Epinephrine ( , Adrenalin or the Adrenaline ), or another name that episode norepinephrine / norepinephrine and / Impact Pictures norepinephrine / epinephrine ( epinephrine ) is a hormone and neurotransmitter synthesis of. Nor-Epinephrine (Norepinephrine), a hormone and neurotransmitter working in the autonomic nervous system. And normally the body releases adrenaline from the adrenal gland.
Scientists have synthesized adrenaline and produced it as a life-saving drug, for example, it can be used as a resuscitation in patients with cardiac arrest, severe allergic reactions, severe asthma, and in combination with anesthetic to Performing various medical procedures, etc.
Example of an epinephrine drug
Epinephrine (generic name) has trade names such as Adrenaline atlantic, Adrenaline GPO, Chalocaine with Adrenaline, EpiPen, Lidok. Lidocation, Scandonest, Septanest 4% SP Injection (Septanest 4% SP Injection), Xylocaine, etc.
Epinephrine dosage form
Epinephrine is another drug listed on the national list of major drugs in Thailand. By stating it as a drug to treat heart failure It is also used as an anesthetic ingredient and for dental procedures. There are forms of epinephrine, injectable, inhaler and eye drop, but for those used in Thailand, we often see epinephrine in injectable form. It is used in both public and private medical facilities. For injectable drugs are as follows
- 1 mg / ml (1: 1,000) injectable in 1 ml ampoules.
- Injectable drugs containing 0.3 and 0.15 milligrams.
- Injectable drugs combined with lidocaine anesthesia include Lidocaine HCl 10 mg / mL + Adrenaline 1: 200,000 (5 mcg / mL) and Lidocaine HCl 20 mg / mL + Adrenaline 1: 200,000 (5 mcg / mL).
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Properties of the drug adrenaline
- It is used as a resuscitation drug in the event of an emergency cardiac arrest [2], [3].
- Used to treat heart failure (Asystole) [3].
- It is used to treat ventricular fibrillation (ventricular fibrillation) [3].
- It is used to treat ventricular tachycardia (ventricular tachycardia) [3].
- Used to treat allergic reactions (Allergic reactions) [3].
- It is used to treat severe hives or giant hives (Angioedema) [1].
- Used to treat asthma during severe symptoms [2], [3]
- Used to treat severe allergic reactions (Anaphylactic shock or Anaphylaxis) [1], [2], [3]
- Used to treat anaphylactoid reactions (Anaphylactoid reaction) [1]
- It is used to treat narrowing of the airways caused by inflammation of the larynx and trachea (Croup) [2].
- Used to treat dilated pupils (Pupillary dilation) [3]
- It is used to treat ocular hypertension such as glaucoma, people with very myopia, diabetes, the elderly [2].
- It is used to treat open-angle glaucoma [2].
- Used to treat low blood pressure (Hypotension) [3]
- Used to treat shock (Shock) [3]
- Used to treat abnormal bradycardia (Bradyarrhythmia) [3]
- It is used in combination with anesthetics such as Lidocaine to perform medical procedures [2].
- It is used to stop bleeding from a capillary, such as gauze moistened with this medication to stop the nosebleed [1].
Mechanism of action of epinephrine drugs
Epinephrine is a drug in the sympathomimetics. (Sympathomimetic) mechanisms of action on alpha and beta adrenergic receptors, which are receptors involved in the autonomic nervous system. This results in loosening of the smooth muscle of the bronchi. Stimulate the work of the heart Including loosening the blood vessels in the muscles By this mechanism, a therapeutic effect is produced [2].
As for the use of adrenaline in a mixed form with anesthetic. Will reduce the absorption of the anesthetic from the organ where the anesthetic is used This makes the anesthetic last longer and more effective [2].
Before using adrenaline medication
When all drugs, including adrenaline drugs are used. Here are some things to tell your doctor or pharmacist:
- History of allergy to adrenaline and all other drugs, including symptoms of an allergic reaction such as increased nausea, rash or tightness, trouble breathing / breathing problems, etc.
- Various medical conditions and prescription or self-administered drugs Including dietary supplements, vitamins, and various herbal drugs that are currently or are currently being used. Because adrenaline medication may exacerbate their symptoms Or drug interactions with other drugs and / or other pre-ingested supplements such as
-
- The combination of epinephrine and antihypertensive drugs such as guanethidine, methyldopa may cause high blood pressure. The combination of these drugs must always monitor blood pressure to be normal. Or, the doctor may adjust the dosage that is appropriate for the patient on a case-by-case basis [2].
- Taking adrenaline with blood sugar lowering drugs or diabetes medications such as alogliptin, metformin, may impair the effectiveness of blood sugar lowering drugs. If necessary to use together The doctor will adjust the appropriate dosage for the patient on a case-by-case basis [2].
- The combination of epinephrine and tricyclic and tetracyclic antidepressants (TCAs) may induce hypertension and arrhythmia. Therefore, these drugs should be avoided together. Or, the doctor may adjust the dosage that is appropriate for the patient on a case-by-case basis [2].
- Epinephrine and diuretics and digitalis, which are used to treat heart failure and arrhythmia This can lead to arrhythmia [1].
- If it’s a lady Should report that you are pregnant or breastfeeding This is because many drugs can pass through the placenta or milk and enter the baby, potentially causing adverse effects on the baby.
Contraindications / precautions for use of epinephrine drugs
- Do not use this drug on people with a history of allergic reaction to epinephrine [2].
- Do not use this drug on people with high blood pressure. And people with arrhythmia or tachycardia [2]
- Do not use this medicine to treat glaucoma Angle-closure glaucoma [2]
- Do not use this medication with anesthetic and spray it into the fingers, toes, ears, nose, and genitals .
- Do not use drugs that have expired or are worn out.
- Caution should be exercised in combination with diuretics and digitalis (Digitalis) as it can lead to arrhythmias. [1]
- Caution should be exercised in patients with coronary heart disease or ischemic heart disease. Patients with high blood pressure Diabetics Parkinson’s disease patients And patients with hyperthyroidism (Toxic thyroid gland) because this drug will cause high pressure. Heart pounding fast and irregularly Which can be dangerous [1], [2]
- Be careful when using this drug in pregnant women. Lactating women And the elderly And dosing in this group of patients must be directed by a doctor only .
How to use epinephrine medication
- For the treatment of cardiac emergencies (Cardiac arrest), cardiac completely (Asystole), atrial ventricular beats faint shiver (Ventricular fibrillation) and Cy ventricular tachycardia disorder (Ventricular tachycardia) in adults for injection. The parenteral dose was 0.5-1 mg (5-10 ml) and was repeated at a dose of 0.5 mg (5 ml) every 5 minutes during the resuscitation. (In children, for the treatment of cardiac arrest, administer a single injection of 0.01-0.03 mg / kg of body weight) [3].
- For treating severe asthma (Asthma) In adults, slowly, one-time intravenous injection of 0.1-0.25 mg (1-2.5 mL). In infants (0-1 months), slow intravenous injection at a dose of 0.01 mg / kg body weight only once. In infants (1-12 months of age), a slow single injection of 0.05 mg intravenously. It may be repeated every 20-30 minutes as needed [3] (Currently, this drug is not recommended to treat severe asthma attacks. This is because there are other drugs that are more effective and safer [1] ).
- For treating allergic reactions ( allergic reactions) and severe allergic reactions. (Anaphylaxis) in adults weighing 30 kg or more. The 0.3 mg dose is administered intramuscularly or subcutaneously in the anterior portion of the thigh. And if necessary, repeated medication may be required (For children weighing 15 to 30 kg, the injection is 0.15 mg; children weighing more than 30 kg, the 0.3 mg injection can be administered the same way and the drug can be repeated when necessary.) [3]
- For use to treat low blood pressure (Hypotension) and shock (shock) in adults, administered intravenously at a dose of 0.05-2 μg / 1 kg / min body weight. And the dose was adjusted according to mean arterial pressure (MAP) [3].
- For treating abnormal bradycardia (Bradyarrhythmia) in adults: 2-10 mcg / min intravenous infusion. And adjust the dose according to the response of the patient [3]
Epinephrine drug storage
- Always keep medicines out of the reach of children and pets.
- The drug should be stored under the temperature of 25 ° C. Keep the drug out of light. And do not store the medication in wet or damp areas (eg in the bathroom, in the freezer of the refrigerator)
- Discard any medication that has expired or is worn out, such as the drug turns brown
Adrenaline drug side effects
This drug may cause symptoms of excitement, tremors, tremors, headache, nausea, and vomiting [1]. Other possible side effects include sweating, increased saliva, increased blood sugar, weakness, tremors. Low blood potassium salts (Causing symptoms of fatigue Muscle cramps Irregular heartbeat), blurred vision, photophobia, swelling, discomfort in the stomach and intestines, indigestion, interruption of urination, etc.
