epinephrine (Rx)

Brand and Other Names:EpiPen, EpiPen Jr, more...Auvi-Q, Symjepi, Adrenalin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

prefilled autoinjector or syringe for SC/IM use

  • 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)

injectable solution

  • 0.1mg/mL (1:10,000)
  • 1mg/mL (1:1000)

Cardiac Arrest

1:10,000 solution

  • IV
    • Recommended dose: 0.5-1.0 mg (5-10 mL)
    • During a resuscitation effort, 0.5 mg (5 mL) IV q5min
  • Intracardiac
    • Intracardiac injection if there has not been sufficient time to establish an IV route
    • Usual dose ranges from 0.3-0.5 mg (3-5 mL)
  • Endotracheal tube
    • Alternatively, if the patient has been intubated, epinephrine can be injected via the endotracheal tube directly into the bronchial tree at the same dosage as for IV injection
    • 2-2.5 mg q3-5min until IV/IO access established or spontaneous circulation restored

Hypotension Associated with Septic Shock

Indicated to increase mean arterial blood pressure in adults with hypotension associated with septic shock

Recommended dose: 0.05-2 mcg/kg/minute IV infusion; titrate to desired mean arterial pressure (MAP); may adjust dose q10-15 min by 0.05-0.2 mcg/kg/minute to achieve desired blood pressure goal

After hemodynamic stabilization, may wean incrementally q30min over 12-24 hr

See also Administration

Anaphylaxis

Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

1:10,000 solution

  • 0.1 mg (0.1mg/mL) IV at rate of 1-4 mcg/min over 5 min to prevent the need to repeat injections frequently OR may initiate with infusion at 5-15 mcg/min (with crystalloid administration); IV administration should only be done in patients who are profoundly hypotensive or are in cardiopulmonary arrest refractory to volume resuscitation and several epinephrine injections

1:1000 solution

  • 0.3-0.5 mg (0.3-0.5 mL) of undiluted epinephrine IM/SC once in anterolateral aspect of the thigh, not to exceed 0.5 mg (0.5 mL) per injection, repeated every 5-10 minutes as necessary
  • Monitor clinically for reaction severity and cardiac effects

Prefilled autoinjector or syringe

  • 0.3 mg (contents of 1 autoinjector) SC/IM once in anterolateral aspect of the thigh; may repeat dose after 5-15 minutes if symptoms persist

See also Administration

Symptomatic Bradycardia

Unresponsive to atropine or pacing: 2-10 mcg//min by IV infusion or 0.1-0.5 mcg/kg/min (7-35 mcg/min in 70 kg patient); titrate to patient response

Mydriasis

Induction and maintenance of mydriasis during intraocular surgery

1:1000 solution

  • After dilution in an ophthalmic irrigating fluid, inject intracamerally as a bolus dose of 0.1 mL at dilution of 1:100,000 to 1:400,000 (10-2.5 mcg/mL)
  • See also Administration

Dosing Considerations

Anaphylaxis

  • With severe persistent anaphylaxis, repeat injections with an additional autoinjector may be necessary
  • More than two sequential doses of epinephrine should only be administered under direct medical supervision

Dosage Forms & Strengths

prefilled autoinjector or syringe for SC/IM use

  • 0.1mg/0.1mL (Auvi-Q)
  • 0.15mg/0.15mL (EpiPen Jr, Auvi-Q, Symjepi)
  • 0.3mg/0.3mL (EpiPen, Auvi-Q, Symjepi)

injectable solution

  • 0.1mg/mL (1:10,000)
  • 1mg/mL (1:1000)

Anaphylaxis

Indicated in emergency treatment of allergic reactions (Type I) including anaphylaxis

1:1000 solution

  • <30 kg (66 lbs): 0.01 mg/kg (0.01 mL/kg) SC/IM, not to exceed 0.3 mg (0.3 mL) per injection, repeated q5-10 min as necessary  
  • ≥30 kg (66 lbs): 0.3-0.5 mg (0.3-0.5 mL) SC/IM, not to exceed 0.5 mg (0.5 mL) per injection, repeated q5-10 min as necessary  

Autoinjector

  • May repeat dose after 5-15 minutes if symptoms persist
  • Infants weighing 7.5-15 kg (16.5-33 lb); Auvi-Q only: 0.1 mg SC/IM once
  • Weight 15 to <30 kg: 0.15 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may repeat dose q5-15min
  • Weight ≥30 kg: 0.3 mg (contents of 1 autoinjector/prefilled syringe) SC/IM once; may repeat dose q5-15min

Asystole/Pulseless Arrest (Off-label)

1:10,000 solution: 0.01 mg/kg (0.1 mg/mL) IO/IV; not to exceed 1 mg; repeat q3-5min until return of spontaneous circulation  

0.1 mg/kg (0.1 mL/kg of 1:1000 solution; 1 mg/mL) endotracheal; not to exceed 2.5 mg q3-5min until IO/IVP access established or spontaneous circulation achieved; flush with 5 mL of normal saline immediately after administration

Symptomatic Bradycardia (Off-label)

1:10,000 solution: 0.01 mg/kg IO/IV q3-5min; not to exceed 1 mg  

1:1,000 solution: 0.1 mg/kg (0.1mL/kg) of endotracheal q3-5min if necessary; flush each dose with at least 5 mL isotonic sodium chloride injection

Neonates (aged <28 days): 0.01-0.03 mg/kg IVP (1:10,000 solution) q3-5min; higher doses not recommended

Neonate IV access not available: 0.05-0.1 mg/kg endotracheal tube (1:10,000 soluiton); lower doses not effective; follow each dose with at least 5 mL isotonic sodium chloride injection

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Interactions

Interaction Checker

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            Contraindicated (15)

            • disopyramide

              epinephrine and disopyramide both increase QTc interval. Contraindicated.

            • ibutilide

              epinephrine and ibutilide both increase QTc interval. Contraindicated.

            • indapamide

              epinephrine and indapamide both increase QTc interval. Contraindicated.

            • iobenguane I 123

              epinephrine decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.

            • isocarboxazid

              isocarboxazid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • linezolid

              linezolid increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • lurasidone

              epinephrine increases toxicity of lurasidone by pharmacodynamic synergism. Contraindicated. Interaction applies only in setting of acute lurasidone overdose. Epinephrine may enhance hypotensive effects of lurasidone in overdose setting.

            • pentamidine

              epinephrine and pentamidine both increase QTc interval. Contraindicated.

            • phenelzine

              phenelzine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • pimozide

              epinephrine and pimozide both increase QTc interval. Contraindicated.

            • procainamide

              epinephrine and procainamide both increase QTc interval. Contraindicated.

            • quinidine

              epinephrine and quinidine both increase QTc interval. Contraindicated.

            • selegiline transdermal

              selegiline transdermal increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • sotalol

              epinephrine and sotalol both increase QTc interval. Contraindicated.

            • tranylcypromine

              tranylcypromine increases effects of epinephrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Serious - Use Alternative (65)

            • amiodarone

              epinephrine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

            • amitriptyline

              epinephrine and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              amitriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              epinephrine and amoxapine both increase QTc interval. Avoid or Use Alternate Drug.

              amoxapine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • artemether/lumefantrine

              epinephrine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • cabergoline

              cabergoline, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • chlorpromazine

              epinephrine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              epinephrine and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              epinephrine and clomipramine both increase QTc interval. Avoid or Use Alternate Drug.

              clomipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desflurane

              desflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

              desflurane increases levels of epinephrine by decreasing metabolism. Contraindicated.

            • desipramine

              epinephrine and desipramine both increase QTc interval. Avoid or Use Alternate Drug.

              desipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dihydroergotamine

              dihydroergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dofetilide

              epinephrine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

            • dosulepin

              epinephrine and dosulepin both increase QTc interval. Avoid or Use Alternate Drug.

            • doxapram

              doxapram increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

            • doxepin

              epinephrine and doxepin both increase QTc interval. Avoid or Use Alternate Drug.

              doxepin, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dronedarone

              epinephrine and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.

            • droperidol

              epinephrine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • ergoloid mesylates

              ergoloid mesylates, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ergotamine

              ergotamine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • erythromycin base

              epinephrine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              epinephrine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              epinephrine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              epinephrine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

            • ether

              ether increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • etomidate

              etomidate increases levels of epinephrine by decreasing metabolism. Contraindicated.

            • fluconazole

              epinephrine and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • fluphenazine

              epinephrine and fluphenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • formoterol

              epinephrine and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

            • haloperidol

              epinephrine and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

              epinephrine and imipramine both increase QTc interval. Avoid or Use Alternate Drug.

              imipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • iobenguane I 131

              epinephrine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

            • isoflurane

              isoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • ketamine

              ketamine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of epinephrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding).

            • ketoconazole

              epinephrine and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • levomilnacipran

              levomilnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.

            • lofepramine

              epinephrine and lofepramine both increase QTc interval. Avoid or Use Alternate Drug.

              lofepramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • lumefantrine

              epinephrine and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • maprotiline

              epinephrine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

              maprotiline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • methoxyflurane

              methoxyflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • methylergonovine

              methylergonovine, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • milnacipran

              milnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.

            • moxifloxacin

              epinephrine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • nadolol

              nadolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

            • nortriptyline

              epinephrine and nortriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              nortriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • octreotide

              epinephrine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

            • octreotide (Antidote)

              epinephrine and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

            • ozanimod

              ozanimod increases toxicity of epinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • perphenazine

              epinephrine and perphenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • pindolol

              pindolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

            • procarbazine

              procarbazine increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of acute hypertensive episode.

            • prochlorperazine

              epinephrine and prochlorperazine both increase QTc interval. Avoid or Use Alternate Drug.

            • promazine

              epinephrine and promazine both increase QTc interval. Avoid or Use Alternate Drug.

            • promethazine

              epinephrine and promethazine both increase QTc interval. Avoid or Use Alternate Drug.

            • propofol

              propofol increases levels of epinephrine by unknown mechanism. Avoid or Use Alternate Drug.

            • propranolol

              propranolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

            • protriptyline

              epinephrine and protriptyline both increase QTc interval. Avoid or Use Alternate Drug.

              protriptyline, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • sevoflurane

              sevoflurane increases toxicity of epinephrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • thioridazine

              epinephrine and thioridazine both increase QTc interval. Avoid or Use Alternate Drug.

            • timolol

              timolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

            • trazodone

              epinephrine and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

              trazodone, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • trifluoperazine

              epinephrine and trifluoperazine both increase QTc interval. Avoid or Use Alternate Drug.

            • trimipramine

              epinephrine and trimipramine both increase QTc interval. Avoid or Use Alternate Drug.

              trimipramine, epinephrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • yohimbe

              yohimbe, epinephrine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • ziprasidone

              epinephrine and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (267)

            • acebutolol

              acebutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              acebutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • aceclofenac

              aceclofenac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • acemetacin

              acemetacin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • albuterol

              albuterol and epinephrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and epinephrine both decrease sedation. Use Caution/Monitor.

              albuterol and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • alfentanil

              alfentanil increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alprazolam

              alprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amiloride

              amiloride increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • amitriptyline

              amitriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              amitriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • amobarbital

              amobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amoxapine

              amoxapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              amoxapine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • arformoterol

              arformoterol and epinephrine both decrease serum potassium. Use Caution/Monitor.

              arformoterol and epinephrine both decrease sedation. Use Caution/Monitor.

              arformoterol and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              aripiprazole increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • armodafinil

              epinephrine and armodafinil both decrease sedation. Use Caution/Monitor.

            • aspirin

              aspirin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aspirin rectal

              aspirin rectal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atenolol

              atenolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              atenolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine, epinephrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously with vasopressors such as epinephrine.

            • azelastine

              azelastine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • azithromycin

              epinephrine and azithromycin both increase QTc interval. Use Caution/Monitor.

            • belladonna and opium

              belladonna and opium increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bendroflumethiazide

              epinephrine and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

            • benperidol

              benperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benzphetamine

              epinephrine and benzphetamine both decrease sedation. Use Caution/Monitor.

              epinephrine and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • betaxolol

              betaxolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              betaxolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • bisoprolol

              bisoprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              bisoprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • bretylium

              bretylium increases effects of epinephrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. If catecholamines are administered to treat systolic BP <75 mmHg, a dilute solution should be employed and blood pressure monitored closely. Bretylium causes an initial norepinephrine release and may enhance catecholamine pressor effects.

            • bromocriptine

              bromocriptine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.

            • brompheniramine

              brompheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bumetanide

              epinephrine and bumetanide both decrease serum potassium. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butabarbital

              butabarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butalbital

              butalbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butorphanol

              butorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • caffeine

              epinephrine and caffeine both decrease sedation. Use Caution/Monitor.

            • carbenoxolone

              epinephrine and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carvedilol

              carvedilol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              carvedilol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • celecoxib

              celecoxib increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • celiprolol

              celiprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              celiprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorothiazide

              epinephrine and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              chlorpromazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              chlorpromazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • chlorthalidone

              epinephrine and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • cinnarizine

              cinnarizine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clemastine

              clemastine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clomipramine

              clomipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              clomipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • clonazepam

              clonazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clorazepate

              clorazepate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              clozapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              clozapine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • codeine

              codeine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • cyclizine

              cyclizine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • cyclopenthiazide

              epinephrine and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • deflazacort

              epinephrine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • desipramine

              desipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              desipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexfenfluramine

              epinephrine and dexfenfluramine both decrease sedation. Use Caution/Monitor.

              epinephrine and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmethylphenidate

              epinephrine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.

              epinephrine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextroamphetamine

              epinephrine and dextroamphetamine both decrease sedation. Use Caution/Monitor.

              epinephrine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextromoramide

              dextromoramide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diamorphine

              diamorphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide and epinephrine both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, epinephrine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • diclofenac

              diclofenac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diethylpropion

              epinephrine and diethylpropion both decrease sedation. Use Caution/Monitor.

              epinephrine and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diflunisal

              diflunisal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • digoxin

              digoxin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dipipanone

              dipipanone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dobutamine

              dobutamine and epinephrine both decrease serum potassium. Use Caution/Monitor.

              dobutamine and epinephrine both decrease sedation. Use Caution/Monitor.

              dobutamine and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dolasetron

              epinephrine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • dopamine

              epinephrine and dopamine both decrease sedation. Use Caution/Monitor.

              epinephrine and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopexamine

              dopexamine and epinephrine both decrease serum potassium. Use Caution/Monitor.

              dopexamine and epinephrine both decrease sedation. Use Caution/Monitor.

              dopexamine and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              dopexamine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • doxepin

              doxepin increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              doxepin increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • droperidol

              droperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • drospirenone

              drospirenone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • droxidopa

              epinephrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension

            • entacapone

              entacapone will increase the level or effect of epinephrine by decreasing metabolism. Use Caution/Monitor. Entacapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.

            • ephedrine

              ephedrine and epinephrine both decrease serum potassium. Use Caution/Monitor.

              ephedrine and epinephrine both decrease sedation. Use Caution/Monitor.

              ephedrine and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • epinephrine inhaled

              epinephrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              epinephrine and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.

              epinephrine and epinephrine racemic both decrease sedation. Use Caution/Monitor.

              epinephrine and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              epinephrine, epinephrine racemic. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely.

            • esmolol

              esmolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              esmolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • estazolam

              estazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ethacrynic acid

              epinephrine and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

            • ethanol

              ethanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • etodolac

              etodolac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fenfluramine

              epinephrine and fenfluramine both decrease sedation. Use Caution/Monitor.

              epinephrine and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • fenoprofen

              fenoprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flecainide

              epinephrine and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluoxetine

              epinephrine and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluphenazine

              fluphenazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              fluphenazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              fluphenazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • flurazepam

              flurazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurbiprofen

              flurbiprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine and epinephrine both increase QTc interval. Modify Therapy/Monitor Closely.

            • formoterol

              epinephrine and formoterol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and formoterol both decrease sedation. Use Caution/Monitor.

              epinephrine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • foscarnet

              epinephrine and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

            • furosemide

              epinephrine and furosemide both decrease serum potassium. Use Caution/Monitor.

            • gentamicin

              epinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.

            • green tea

              green tea increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

            • haloperidol

              haloperidol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydralazine

              hydralazine, epinephrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

            • hydrochlorothiazide

              epinephrine and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • hydromorphone

              hydromorphone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen

              ibuprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen IV

              ibuprofen IV increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • iloperidone

              epinephrine and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              iloperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • imipramine

              imipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              imipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • indacaterol, inhaled

              epinephrine increases effects of indacaterol, inhaled by Other (see comment). Use Caution/Monitor. Comment: If additional adrenergic drugs are to be administered by any route, they should be used with caution because the sympathetic effects of indacaterol may be potentiated.

            • indapamide

              epinephrine and indapamide both decrease serum potassium. Use Caution/Monitor.

            • indomethacin

              indomethacin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • insulin degludec

              epinephrine decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin degludec/insulin aspart

              epinephrine decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin inhaled

              epinephrine decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • isoproterenol

              epinephrine and isoproterenol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and isoproterenol both decrease sedation. Use Caution/Monitor.

              epinephrine and isoproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ketoprofen

              ketoprofen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac

              ketorolac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac intranasal

              ketorolac intranasal increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • ketotifen, ophthalmic

              ketotifen, ophthalmic increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • labetalol

              labetalol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              labetalol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • levalbuterol

              epinephrine and levalbuterol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and levalbuterol both decrease sedation. Use Caution/Monitor.

              epinephrine and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • levofloxacin

              epinephrine and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • levorphanol

              levorphanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levothyroxine

              levothyroxine will increase the level or effect of epinephrine by unspecified interaction mechanism. Use Caution/Monitor.

            • lisdexamfetamine

              epinephrine and lisdexamfetamine both decrease sedation. Use Caution/Monitor.

              epinephrine and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • lofepramine

              lofepramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              lofepramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • lofexidine

              lofexidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loprazolam

              loprazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lorazepam

              lorazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lormetazepam

              lormetazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lornoxicam

              lornoxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              loxapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • maprotiline

              maprotiline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              maprotiline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • marijuana

              marijuana increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meclofenamate

              meclofenamate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefenamic acid

              mefenamic acid increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • melatonin

              melatonin increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meloxicam

              meloxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meperidine

              meperidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meprobamate

              meprobamate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaproterenol

              epinephrine and metaproterenol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and metaproterenol both decrease sedation. Use Caution/Monitor.

              epinephrine and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methadone

              epinephrine and methadone both increase QTc interval. Modify Therapy/Monitor Closely.

              methadone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methamphetamine

              epinephrine and methamphetamine both decrease sedation. Use Caution/Monitor.

              epinephrine and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methyclothiazide

              epinephrine and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

            • methyldopa

              methyldopa increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              epinephrine and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.

              epinephrine and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methylphenidate

              epinephrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • metolazone

              epinephrine and metolazone both decrease serum potassium. Use Caution/Monitor.

            • metoprolol

              metoprolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              metoprolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • midazolam

              midazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midodrine

              epinephrine and midodrine both decrease sedation. Use Caution/Monitor.

              epinephrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • mirtazapine

              mirtazapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • modafinil

              epinephrine and modafinil both decrease sedation. Use Caution/Monitor.

            • morphine

              morphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • motherwort

              motherwort increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • moxonidine

              moxonidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabilone

              nabilone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabumetone

              nabumetone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nadolol

              nadolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nadolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • nalbuphine

              nalbuphine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • naproxen

              naproxen increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nateglinide

              epinephrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.

            • nebivolol

              nebivolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nebivolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • norepinephrine

              epinephrine and norepinephrine both decrease serum potassium. Use Caution/Monitor.

              epinephrine and norepinephrine both decrease sedation. Use Caution/Monitor.

              epinephrine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • nortriptyline

              nortriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • ofloxacin

              epinephrine and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • olanzapine

              olanzapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • olodaterol inhaled

              epinephrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

            • opicapone

              opicapone will increase the level or effect of epinephrine by decreasing metabolism. Use Caution/Monitor. Opicapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.

            • opium tincture

              opium tincture increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxaprozin

              oxaprozin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxazepam

              oxazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxycodone

              oxycodone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxymetazoline topical

              oxymetazoline topical and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • oxymorphone

              oxymorphone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxytocin

              oxytocin increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

              epinephrine and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              paliperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • papaveretum

              papaveretum increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • parecoxib

              parecoxib increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • paroxetine

              epinephrine and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • penbutolol

              penbutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              penbutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • pentazocine

              pentazocine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pentobarbital

              pentobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • perphenazine

              perphenazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              perphenazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              perphenazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • phendimetrazine

              epinephrine and phendimetrazine both decrease sedation. Use Caution/Monitor.

              epinephrine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenobarbital

              phenobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenoxybenzamine

              phenoxybenzamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phentermine

              epinephrine and phentermine both decrease sedation. Use Caution/Monitor.

              epinephrine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phentolamine

              phentolamine, epinephrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phenylephrine

              epinephrine and phenylephrine both decrease sedation. Use Caution/Monitor.

              epinephrine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine PO

              epinephrine and phenylephrine PO both decrease sedation. Use Caution/Monitor.

              epinephrine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pholcodine

              pholcodine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimozide

              pimozide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pindolol

              pindolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pindolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • pirbuterol

              epinephrine and pirbuterol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and pirbuterol both decrease sedation. Use Caution/Monitor.

              epinephrine and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • piroxicam

              piroxicam increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • posaconazole

              epinephrine and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • potassium acid phosphate

              potassium acid phosphate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium chloride

              potassium chloride increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium citrate

              potassium citrate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • primidone

              primidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • prochlorperazine

              prochlorperazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              prochlorperazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              prochlorperazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • promazine

              promazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              promazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • promethazine

              promethazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              promethazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              promethazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • propranolol

              propranolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              propranolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • propylhexedrine

              epinephrine and propylhexedrine both decrease sedation. Use Caution/Monitor.

              epinephrine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • protriptyline

              protriptyline increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              protriptyline increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • pseudoephedrine

              epinephrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • quazepam

              quazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quetiapine

              quetiapine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ranolazine

              epinephrine and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

            • rasagiline

              rasagiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.

            • risperidone

              epinephrine and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

              risperidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sacubitril/valsartan

              sacubitril/valsartan increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salicylates (non-asa)

              salicylates (non-asa) increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salmeterol

              epinephrine and salmeterol both decrease serum potassium. Use Caution/Monitor.

              epinephrine and salmeterol both decrease sedation. Use Caution/Monitor.

              epinephrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • salsalate

              salsalate increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              scullcap increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • secobarbital

              secobarbital increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • selegiline

              selegiline increases effects of epinephrine by pharmacodynamic synergism. Use Caution/Monitor. Avoid concomitant use if possible. Caution is advised.

            • shepherd's purse

              shepherd's purse increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              epinephrine and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • solriamfetol

              epinephrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • sotalol

              sotalol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • spironolactone

              spironolactone increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • succinylcholine

              succinylcholine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              sufentanil increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulfamethoxazole

              epinephrine and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • sulfasalazine

              sulfasalazine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulindac

              sulindac increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tapentadol

              tapentadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • telavancin

              epinephrine and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

            • temazepam

              temazepam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • terbutaline

              epinephrine and terbutaline both decrease serum potassium. Use Caution/Monitor.

              epinephrine and terbutaline both decrease sedation. Use Caution/Monitor.

              epinephrine and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • thioridazine

              thioridazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              thioridazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              thioridazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • thiothixene

              thiothixene increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • timolol

              timolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • tolcapone

              tolcapone will increase the level or effect of epinephrine by decreasing metabolism. Use Caution/Monitor. Tolcapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.

            • tolfenamic acid

              tolfenamic acid increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolmetin

              tolmetin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolvaptan

              tolvaptan increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • topiramate

              topiramate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • torsemide

              epinephrine and torsemide both decrease serum potassium. Use Caution/Monitor.

            • tramadol

              tramadol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trazodone

              trazodone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              trazodone increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • triamterene

              triamterene increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • triazolam

              triazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • triclofos

              triclofos increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              trifluoperazine, epinephrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

              trifluoperazine decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia.

            • trimethoprim

              epinephrine and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

            • trimipramine

              trimipramine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              trimipramine increases effects of epinephrine by unknown mechanism. Use Caution/Monitor.

            • triprolidine

              triprolidine increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tropisetron

              epinephrine and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • venlafaxine

              epinephrine and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

            • voriconazole

              epinephrine and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • xylometazoline

              epinephrine and xylometazoline both decrease sedation. Use Caution/Monitor.

              epinephrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • yohimbine

              epinephrine and yohimbine both decrease sedation. Use Caution/Monitor.

              epinephrine and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ziconotide

              ziconotide increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziprasidone

              ziprasidone increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            Minor (18)

            • bendroflumethiazide

              epinephrine, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • bumetanide

              epinephrine, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorothiazide

              epinephrine, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorthalidone

              epinephrine, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • cyclopenthiazide

              epinephrine, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • desmopressin

              desmopressin increases effects of epinephrine by pharmacodynamic synergism. Minor/Significance Unknown.

            • ethacrynic acid

              epinephrine, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • eucalyptus

              eucalyptus increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • furosemide

              epinephrine, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • hydrochlorothiazide

              epinephrine, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • indapamide

              epinephrine, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • methyclothiazide

              epinephrine, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • metolazone

              epinephrine, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • noni juice

              noni juice increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • sage

              sage increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • thiothixene

              thiothixene decreases effects of epinephrine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • torsemide

              epinephrine, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • vasopressin

              epinephrine decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

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            Adverse Effects

            Frequency Not Defined

            Angina

            Anxiety

            Apprehensiveness

            Cardiac arrhythmias

            Dizziness

            Dyspnea

            Flushing

            Headache

            Hypertension

            Nausea

            Nervousness

            Pallor

            Palpitations

            Respiratory difficulties

            Restlessness

            Stress cardiomyopathy

            Sweating

            Tachycardia

            Tremor

            Vasoconstriction

            Vomiting

            Weakness

            Postmarketing Reports

            Necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene)

            Reduced blood flow to digits, hands, or feet with accidental injection to those areas

            Arrhythmias, including fatal ventricular fibrillation, reported, particularly in patients with underlying cardiac disease or those receiving certain drugs

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            Warnings

            Contraindications

            There are no contraindications for life-threatening situations

            Nonanaphylactic shock

            Narrow-angle glaucoma

            Coadministration during genral anesthesia with halogenated hydrocarbons or cyclopropane

            Labor

            Situations where vasopressors may be contraindicated, including thyrotoxicosis, diabetes

            Maternal blood pressure in excess of 130/80 mm Hg in hypertension and other cardiovascular disorders

            Cautions

            Use caution in patients with cardiac disease, angina (especially with history of CAD) or that are receiving drugs that sensitize the myocardium; treatment may induce cardiac arrhythmias

            Pulmonary edema may occur as the result of cardiac stimulation and peripheral constriction

            Decreased urine output may occur as the result of renal blood vessel constriction

            Use caution in cerebrovascular insufficiency

            Use with caution in patients with hypertension, diabetes mellitus, thyroid disease, prostatic hypertrophy, geriatric patients, pregnancy, and previous hospitalization for asthma

            Rapid IV administration, although necessary in pulesless arrest, may cause death from cerebrovascular hemorrhage or cardiac arrhythmias

            Patients that are sulfite-sensitive, should still be treated during a serious allergic reaction or other emergency even if products available contain sulfites

            May cause worsening of symptoms in patients with Parkinson disease

            Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion

            Correct blood volume depletion before administering any vasopressor

            Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene), reported at injection site following injection for anaphylaxis; to decrease risk, do not inject into buttock; advise patients to seek medical care if they develop signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at epinephrine injection site; cleansing with alcohol does not kill bacterial spores, and therefore, does not lower risk of infection

            Multiple-dose vial not for ophthalmic use; contains chlorobutanol which may be harmful to corneal endothelium

            Solutions must be diluted prior to intraocular use; other epinephrine products containing sodium bisulfite have been associated with corneal endothelial damage when used in the eye at undiluted concentrations (1 mg/mL)

            Autoinjector is to be used in conjunction with immediate medical or hospital care; more than two sequential doses of epinephrine should only be administered under direct medical supervision

            Extravasation

            • Avoid extravasation; ensure proper needle or catheter placement prior to and during infusion
            • To prevent sloughing and necrosis in areas has extravasation, infiltrate the area with 10-15 mL of 0.9% NaCl solution containing phentolamine 5-10 mg
            • Use a syringe with a fine hypodermic needle, with solution being infiltrated liberally throughout the area, which has a cold, hard, and pallid appearance
            • Phentolamine may cause immediate and conspicuous local hyperemic changes if area is infiltrated within 12 hr

            Injection related complications

            • Injection into buttock may not provide effective treatment of anaphylaxis
            • Accidental injection into hands, digits, or feet may result in local reactions including injection site coldness, pallor, and hypoesthesia or injury resulting in bruising, discoloration, erythema, bleeding, or skeletal injury
            • To minimize the risk of injection-related injury when administering autoinjector to children or infants, instruct caregivers to firmly hold child’s leg in place and limit movement prior to and during injection

            Drug interactions overview

            • Coadministration with cardiac glycosides, diuretics, or anti-arrhythmics should be observed carefully for the development of cardiac arrhythmias
            • Effects of epinephrine may be potentiated by tricyclic antidepressants, monoamine oxidase inhibitors, levothyroxine sodium, and certain antihistamines, notably chlorpheniramine, tripelennamine, and diphenhydramine
            • Cardiostimulating and bronchodilating effects of epinephrine are antagonized by beta-adrenergic blocking drugs, such as propranolol
            • Vasoconstricting and hypertensive effects of epinephrine are antagonized by alpha-adrenergic blocking drugs, such as phentolamine
            • Ergot alkaloids may reverse the pressor effects of epinephrine
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            Pregnancy & Lactation

            Pregnancy

            During pregnancy, anaphylaxis can be catastrophic and can lead to hypoxic-ischemic encephalopathy and permanent central nervous system damage or death in the mother and, more commonly, in the fetus or neonate

            The prevalence of anaphylaxis occurring during pregnancy is reported to be approximately 3 cases per 100,000 deliveries; management of anaphylaxis during pregnancy is similar to management in the general population

            Epinephrine is the first line-medication of choice for treatment of anaphylaxis; it should be used in the same manner in pregnant and non-pregnant patients

            In conjunction with the administration of epinephrine, the patient should seek immediate medical or hospital care

            Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated; delaying treatment in pregnant women with hypotension associated with septic shock may increase risk of maternal and fetal morbidity and mortality

            Life-sustaining therapy for pregnant woman should not be withheld due to potential concerns regarding effects of epinephrine on fetus

            Labor and delivery

            • Epinephrine usually inhibits spontaneous or oxytocin-induced contractions of the pregnant human uterus and may delay second stage of labor; avoid epinephrine during second stage of labor; in dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage
            • Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg; although epinephrine may improve maternal hypotension associated with septic shock and anaphylaxis, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia

            Lactation

            There is no information regarding presence of epinephrine in human milk or effects on the breastfed infant or on milk production

            However, due to poor oral bioavailability and short half-life, epinephrine exposure is expected to be very low in breastfed infant

            Epinephrine is first-line medication of choice for treatment of anaphylaxis; it should be used in same manner for anaphylaxis in breastfeeding and non-breastfeeding patients

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Strong alpha-adrenergic effects, which cause an increase in cardio output and HR, a decrease in renal perfusion and PVR, and a variable effect on BP, resulting in systemic vasoconstriction and increased vascular permeability

            Strong beta1- and moderate beta2-adrenergic effects, resulting in bronchial smooth muscle relaxation

            Secondary relaxation effect on smooth muscle of stomach, intestine, uterus, and urinary bladder

            Absorption

            Onset: 5-10 min (SC); 1 min (inhalation)

            Duration: 4 hr

            Metabolism

            Metabolized by MAO and COMT in adrenergic neuron

            Metabolites: Metadrenaline, sulfate conjugates, and hydroxy derivatives of mandelic acid (inactive)

            Elimination

            Excretion: Urine

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            Administration

            IV Incompatibilities

            Solution: Na-bicarbonate 5%, Ionosol PSL, Ionosol T/D5

            Additive: Aminophylline, hyaluronidase, mephentermine, Na-bicarbonate

            Syringe: Na-bicarbonate(?)

            Y-site: Ampicillin, thiopental

            Not specified: Atropine, carbenicillin, diazepam, erythromycin, lidocaine

            IV Compatibilities

            Solution: D5W, D10W, dextrose-Ringer's, dextrose-saline, NS, LR, Ringer's

            Additive: Amikacin, cimetidine, dobutamine, floxacillin, furosemide, metaraminol, ranitidine, verapamil

            Syringe: Caffeine, doxapram, heparin, milrinone

            Y-site: Amiodarone, atracurium, bivalirudin, CaCl2, Ca gluconate, cefpirome, cisatracurium, dexmedetomidine, diltiazem, dobutamine, dopamine, famotidine, fenoldopam, fentanyl, furosemide, heparin, Hextend, hydrocortisone Na succinate, hydromorphone, inamrinone, labetalol, levofloxacin, lorazepam, midazolam, milrinone, morphine SO4, nicardipine, nitroglycerin, norepinephrine, pancuronium, phytonadione, KCl, propofol, ranitidine, remifentanil, nitroprusside, tirofiban, vasopressin, vecuronium, vitamin B/C, warfarin

            Not specified: Meperidine

            IV Preparation

            Dilute epinephrine in D5W or D5W 0.9% NaCl

            Administration in saline solution alone is not recommended

            Add 1 mL (1 mg) of epinephrine from its ampule to 1000 mL of a D5W containing solution

            Each mL of this dilution contains 1 mcg of epinephrine

            Solution: 1 mg in 250 mL D5W or NS (4 mcg/mL) to make up concentration of 15-60 mL/hr (1-4 mcg/min)

            IV Administration

            Correct blood volume depletion as fully as possible prior to administering any vasopressor

            When, as an emergency measure, intraaortic pressures must be maintained to prevent cerebral or coronary artery ischemia, epinephrine can be administered before and concurrently with blood volume replacement

            Whenever possible, administer epinephrine infusions into a large vein

            Avoid using a catheter tie-in technique, because the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug

            Central line; infusion pump required

            Do not mix with alkaline solutions

            Discard after 24 hours or if solution is discolored or contains precipitate

            Store in light-resistant container

            Intraocular Preparation

            Epinephrine must be diluted prior to intraocular use

            Dilute 1 mL of epinephrine 1 mg/mL (1:1000) in 100 to 1000 mL of an ophthalmic irrigation fluid to create an epinephrine concentration of 1:100,000 to 1:1,000,000 (10-1 mcg/mL)

            Use the irrigating solution as needed for the surgical procedure

            Intraocular Administration

            After dilution in an ophthalmic irrigating fluid, inject intracamerally

            SC/IM Administration

            SC or IM administration only

            Inject IM or SC into the anterolateral aspect of the thigh, through clothing if necessary

            Do not administer autoinjector IV; administer only in outer thigh to ensure SC or IM administration

            Do not inject into buttock, or into digits, hands, or feet

            To minimize the risk of injection-related injury, instruct caregivers to hold the child's leg firmly in place and limit movement prior to and during injection when administering to young children

            Discard remaining volume after dose has been administered

            In conjunction with use, seek immediate medical or hospital care

            Storage

            Injection

            • Unused vials
              • Store at room temperature, 20-25°C (68-77°F)
              • Protect from light until ready to use; do not refrigerate; protect from freezing
              • Protect from alkalis and oxidizing agents
            • Diluted solutions
              • Store at room temperature (25°C) or refrigeration (4°C) is 24 hr

            Autoinjector

            • Store at room temperature 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F; do not refrigerator
            • The trainer for AUVI-Q should not be used at temperatures <50ºF (10ºC) or >104ºF (40ºC)
            • Store the trainer for AUVI-Q in its outer case; keep away from dirt, chemicals, and water
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            EpiPen Jr 2-Pak injection
            -
            0.15 mg/0.3 mL device
            EpiPen 2-Pak injection
            -
            0.3 mg/0.3 mL device
            Adrenalin injection
            -
            1 mg/mL (1 mL) vial
            Adrenalin injection
            -
            1 mg/mL vial
            Auvi-Q injection
            -
            0.15 mg/0.15 mL device
            Auvi-Q injection
            -
            0.3 mg/0.3 mL device
            EpiPen Jr injection
            -
            0.15 mg/0.3 mL device
            EpiPen injection
            -
            0.3 mg/0.3 mL device
            epinephrine injection
            -
            0.15 mg/0.3 mL device
            epinephrine injection
            -
            0.3 mg/0.3 mL device
            epinephrine injection
            -
            0.3 mg/0.3 mL device
            epinephrine injection
            -
            0.15 mg/0.3 mL device
            epinephrine injection
            -
            0.15 mg/0.3 mL device
            epinephrine injection
            -
            0.3 mg/0.3 mL device
            epinephrine injection
            -
            0.1 mg/mL solution
            epinephrine injection
            -
            0.15 mg/0.15 mL device
            epinephrine injection
            -
            0.3 mg/0.3 mL device
            epinephrine injection
            -
            0.3 mg/0.3 mL device
            epinephrine injection
            -
            0.15 mg/0.3 mL device
            epinephrine injection
            -
            1 mg/mL (1 mL) solution
            Epinephine Professional EMS injection
            -
            1 mg/mL kit
            Epinephrine Professional injection
            -
            1 mg/mL kit
            EpinephrineSnap-V injection
            -
            1 mg/mL kit
            EpinephrineSnap-V injection
            -
            1 mg/mL kit
            EpinephrineSnap-EMS injection
            -
            1 mg/mL kit

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            epinephrine injection

            EPINEPHRINE - INJECTION

            (EP-i-NEF-rin)

            COMMON BRAND NAME(S): Auvi-Q, Epipen, Symjepi, Twinject

            USES: This medication is used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances. Epinephrine works quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat.

            HOW TO USE: Read the Patient Information Leaflet and Instructions for Use provided by your pharmacist before you need to use epinephrine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Keep this product near you at all times. When you receive it and before you need to use it, check that the product comes out of its carrying case easily. If it does not, consult your pharmacist.The solution in this product should be clear. From time to time, check this product visually for particles or discoloration. If it has turned cloudy or pink/brown in color, do not use the product. Discard and replace it.Different brands of this medication have different directions for preparing and using this medication. Learn ahead of time how to properly inject this medication so you will be ready if you need to use it. Also, make sure a family member, caregiver, or other responsible person knows where you keep this medication and how to use it in case you cannot inject the medication yourself. The dosage is based on your medical condition, weight, and response to treatment.Inject this medication into the thigh as directed by your doctor and the manufacturer. This medication can be injected through clothing if needed. This medication acts quickly but does not last long. After injecting epinephrine, get medical help right away. Tell the health care professional that you have given yourself an injection of epinephrine. You may need another dose of epinephrine if your symptoms do not get better, or if they return after one dose.Avoid injecting this medication into the hands, feet, buttocks, or areas of your body other than the thigh. If this accidentally happens, get medical help right away. For infants and young children, be sure to hold their leg firmly in place before and during the injection to prevent injury. Discard the injector properly after use.

            SIDE EFFECTS: Fast/pounding heartbeat, nervousness, sweating, nausea, vomiting, trouble breathing, headache, dizziness, anxiety, shakiness, or pale skin may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: irregular heartbeat, signs of infection at the injection site (such as redness that doesn't go away, warmth, swelling, or pain).Get medical help right away if you have any very serious side effects, including: chest pain, fainting, vision changes, seizures, confusion.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before using this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This product may contain sulfites. However, if you have a sulfite allergy, you should still use this medication during an emergency. Since epinephrine can save your life, using it is more important than avoiding any sulfite-related problems.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart problems (such as angina, irregular heartbeat), high blood pressure, thyroid disease, diabetes.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Older adults may be more sensitive to the side effects of this drug, especially a rapid rise in blood pressure.If you are pregnant, this drug can be used the same way as if you were not pregnant.It is unknown if this medication passes into breast milk, but it is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: irregular heartbeat, fainting, vision changes, confusion, seizures.

            NOTES: Do not share this medication with others.

            MISSED DOSE: Not applicable.

            STORAGE: Store this product in the carrying case/original packaging at room temperature away from light and moisture. Avoid extreme heat and cold. Do not store this medication in your vehicle or in the bathroom. Do not refrigerate or freeze.From time to time, check the expiration date. Check this product visually for particles or discoloration. Replace the unit before it expires or if particles/discoloration are present. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this medication when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised October 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.