Neonatal Drug Therapy Manual

EPINEPHrine

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Adrenalin
Classification: 
Sympathomimetic
Original Date: 
March 1993
Revised Date: 
April 2022
Indications: 
  • Cardiopulmonary resuscitation
  • Hypotension/Shock, Inotropic support
Administration: 

Cardiopulmonary resuscitation:

  • ETT: In emergency situations, when IV access is unavailable.
    • Draw up dose in a 3 or 5 mL syringe and label "for ETT".  Administer rapidly.  Do not follow with a flush.
  • IV direct: Preferred route.
    • Draw up dose in a 1 mL syringe and label "for IV/UVC".  Administer rapidly over 1 minute.  Follow with up to 3 mL 0.9% NaCl flush.

Hypotension/Shock, Inotropic support:

  • IV continuous infusion
Dosage: 
  • Cardiopulmonary Resuscitation
    • ETT: 0.1 mg/kg (1 mL/kg of a 1: 10 000 (0.1 mg/mL) solution). 
    • IV/UVC: 0.02* mg/kg (0.2 mL/kg of a 1: 10 000 (0.1 mg/mL) solution) every 3 to 5 minutes PRN. 

* the dosage range is 0.01-0.03 mg/kg (0.1-0.3 mL/kg), however 0.02 mg/kg is the recommended initial dose

  • Hypotension/Shock, Inotropic support
    • IV continuous infusion: 0.05 mcg/kg/min, titrate to a maximum dose of 1 mcg/kg/min
Side Effects: 
  • CVS: cardiac arrhythmia, hypertension, tachycardia, vasoconstriction
  • Local: IV infiltration may cause tissue ischemia and necrosis
Parameters to Monitor: 
  • HR
  • BP
  • ECG
  • Site of injection
Reconstitution and Stability: 

For Hypotension/Shock, Inotropic support

  • EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
    • Take 1.2 mL (0.12 mg) and add to 18.8 mL D5W
    • Final concentration: 6 mcg/mL
  • EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
    • Take 5 mL (0.5 mg) and add to 15 mL D5W
    • Final concentration: 25 mcg/mL
  • EPINEPHrine 0.1 mg/mL (1:10 000) (prefilled syringe)
    • Take 10 mL (1 mg) and add to 10 mL D5W
    • Final concentration: 50 mcg/mL (only with central line)
Compatibility: 

- Solutions Compatible: D5W, D10W, 0.9% NaCl, dextrose-saline combinations

- Y-site Compatible: dobutamine, dopamine, hydrocortisone, midazolam, morphine, potassium chloride (up to 40 mmol/L), SMOF, TPN

Incompatible: sodium bicarbonate

Notes: 
  • Do not use if solution is brown or a precipitate is present
References: 

- Taketomo CK, Hodding JH, Kraus DM.  Pediatric Dosage Handbook 19th Edition. Hudson: Lexi-Comp Inc; 2012

-Trissel LA. Handbook on Injectable Drugs. 16th Editions. Bethesda: American Society of health-System Pharmacists 2011

- Canadian Pediatric Society- updated NRP Guidelines 2022

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