Adrenalin

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 21.12.2021

Synonym(s)

Epinephrine

Definition
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Biogenic hormone of the adrenal medulla, neurotransmitter of adrenergic neurons in the CNS, catecholamine which belongs to the sympathomimetics.

Half-life
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1-3 minutes.

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Indication
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Acute bronchial asthma, anaphylactic shock. Additive to local anaesthetics (to reduce their absorption and thus toxicity and prolong their effect), haemostasis on skin and mucous membrane.

Remember! Do not use local anaesthetics containing adrenaline and tampons in the acral area. Risk of necrosis!

Limited indication
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Pregnancy, Cave! Sulphite hypersensitivity, cor pulmonale, diabetes mellitus, hypercalcemia, hypokalemia, Parkinson's disease (increased tremor), severe renal insufficiency.

Dosage and method of use
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Acute bronchial asthma: 0.2-0.5 mg s.c. or by inhalation.
Anaphylactic shock: dilute 1 ml ampoule (1:1000) with 9 ml NaCl 0.9% (1 ml = 0.1 mg), adults 1 ml of the diluted solution slowly i.v., if necessary equal dose after approx. 5 min.; children 0.1 ml of the diluted solution/10 kg bw i.v.
Local anaesthesia: Procaine 0.05 ml of solution 1:1000 per 10 ml, half of the diluted solution for lidocaine.
Hemostasis: Press the tampon onto the wound with max. 10 drops of the solution diluted 10 times (0.01%).

Undesirable effects
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Angina pectoris, cardiac arrhythmia, anaphylaxis (sulfite content of the solution), anxiety, insomnia, danger of cerebral hemorrhage due to abrupt rise in blood pressure, hyperglycemia, hypokalemia, hyperhidrosis.

Interactions
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s. Table 1.

Contraindication
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Narrow-angle glaucoma, pheochromocytoma, prostate hypertrophy, hyperthyroidism, arteriosclerosis, coronary insufficiency, heart muscle damage, absolute arrhythmia, severe hypertension, anaesthesia with inhalation narcotics (cyclopan, halothane), local anaesthesia of the acra (fingers, hands, feet, nose, chin, tongue, etc.).

Preparations
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Adrenalin 1:1000, Fastject injection solution with autoinjector, Suprarenin 1:1000; Anapen autoinjector 150 µg or 300 µg.

Tables
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Major interactions of adrenaline

Alimemazine	RR drop, adrenaline reversal
Amantadine	Reciprocal toxicity ↑, enhanced central effects.
Antidepressants, tricyclic.	Blood pressure crisis, avoid combination
Appetite inhibitors	RR rise, reciprocal toxicity ↑
Acetazolamide	Adreanlin effect ↓
Bromocriptine	reciprocal toxicity ↑
Clozapine	RR drop, reversal of effect
Diclofenamide	Adrenaline effect ↓
Dihydralazine	Angina pectoris, tachycardia, dihydralazine effect ↓
L-dopa	sympathomimetic effect ↑
Enflurane	Cardiac arrhythmias
Guanethidine	RR increase, guanethidine effect ↓
Guanfacine	Guanfacine effect ↓
Halothane	Cardiac arrhythmia, death
Cardiac glycosides	ventricular arrhythmias
Insulin	Hyperglycemia
Isoflurane	Cardiac arrhythmias
Metformin	Hyperglycemia
Metoclopramide	Avoid combination
Mianserin	sympathomimetic effect ↑
Neuroleptics	RR drop, adrenal reversal
Procarbazine	Hypertensive crisis
α -receptor blockers	RR drop, reversal of effect
β-Receptor blockers	Bradycardia, hypertension
Thyroid hormones	Coronary insufficiency
β-sympathomimetics	Reciprocal toxicity ↑