Home Drug Guide Epinephrine Bitartrate

Drug Guide

Generic Name

Epinephrine Bitartrate

Brand Names Medihaler-epi, Bronitin Mist, Epinephrine Bitartrate In 0.9% Sodium Chloride

Classification

Therapeutic: Vasopressor, Bronchodilator

Pharmacological: Adrenergic agonist (alpha and beta adrenergic receptors)

FDA Approved Indications

  • Anaphylaxis
  • Asthma exacerbation
  • Cardiac arrest (as emergency treatment)
  • Local vasoconstriction in procedures

Mechanism of Action

Epinephrine stimulates alpha-adrenergic receptors causing vasoconstriction and reduction of mucosal edema, and beta-adrenergic receptors leading to bronchodilation, increasing cardiac output, and improving airway patency.

Dosage and Administration

Adult: Dose varies by indication: for anaphylaxis, 0.3 mg IM every 5-15 minutes as needed; inhalation doses vary per formulation.

Pediatric: 0.01 mg/kg IM (max 0.3 mg per dose) for anaphylaxis; inhalation doses based on age and weight.

Geriatric: Adjust based on clinical response; caution due to cardiovascular risks.

Renal Impairment: Use with caution; no specific dose adjustment, but monitor closely.

Hepatic Impairment: No specific dose adjustment established.

Pharmacokinetics

Absorption: Rapid absorption via injection route; inhalation delivers localized effect.

Distribution: Widely distributed; crosses the placenta.

Metabolism: Primarily hepatic via COMT and MAO enzymes.

Excretion: Renal excretion of metabolites.

Half Life: Approximately 2-3 minutes intravenously; longer when administered via inhalation or intramuscularly.

Contraindications

  • Hypersensitivity to epinephrine or adrenergic amines.
  • Use with caution in patients with cardiac disease, hypertension, or hyperthyroidism.

Precautions

  • Monitor cardiac status; use with caution in patients on certain antidepressants or MAO inhibitors.
  • Pregnancy Category C; weigh benefits vs risks.

Adverse Reactions - Common

  • Increase in blood pressure (Common)
  • Tachycardia (Common)
  • Palpitations (Common)
  • Anxiety, tremor (Common)

Adverse Reactions - Serious

  • Arrhythmias (Rare)
  • Hypertension leading to cerebrovascular accidents (Rare)
  • Pulmonary edema (Rare)

Drug-Drug Interactions

  • Tricyclic antidepressants and MAO inhibitors can increase adrenergic effects.
  • Beta-blockers can antagonize epinephrine effects.

Drug-Food Interactions

  • Avoid other vasoconstrictive agents.

Drug-Herb Interactions

  • Use caution with herbal supplements affecting blood pressure or cardiac function.

Nursing Implications

Assessment: Monitor vital signs closely, especially heart rate, blood pressure, and respiratory status.

Diagnoses:

  • Ineffective tissue perfusion related to vasoconstriction or arrhythmias.
  • Imbalanced nutrition: less than body requirements related to metabolic demands.

Implementation: Administer via appropriate route (IM, inhalation, IV) as prescribed; monitor for adverse effects.

Evaluation: Assess for improvement of respiratory symptoms, blood pressure regulation, and presence of adverse reactions.

Patient/Family Teaching

  • Instruct on proper use of inhaler or injection device.
  • Notify healthcare provider of chest pain, palpitations, or severe hypertension.
  • Carry identification indicating allergy to epinephrine if applicable.

Special Considerations

Black Box Warnings:

  • Potential for severe hypertension, myocardial ischemia, or arrhythmias.

Genetic Factors: No specific genetic considerations.

Lab Test Interference: None significant.

Overdose Management

Signs/Symptoms: Hypertension, tachycardia, palpitations, tremors, anxiety, chest pain.

Treatment: Discontinue epinephrine, provide supportive care, monitor cardiac status, treat hypertension with antihypertensives if necessary.

Storage and Handling

Storage: Store at controlled room temperature (68-77°F), protected from light and moisture.

Stability: Stable under recommended storage conditions; check expiration before use.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.