epinephrine (Adrenalin)
Epinephrine (Adrenalin) is a medication typically used in the hospital to treat severe allergic reactions (anaphylaxis) and severely low blood pressure from septic shock. It's given as an injection into the veins, into the muscle, or under the skin by a healthcare provider, depending on why you need epinephrine (Adrenalin). Side effects include high heart rate, high blood pressure, and headache.
What is Epinephrine (Adrenalin)?
What is Epinephrine (Adrenalin) used for?
- Severe allergic reactions
- Low blood pressure from serious infections (called septic shock)
How Epinephrine (Adrenalin) works
Epinephrine (Adrenalin) acts on both alpha and beta-adrenergic receptors. These receptors are located throughout the body and have various functions. When epinephrine (Adrenalin) attaches to these receptors, it keeps your blood pressure from dropping too low, raises your heart rate, and opens your lungs so you can breathe normally.
Drug facts
Side effects of Epinephrine (Adrenalin)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Anxiety
- Restlessness
- Tremor
- Weakness
- Dizziness
- Sweating
- Pounding heart
- Nausea/vomiting
- Headache
- Looking pale
Please note: The side effects listed were reported in cases where people received epinephrine (Adrenalin) injections into the muscle or under the skin.
Less Common Side Effects
- High heart rate
- Irregular heart rhythm
- High blood pressure
- Chest pain
- Kidney problems
- Breathing problems
Epinephrine (Adrenalin) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- High blood pressure: headache, chest pain, dizziness, blurry vision
- Irregular heart rhythm (arrhythmias): fatigue, weakness, dizziness, shortness of breath, chest pain, sweating
- Skin problems: pain, warmth, swelling, tenderness, redness at injection site
- Too much fluid in the lungs: shortness of breath, wheezing, quick, shallow breaths
- Kidney problems: low urine output, muscle cramps, swelling in arms/legs
- Serious allergic reaction: hives, rash, blisters, skin reddening, swelling of the lips or tongue, difficulty breathing
The following Epinephrine (Adrenalin) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Incidence not known
Abnormal or decreased touch sensation
arm, back, or jaw pain
bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
blurred vision
chest pain, tightness, heaviness, or discomfort
cold, pale, or bluish color of the skin of the fingers or toes
confusion
difficulty in speaking
dizziness
double vision
fainting
fast, slow, irregular, pounding, or racing heartbeat or pulse
headache
inability to move the arms, legs, or facial muscles
inability to speak
numbness, tingling, or pain in the fingers
paleness of the skin
pounding in the ears
restlessness
shakiness in the legs, arms, hands, or feet
slow speech
sweating
trembling or shaking of the hands or feet
trouble breathing
unusual tiredness or weakness
vomiting
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Agitation
coldness of the skin
confusion
decreased awareness or responsiveness
decreased urine output
drowsiness
hostility
irritability
lightheadedness
loss of consciousness
muscle twitching
rapid weight gain
rapid, deep breathing
seizures
severe sleepiness
stomach cramps
swelling of the face, ankles, or hands
unusual drowsiness, dullness, or feeling of sluggishness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Epinephrine (Adrenalin)
Pros
- Starts to work quickly
- Works well to raise blood pressure and heart rate
- Can be used in people of all ages
Cons
- Can cause irregular heart rhythms (arrhythmia)
- Can cause skin tissue damage if not properly administered
Pharmacist tips for Epinephrine (Adrenalin)
- Your provider will routinely monitor you for side effects and your vital signs while receiving a epinephrine (Adrenalin) IV infusion.
- Your provider or nurse will regularly check the epinephrine (Adrenalin) infusion site and surrounding skin to make sure there are no signs or symptoms of skin necrosis or infection. Let your provider or nurse know right away if you notice pain, swelling, or changes to your skin around the injection site
- People with certain medical conditions (e.g., diabetes, kidney problems, pheochromocytoma, hyperthyroidism) should receive epinephrine (Adrenalin) with caution. Make sure your provider knows about all of your medical conditions.
- Epinephrine (Adrenalin) interacts with many different medications. Make sure your provider knows about all of the medications you're taking at home. It's best to bring a complete list of your medications with you to the hospital so nothing is missed.
Common questions about Epinephrine (Adrenalin)
Yes, epinephrine (also called the hormone adrenaline) is a hormone that's normally made in your adrenal glands. The overall purpose of epinephrine is to prepare your body for the "fight-or-flight" response to stress. It does this by raising your heart rate and blood pressure and opening your airways to make it easier to breathe. Epinephrine (Adrenalin) is a synthetic (man-made) version of natural epinephrine that has these same actions in your body.
No, epinephrine isn't a steroid; it's a hormone. The body's release of epinephrine in stressful situations can cause your body to release cortisol, a steroid hormone.
Yes, epinephrine (Adrenalin) can raise low blood pressure or heart rate. Your provider will hook you up to a monitor (called a telemetry monitor) to measure your heart rate and blood pressure while you receive epinephrine (Adrenalin). Your provider will adjust your dose of epinephrine (Adrenalin) on your readings.
When given IV, epinephrine (Adrenalin) starts to work within 5 minutes and lasts for about 20 minutes.
Epinephrine is a natural hormone made in your body, so it's not possible to be allergic to it. But, it's possible to be allergic to the inactive ingredients that are in epinephrine (Adrenalin). For example, if you have a sulfite allergy, epinephrine (Adrenalin) might not be the best choice because epinephrine (Adrenalin) contains a sulfite preservative.
One of the main difference between epinephrine (Adrenalin) and epinephrine (EpiPen) is in which setting they're used. Adrenalin is typically only used in a hospital or clinic setting, and it comes in vials that your provider first need to draw up. Epipen doesn't have to be used in a hospital or clinic, and it comes as a easy-to-use auto-injector. Another difference is what condition they treat. Adrenalin can be given for anaphylaxis or low blood pressure, whereas an EpiPen can only be given for anaphylaxis. A third difference is how they're given. epinephrine (Adrenalin) can be given as an injection into the veins, into the muscle, or under the skin, whereas an EpiPen can only be given as an injection into the muscle.
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Risks and warnings for Epinephrine (Adrenalin)
Epinephrine (Adrenalin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
High blood pressure and heart rate
- Risk factors: Receiving epinephrine (Adrenalin) through the veins | Too high of a epinephrine (Adrenalin) dose | History of heart problems | Taking medications that affect heart rate or blood pressure
Epinephrine (Adrenalin) raises blood pressure and heart rate. Your provider will closely monitor your vital signs closely while you receive epinephrine (Adrenalin) and will adjust the dose as needed. Let your provider know if you experience any trouble breathing, chest pain, dizziness, changes in vision, or headache. These could be signs that your blood pressure or heart rate is too high and your epinephrine (Adrenalin) dose needs to be lowered.
Tissue damage (infusion only)
Though rare, it's possible for epinephrine (Adrenalin) IV infusion to leak into the tissue surrounding the injection site if the needle isn't placed properly. This can lead to skin damage (skin necrosis). If this happens, your provider might need to switch infusion sites to give the tissues a chance to recover and avoid further damage. Sometimes, you might need to receive an antidote medication called phenotolamine. Your provider or nurse will regularly check the infusion site to make sure there aren't signs or symptoms of skin necrosis. Tell your care team right away if you feel pain, warmth, swelling, tenderness or notice redness around the epinephrine (Adrenalin) injection site.
Too much fluid in the lungs (infusion only)
Epinephrine (Adrenalin) IV infusion can cause fluid to build up in the lungs, which can cause trouble breathing, wheezing, or discomfort when breathing. Let your provider know if you experience any changes in your breathing while receiving epinephrine (Adrenalin). You might need to receive phenotolamine to reverse the effects of epinephrine (Adrenalin) and possible breathing support.
Kidney problems (infusion only)
Epinephrine (Adrenalin) can slow down blood flow to the kidneys. This can worsen kidney health and cause damage, which can cause you to not produce urine as well. Your provider will monitor your kidney health while receiving epinephrine (Adrenalin) and adjust the dose or stop the medication if it's hurting your kidneys.
Risk of serious infection at injection site
Though rare, there have been few reported cases of people experiencing infections at the injection site after receiving epinephrine (Adrenalin) for anaphylaxis. Let your healthcare team know right away if you notice redness, warmth, swelling, or tenderness at the site where you've received the injection.
Contains sulfites
- Risk factors: Allergy to sulfites
Epinephrine (Adrenalin) contains a sulfite preservative. Depending on your reaction to sulfa, you might need to avoid receiving epinephrine (Adrenalin). If you notice hives, rash, red skin, swelling of the lips or tongue, or difficulty breathing after using epinephrine (Adrenalin), get medical attention right away.
Epinephrine (Adrenalin) dosage
Interactions between Epinephrine (Adrenalin) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Dihydroergotamine
- Isocarboxazid
- Linezolid
- Phenelzine
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amineptine
- Amitriptyline
- Amitriptylinoxide
- Amoxapine
- Benperidol
- Bromperidol
- Bucindolol
- Carteolol
- Carvedilol
- Clomipramine
- Desipramine
- Dibenzepin
- Digoxin
- Dilevalol
- Dixyrazine
- Doxepin
- Droperidol
- Entacapone
- Ergonovine
- Fexofenadine
- Fluphenazine
- Furazolidone
- Haloperidol
- Halothane
- Imipramine
- Iobenguane I 123
- Iproniazid
- Levalbuterol
- Levobunolol
- Lofepramine
- Loxapine
- Melitracen
- Melperone
- Methdilazine
- Methotrimeprazine
- Methylene Blue
- Methylergonovine
- Metipranolol
- Metopimazine
- Nadolol
- Nialamide
- Nortriptyline
- Opicapone
- Opipramol
- Oxprenolol
- Penbutolol
- Perazine
- Periciazine
- Perphenazine
- Pindolol
- Pipamperone
- Pipotiazine
- Practolol
- Procarbazine
- Prochlorperazine
- Promazine
- Promethazine
- Propiomazine
- Propranolol
- Protriptyline
- Rasagiline
- Selegiline
- Sotalol
- Terfenadine
- Tertatolol
- Thiethylperazine
- Thioproperazine
- Thioridazine
- Tianeptine
- Timolol
- Trifluoperazine
- Triflupromazine
- Trimipramine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
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