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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Lidocaine Hydrochloride, Epinephrine Hydrochloride
Brand Name
The Solution
Generic Name
Lidocaine Hydrochloride, Epinephrine Hydrochloride
Active Ingredient
EpinephrineCategory
alpha-Adrenergic Agonist [EPC]
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| .01 g/100mL | SPRAY | TOPICAL | 82617-101 |
Detailed information about The Solution
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for The Solution, you must consult a qualified healthcare professional.
Epinephrine is a life-saving sympathomimetic catecholamine used primarily for the emergency treatment of severe allergic reactions (anaphylaxis) and cardiac arrest. It acts as a non-selective agonist at alpha and beta-adrenergic receptors to restore cardiovascular and respiratory function.
Dosage of Epinephrine is highly dependent on the medical indication and the route of administration. For the emergency treatment of anaphylaxis in adults, the standard dose is 0.3 mg to 0.5 mg administered via intramuscular (IM) injection. This dose may be repeated every 5 to 15 minutes if symptoms do not improve or if they worsen. In the context of cardiac arrest, the standard ACLS dose is 1 mg (10 mL of a 1:10,000 solution) administered intravenously (IV) or intraosseously (IO) every 3 to 5 minutes during resuscitation efforts.
For adjunctive use with local anesthesia, concentrations typically range from 1:50,000 to 1:200,000, depending on the surgical site and the patient's cardiovascular health.
Pediatric dosing is strictly weight-based to ensure safety. For anaphylaxis in children:
For pediatric cardiac arrest, the standard IV/IO dose is 0.01 mg/kg (0.1 mL/kg of the 1:10,000 concentration).
No specific dose adjustments are required for patients with renal impairment, as the drug is primarily metabolized by enzymes (COMT/MAO) rather than renal clearance. However, patients with kidney disease should be monitored for potential hypertensive crises.
No specific dose adjustments are typically necessary for hepatic impairment, though the duration of action may be slightly prolonged in severe liver failure due to reduced metabolic enzyme activity.
Geriatric patients are at a higher risk of adverse cardiovascular effects, such as arrhythmias or myocardial infarction (heart attack). Healthcare providers typically use the lowest effective dose and monitor blood pressure and heart rate closely in this population.
Epinephrine auto-injectors are designed for ease of use during a crisis. Patients should be trained on the following steps:
Storage: Store Epinephrine at room temperature (68°F to 77°F). Do not refrigerate or freeze. Protect the solution from light and extreme heat. Periodically check the 'viewing window' of the device; if the liquid is cloudy, discolored, or contains particles, replace it immediately.
Epinephrine is an 'as-needed' emergency medication. There is no schedule for missed doses. However, patients with known allergies should ensure they have their auto-injector with them at all times.
An overdose of Epinephrine can cause a sudden, dangerous rise in blood pressure, which may lead to a cerebrovascular hemorrhage (stroke) or pulmonary edema (fluid in the lungs). Symptoms of overdose include extreme headache, severe anxiety, chest pain, irregular heartbeat, and shortness of breath. Treatment involves supportive care and the administration of rapid-acting alpha-blockers or vasodilators to lower blood pressure.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose without medical guidance.
Because Epinephrine stimulates the 'fight or flight' system, side effects are common and often expected as part of the drug's therapeutic action. These symptoms usually appear within minutes of injection and typically fade within 30 to 60 minutes as the drug is metabolized. Common experiences include:
> Warning: Stop taking Epinephrine and call your doctor immediately if you experience any of these serious reactions. While Epinephrine is life-saving, its potent effects on the cardiovascular system can lead to complications in susceptible individuals.
Epinephrine is typically used for acute emergencies, so long-term side effects are rare. However, in patients requiring frequent use (such as those with severe, poorly controlled asthma using OTC inhalers), potential long-term issues include:
Currently, there are no FDA black box warnings for Epinephrine auto-injectors. This is because the benefits of treating life-threatening anaphylaxis far outweigh the risks of the medication. However, the labeling emphasizes that Epinephrine is the only effective treatment for anaphylaxis and should not be withheld even if the patient has heart disease.
Report any unusual symptoms to your healthcare provider.
Epinephrine is a potent medication that must be handled with care. The most important safety rule is that there are no absolute contraindications to the use of Epinephrine in a life-threatening situation. Even if a patient has a heart condition or an allergy to sulfites (a common preservative in Epinephrine), the drug should still be administered if they are experiencing anaphylaxis.
No FDA black box warnings for Epinephrine. However, the FDA requires clear labeling regarding the necessity of immediate medical follow-up after use.
In a clinical or hospital setting, patients receiving Epinephrine (especially via IV infusion) require continuous monitoring of:
Following the administration of Epinephrine, patients often experience tremors, anxiety, and blurred vision. You should not drive or operate heavy machinery until these symptoms have completely resolved and you have been cleared by a healthcare professional. The underlying allergic reaction itself may also cause fatigue or cognitive clouding.
Alcohol can potentiate the cardiovascular effects of Epinephrine, potentially leading to greater increases in heart rate or blood pressure. Additionally, alcohol can mask the symptoms of an allergic reaction or an adverse drug effect. It is strongly advised to avoid alcohol consumption immediately following an Epinephrine injection.
Epinephrine is not a daily medication and does not require tapering. There is no risk of a 'withdrawal syndrome' from a single emergency dose. However, if a patient has been on a continuous Epinephrine infusion in an ICU setting, the dose is gradually 'weaned' to allow the body's own blood pressure regulation to take back over.
> Important: Discuss all your medical conditions with your healthcare provider before starting Epinephrine.
While Epinephrine is used in emergencies regardless of other medications, certain drugs can create dangerous interactions. In a controlled setting, these combinations are avoided:
There are no significant food interactions that prevent the use of Epinephrine in an emergency. However, caffeine (found in coffee, tea, and energy drinks) is a stimulant that can worsen the tremors and fast heart rate caused by Epinephrine.
Epinephrine can temporarily alter certain laboratory results:
For each major interaction, the mechanism involves either the competition for receptors or the inhibition of metabolic pathways. Management usually involves dose reduction of the interacting drug or intensive hemodynamic monitoring.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.
In the context of life-threatening anaphylaxis, there are no absolute contraindications. The risk of death from the allergic reaction is far greater than any risk posed by the medication. However, in non-emergency elective procedures (such as adding Epinephrine to a local anesthetic), the following are absolute contraindications:
These are conditions where the healthcare provider must carefully weigh the risks versus the benefits:
There is a known cross-sensitivity issue regarding Sulfites. Many Epinephrine injections contain sodium bisulfite or potassium metabisulfite as a preservative. Patients with a known 'sulfite allergy' (common in some asthmatics) may react to the preservative. However, the American Academy of Allergy, Asthma & Immunology (AAAAI) states that the presence of sulfites should not prevent the use of Epinephrine for anaphylaxis, as it is the only life-saving treatment available.
> Important: Your healthcare provider will evaluate your complete medical history before prescribing Epinephrine.
Epinephrine is classified as FDA Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Epinephrine has been shown to have teratogenic (birth defect-causing) effects in some animal studies when given at doses much higher than the human therapeutic dose. However, in the case of maternal anaphylaxis, Epinephrine is the treatment of choice. Maternal anaphylaxis causes significant hypoxia (low oxygen) and hypotension, which pose a much greater threat to the fetus than the medication itself. Healthcare providers typically prioritize stabilizing the mother to ensure fetal survival.
It is not known whether Epinephrine is excreted in human milk. However, because Epinephrine has extremely poor oral bioavailability, any drug that the infant might ingest through breast milk would likely be broken down in the infant's digestive tract and not absorbed. Breastfeeding is generally considered safe after the mother has stabilized following an emergency dose of Epinephrine.
Epinephrine is safe and effective for use in children for the treatment of anaphylaxis. The most critical factor is ensuring the correct dose based on weight (0.15 mg vs. 0.3 mg). There is no minimum age for Epinephrine use in a life-threatening emergency. However, children are more prone to accidental 'thumb' injections if the device is handled incorrectly, so caregiver education is vital. Long-term, repeated use of Epinephrine in children has not been extensively studied regarding its effect on growth and development.
Patients aged 65 and older are at a significantly higher risk of adverse effects from Epinephrine. This population is more likely to have underlying coronary artery disease, hypertension, or cardiac arrhythmias. A sudden surge in adrenaline can trigger a heart attack or stroke in vulnerable seniors. Despite these risks, Epinephrine remains the treatment of choice for anaphylaxis in the elderly, though providers may monitor them more intensely in a hospital setting following administration.
No specific dosage adjustments are recommended for patients with kidney disease. However, these patients may be more sensitive to the hypertensive effects of the drug. Monitoring of blood pressure is recommended during and after administration.
In patients with severe liver disease (Child-Pugh Class C), the metabolism of Epinephrine by COMT and MAO may be slightly slower. This could theoretically lead to a longer duration of side effects. No formal dose adjustment protocols exist, but clinical monitoring is advised.
> Important: Special populations require individualized medical assessment.
Epinephrine is a potent agonist at both alpha- and beta-adrenergic receptors. Its action is mediated through the activation of G-protein coupled receptors.
The onset of action for IM Epinephrine is approximately 3 to 5 minutes, while IV administration results in an immediate effect. The duration of action is short, typically 1 to 4 hours, though the primary cardiovascular surge subsides within 20 minutes. Tolerance (tachyphylaxis) is not typically an issue with emergency use but can occur with chronic inhalation.
| Parameter | Value |
|---|---|
| Bioavailability | 100% (IV); Rapid/Complete (IM) |
| Protein Binding | ~50% |
| Half-life | 2 - 3 minutes |
| Tmax | 5 - 10 minutes (IM) |
| Metabolism | Enzymatic (COMT and MAO) |
| Excretion | Renal (95% as metabolites) |
Epinephrine is the prototypical catecholamine and sympathomimetic agent. Related medications include Norepinephrine (Levophed), which has more alpha-activity, and Isoproterenol, which has pure beta-activity. Epinephrine is unique in its balanced, potent stimulation of all adrenergic receptor subtypes.
Common questions about The Solution
Epinephrine is primarily used as a life-saving emergency treatment for severe allergic reactions, known as anaphylaxis. It is also a critical component of advanced cardiac life support (ACLS) for treating cardiac arrest by stimulating the heart. Additionally, it can be used to treat severe croup in children and to manage acute bronchospasms in asthma. In surgical settings, it is often combined with local anesthetics to prolong their numbing effect and reduce bleeding. It works by opening the airways, increasing blood pressure, and reducing swelling.
The most common side effects of Epinephrine are directly related to its role as the 'fight or flight' hormone. Patients frequently experience a rapid or pounding heartbeat (palpitations), tremors or shaking (especially in the hands), and a feeling of intense anxiety or nervousness. Other common symptoms include sweating, dizziness, headache, and pale skin. These effects usually begin within minutes of the injection and typically fade within an hour as the medication is naturally broken down by the body. While uncomfortable, these side effects are generally not dangerous in healthy individuals.
It is strongly advised to avoid alcohol consumption immediately after receiving an Epinephrine injection. Alcohol can interact with Epinephrine by potentially worsening the cardiovascular side effects, such as a dangerously high heart rate or increased blood pressure. Furthermore, alcohol can impair your judgment and may mask the symptoms of a recurring allergic reaction (biphasic reaction). Since Epinephrine is used in emergency situations, your body needs to be fully alert to monitor for any returning symptoms of anaphylaxis. Always consult with a healthcare professional before resuming alcohol use after an emergency.
Epinephrine is used during pregnancy if the benefits to the mother outweigh the potential risks to the fetus, which is almost always the case in a life-threatening emergency like anaphylaxis. While it is classified as Pregnancy Category C, the primary danger to a fetus during an allergic reaction is the mother's low blood pressure and lack of oxygen. By treating the mother with Epinephrine, healthcare providers ensure that the fetus continues to receive adequate blood flow. There are no known long-term birth defects associated with a single emergency dose of Epinephrine. Pregnant women should always seek immediate medical care after using an auto-injector.
Epinephrine works very rapidly, which is why it is the preferred treatment for emergencies. When injected into the muscle (IM), the medication usually begins to take effect within 3 to 5 minutes, with peak concentrations reached shortly thereafter. If given intravenously (IV) in a hospital setting, the effects are almost instantaneous. Patients will typically feel their heart rate increase and their breathing become easier very quickly. Because the drug wears off quickly (within 20-30 minutes), it is essential to seek emergency medical help immediately, as symptoms may return.
Since Epinephrine is an emergency medication used on an 'as-needed' basis rather than a daily maintenance drug, there is no need to 'stop' taking it or worry about withdrawal. You do not need to taper the dose after a single emergency injection. However, you should never 'stop' carrying your Epinephrine auto-injector if you have been prescribed one for a known allergy. Keeping the device with you at all times is essential for safety. If you have been treated with an Epinephrine infusion in a hospital, the doctors will gradually reduce the dose under close supervision.
Epinephrine does not have a regular dosing schedule, so there is no such thing as a 'missed dose' in the traditional sense. It is only used when an emergency occurs. The most important thing is to ensure that your Epinephrine auto-injector has not expired and that you have it with you at all times. If you experience an allergic reaction and realize you do not have your medication, call emergency services (911) immediately. Do not attempt to take a double dose if you delayed your injection; simply administer the dose as soon as possible and wait for paramedics.
No, Epinephrine does not cause weight gain. In fact, Epinephrine is a catabolic hormone, meaning it helps the body break down fats (lipolysis) and sugars (glycogenolysis) for quick energy. Because it is used only in acute, emergency situations, it has no long-term effect on a person's weight or metabolism. If you are experiencing unexplained weight gain, it is likely due to another cause, and you should discuss this with your healthcare provider. Epinephrine is not used for weight management and should never be taken for any purpose other than its approved emergency indications.
Epinephrine can interact with several other medications, so it is vital that your doctor knows your full medication list. Specifically, beta-blockers (like Propranolol) can cause a dangerous interaction that leads to very high blood pressure during an Epinephrine injection. Antidepressants, such as TCAs or MAOIs, can also intensify the drug's effects. However, in a life-threatening emergency, Epinephrine should still be administered regardless of what other drugs you are taking. The medical team at the hospital will manage any potential interactions once you arrive for follow-up care.
Yes, Epinephrine is available as a generic medication. While many people are familiar with the brand name EpiPen, several manufacturers produce generic versions of the auto-injector that work in the exact same way and contain the same dose of medication. Generic versions are typically more affordable and are required by the FDA to meet the same rigorous standards for safety and effectiveness as the brand-name products. When picking up your prescription, you can ask your pharmacist if a generic version is available for your specific device type.
Other drugs with the same active ingredient (Epinephrine)