiency of its microcirculation).
- Atherosclerosis ( chronic illness arteries, arising as a result of lipid metabolism disorders and accompanied by the deposition of cholesterol in inner shell vessels).
- Arterial embolism (sudden cessation of blood flow to an organ or part of the body due to a blood clot).
- Buerger's disease (narrowing of the veins and arteries in the legs and arms as a result of inflammation).
- Raynaud's disease (a disease in which the arterial blood supply to the hands or feet is disrupted).
- Hypovolemia (decreased blood microcirculation).
- Thyrotoxicosis.
- Metabolic acidosis (a disease characterized by an imbalance in the acid-base balance in the blood).
- Hypoxia (a pathology characterized by oxygen starvation).
- Hypercapnia (increased carbon dioxide in the blood, which is caused by impaired breathing processes).
- Prostate hyperplasia (a urological disease in which the growth of cellular elements prostate, which causes compression urethra, resulting in urinary problems).
- Combined use with inhaled drugs for general anesthesia.
All of the above prohibitions are considered relative for diseases that threaten human life.
Federal State Unitary Enterprise Moscow Endocrine Plant does not produce the drug in tablets.
With extreme caution, it is necessary to prescribe an injection solution for a disease caused by an increase in hormonal activity of the thyroid gland and excessive production of hormones. In addition, people of retirement age also need to be careful. For preventive purposes, to prevent arrhythmias, the medicine is recommended to be used in combination with beta-blockers.
“Adrenaline” does not exist in tablets, but in the form of a solution for topical use, patients with the following disorders are prescribed with extreme caution:
- Pathological condition, which is characterized by a violation of the acid-base balance in the blood.
- Ventricular arrhythmia.
- Hypovolemia.
- Myocardial infarction.
- Cerebral atherosclerosis.
- Convulsive syndrome.
- Parkinson's disease.
How to use the drug correctly?
According to the instructions for use for Adrenaline, it is known that to stop bleeding, a tampon soaked in the drug should be applied to the wound surface. Recommended dosage regimen for adult patients:
- Anaphylactic shock: the drug must be administered slowly intravenously. To achieve the greatest effect, treatment is carried out by drip injection into a vein, in a ratio of one to ten thousand. If there is no threat to a person’s life, the medication should be administered intramuscularly or subcutaneously in a dosage of 0.3-0.5 milligrams; if necessary, the injection can be repeated with a time interval of ten to twenty minutes up to three times.
- At bronchial asthma administered subcutaneously - 0.3-0.5 milligrams; to achieve the desired effect, repeated administration of the same dosage is indicated every twenty minutes up to three times, or intravenously - 0.1-0.25 milligrams.
What other diseases is the medicine used for?
Doctors know that Adrenaline is not produced in tablets. Active substance The drug has a detrimental effect on the following disorders in the body:
- Arterial hypotension: for this disease it is administered intravenously.
- When inserted into the trachea to ensure patency respiratory tract it is necessary to carry out therapy by endotracheal instillation in a dosage that exceeds the dosage for intravenous administration 2-2.5 times.
- For fainting caused by sharp decline cardiac output and cerebral ischemia due to an acute cardiac arrhythmia: one milligram of the drug diluted in 250 milliliters of a 5 percent glucose solution is administered intravenously.
"Adrenaline" for children
"Adrenaline" contains epinephrine, which during asystole in newborns is administered intravenously (slowly) at 0.01-0.03 milligrams per kilogram of the child's weight every three to five minutes. For children after one month of life - intravenously, 0.01 milligrams per kilogram, then 0.1 milligrams per kilogram every five minutes.
"Adrenaline" is the trade name for epinephrine.
Endotracheal administration of the drug is indicated for the following diseases:
Anaphylactic shock: subcutaneously or intravenously - 0.01 mg per kilogram of weight, but not more than 0.3 mg. If necessary, the procedure should be repeated with a break of fifteen minutes no more than three times.
For bronchospasm, the drug is administered subcutaneously; if necessary, the medication is administered every fifteen minutes up to three to four times or every four hours. Adrenaline injection solution can be used topically to prevent bleeding.
Adverse reactions
According to the instructions for use, "Epinephrine" can cause certain negative effects if the dosage is not followed correctly:
- Anxiety.
- Migraine.
- Tremor.
- Fatigue.
- Dizziness.
- Nervousness.
- Memory impairment.
- Aggression.
Negative effects from the heart and blood vessels
Adrenaline causes the following undesirable effects:
- Sleep disturbance.
- Cardiopalmus.
- Feeling of discomfort behind the sternum.
- Arrhythmia.
Additionally, as a result of using the injection solution, pulmonary edema and vomiting may occur on the cardiovascular system.
Local reactions occur infrequently, mainly in the form of irritation or pain syndrome at the injection site. If these or other side effects occur, you should report them to your healthcare professional.
Peculiarities
Accidentally administered intravenously "Adrenaline" can sharply increase blood pressure. Against the background of increased blood pressure, angina attacks may occur when the medication is administered. Exposure to epinephrine may cause decreased urine output.
The injection must be carried out into a large vein, using a device to adjust the rate of administration of the medication. Intracardiac administration during asystole is used when other methods are unavailable, since there is a risk of cardiac tamponade and pneumothorax.
Therapy should be accompanied by determination of the content of potassium ions in the blood, measurement of blood pressure, minute microcirculation, and electrocardiography.
The use of the drug in increased dosages during myocardial infarction may increase the manifestations of ischemia due to the increased need for oxygen. During therapy for patients suffering from diabetes, it is necessary to increase the concentration of sulfonylurea derivatives and insulin, since Adrenaline increases glycemia.
It must be remembered that "Adrenaline" is the trade name for epinephrine.
What other special instructions does the drug have?
The absorption and final level of epinephrine in the blood after intratracheal administration may be unexpected. In case of shock, the use of medication does not replace the transfusion of blood substitutes or blood. Prolonged use of epinephrine provokes a narrowing of peripheral blood vessels, as well as the likelihood of necrosis or gangrene.
Interaction
According to the instructions for use for epinephrine, it is known that adrenergic agonists can increase the effect of epinephrine and the severity negative effects from the heart and blood vessels. When using cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalational anesthesia, and cocaine, it increases the risk of developing arrhythmias.
The use of "Adrenaline" with narcotic painkillers, sleeping pills, antihypertensive drugs, insulin and other hypoglycemic drugs reduces their effectiveness.
When using "Adrenaline" with nitrates, it weakens them pharmacological action. "Phenoxybenzamine" in combination with "Adrenaline" provokes tachycardia and increased hypotensive effect.
When used with Phenytoin, a sharp decrease in blood pressure is observed and bradycardia occurs. Preparations of hormones of the endocrine gland cause a mutual enhancement of effects.
Analogues
Adrenaline substitute drugs are:
- "Epinephrine."
- "Mezaton".
- "Dopamine."
- "Dopmin."
- "Gutron."
- "Isomiline."
- "Adrenor."
- "Simdax".
- "Epiject".
It is necessary to keep "Adrenaline" at temperatures up to + 15 degrees in a dark place. Keep away from children. Shelf life - three years. The drug is dispensed strictly according to the prescription of a medical specialist.
