Adrenaline Pharmacology


About Adrenaline
Alpha and Beta adrenergic agonist, catecholamine, Vasoconstrictor., Anti asthma, inanaphylatic shock.
Mechanism of Action of Adrenaline
Adrenaline is an alpha and beta adrenergic agonist which exerts it`s therapeutic actions through predominant beta receptor agonistic action. It is a positive inotropic and chronotropic drug and it increases stroke volume, cardiac output and improves coronary blood flow. It increases systolic and mean blood pressure. It increases blood flow to skeletal muscles. It is a powerful bronchial smooth muscle relaxant and antagonizes spasm of bronchial muscle. It acts through alpha receptors in skin, mucous membrane, and viscera and causes vasoconstriction and which reduces absorption of local anaesthetics localizes and prolongs the duration of anaesthesia. Local vasoconstrictor action also produces haemostasis.Role in local anaesthesia: The speed of onset and duration of action of local anaesthetics may be increased by the addition of vasoconstrictors like Adrenaline which has the effect of reducing the uptake of the local anaesthetic into the circulation from the injection site. Vasoconstrictors should not be used when producing a nerve block in an appendage such as a digit, as gangrene may occur. Vasoconstrictors have been added to injections for spinal block, but their use is not recommended because of the danger of reducing the blood supply to the spinal cord.
Pharmacokinets of Adrenaline
Absorption: Well absorbed after sub cutaneous or intramuscular injection. Distribution: Widely distributed through out the body. Metabolism: Metabolized in to inactive metabolites in sympathetic nerve endings, liver and other tissues. Excretion: Excreted through urine as metabolites and conjugates.
Onset of Action for Adrenaline
I.V.: Rapid
Subcutaneous: 5 to 15minutes
Inhalation: Within 5 minutes
Duration of Action for Adrenaline
I.M.: 1 to 4 hours
I.V.: Short
Subcutaneous: 1 to 4 hours
Inhalation: 1 to 3 hours
Half Life of Adrenaline
Side Effects of Adrenaline
4.Ventricular fibrillation
6.Anginal pain
7.ECG changes
9. Tremor
Contra-indications of Adrenaline
1.Hypersensitivity to the drug,
2.Shock other than anaphylactic shock,
3.Angle closure glaucoma,
4.Anaesthesia of extreamities,
5.During labour,
6.Cardiac dilatation,
7.Coronary insufficiency,
8.Organic brain damage,
9.Cerebral arteriosclerosis,
11.Along general anaesthesia with halogenated hydrocarbons or cyclopropane.
Special Precautions while taking Adrenaline
1.Bronchial asthma
4.Cardiovascular disease
7.Parkinson`s disease(ophthalmic preparation)
Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
Use with caution
Indications for Adrenaline
3.Hypersensitivity reactions
4.Anaphylactic shock
5.To restore cardiac rhythm in cardiac arrest
7.Prolong duration of anaesthesia
8.Nasal congestion
9.Open angle glaucoma.
Interactions for Adrenaline
Beta Blockers: Concomitant administration may block beta adrenergic effects of adrenaline causing hypertension.
Cardiac glycosides: May make cardiac arrhythmias more likely.
Ergot alkaloids and phenothiazines: May reverse the pressor effects of adrenaline.
Antihistamines: Pressor effect may be potentiated.
Halogenated hydrocarbon anaesthetics: Sensitise the myocardium to the effects of catecholamines leading to serious arrhythmias.
Oxytocic drugs: May cause severe persistent hypertension.
Sympathomimetic drugs: Additive effects and increased toxicity. May induce serious cardiac arrhythmias.
Tricyclic antidepressants: Pressor response may be potentiated.
Typical Dosage for Adrenaline
Bronchospasm, Hypersensitivity reactions, Anaphylaxis:
Adults: Starts with 0.1 to 0.5mg (0.1 to 0.5ml of a 1: 1,000 solution) S.C. or I.M. Repeat as required at 10 to 15minute intervals. Alternatively 0.1 to 0.25mg (1 to 2.5ml of a 1: 10,000 solution) I.V.; slowly over 5 to 10 minutes. Repeated if required at every 5 to 15minutes or followed by 1 to 4mcg/minute I.V. infusion.
Children: 0.01mg/kg (0.01ml/kg of a 1: 1000 solution) S.C. Dose not to exceed 0.5mg. Repeated as required; at every 20 minutes to 4hour intervals. Alternatively 0.02 to 0.025 mg/kg (0.004 to0.005 mi/kg) of a 1:200 solution. Repeat if required but not to exceed than four times daily. Alternatively
To restore cardiac rhythm in cardiac arrest:
Starts with 0.5 to 1mg (5 to 10ml of 1: 10,000 solutions) diluted to 10ml and administered I.V. or intra cardiac. During resuscitation 0.5 to 1mg I.V. every 5minutes or injected through endotracheal tube. Administer 10ml containing 1ml adrenaline (0.1mg/ml) by 5 rapid insufflations directly in to the tube and followed by 5 rapid insufflations.
Adults: I.V.: 100mcg to 250mcg injected slowly.
Neonates: 0.01mg/kg
Infants: 50mcg initial dose repeated at 20 to 30 minutes intervals in asthma attacks.
Resuscitation for children and neonates: 0.iml/kg of 1: 10000solution I.V.
As a haemostatic agent:
Adults: 1: 50,000 to 1: 1000 applied topically.
To prolong local anaesthetic effect: 1:500000 to 1: 50000 mixed with local anaesthetic agent.
Intra spinal use: 0.2 to 0.4ml of 1: 2000 solutions added to anaesthetic fluid to prolong anaesthetic action.
Nasal congestion, local superficial bleeding: Instill 1 to 2 drops of solution.
Open angle glaucoma: 1 to 2 drops instill daily or twice daily.
Schedule of Adrenaline
C & C1.
Storage Requirements for Adrenaline
Store below 25 degree C and protects from light.

Effects of Missed Dosage of Adrenaline
Effects of Overdose of Adrenaline
Treatment is supportive and symptomatic. Epinephrine is rapidly inactivated in the body. Closely monitor vital signs. Treat hypotension with Phentolamine & arrhythmias with beta blockers like Propranolol.

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