Epinephrine hydrochloride-Vial (Adrenaline hydrochloride-Vial)

Composition Pharmacodynamics Indications Carefully Contraindications Dosing and Administration Side effects Form release / dosage
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Active substanceEpinephrineEpinephrine
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    solution for injections 
    VIAL, LLC     Russia
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    solution w / m 
    Meda AB     Sweden
    • Dosage form: & nbspinjection
    Composition:

    Active substance: epinephrine hydrochloride (epinephrine hydrochloride) in terms of epinephrine (adrenaline) 1 mg.

    Excipients: sodium disulfite (sodium metabisulphite), sodium chloride, edetic acid (EDTA), hydrochloric acid, water for injection.

    Description:

    Transparent colorless or slightly yellowish liquid. Easily changes under the influence of light and air.

    Pharmacotherapeutic group:Alpha- and beta-adrenomimetic
    ATX: & nbsp

    C.01.C.A.24   Epinephrine

    Pharmacodynamics:

    Alpha- and beta-adrenostimulating agent. The effect is due to the activation of adenylate cyclase on the inner surface of the cell membrane, an increase in the intracellular concentration of cyclic adenosine monophosphate (cAMP) and calcium ions.

    In very low doses, with an administration rate of less than 0.01 μg / kg / min, it can lower blood pressure (BP) due to an expansion of the vessels of the skeletal muscle.At a rate of administration of 0.04-0.1 μg / kg / min, increases the frequency and strength of heartbeats, the shock volume of blood and the minute volume of blood, reduces the overall peripheral vascular resistance (OPSS); above 0.02 mcg / kg / min narrows the vessels, increases blood pressure (mainly systolic) and OPSS. The pressor effect can cause a short-term reflex slowing of the heart rate.

    Relaxes the smooth muscles of the bronchi. Doses above 0.3 mcg / kg / min, reduce renal blood flow, blood supply to the internal organs, tone and motility of the gastrointestinal tract (GIT).

    It dilates the pupils, helps reduce the production of intraocular fluid and intraocular pressure. It causes hyperglycemia (increases glycogenolysis and gluconeogenesis) and increases the content of free fatty acids in the plasma.

    Increases the conductivity, excitability and automatism of the myocardium, increases the need for myocardium in oxygen.

    Inhibits the antigen-induced release of histamine and the slowly reacting substance of anaphylaxis, eliminates spasm of bronchioles, prevents the development of edema of their mucosa. Acting on alpha-adrenergic receptors located in the skin, mucous membranes and internal organs,causes vasoconstriction, a decrease in the rate of absorption of local anesthetics, prolongs the duration and reduces the toxic effect of local anesthesia.

    Stimulation of beta2-adrenergic receptors is accompanied by increased excretion of K + from the cell and can lead to hypokalemia.

    With intracavernous injection reduces blood filling of cavernous bodies. The therapeutic effect develops almost instantaneously with intravenous administration (duration of action is 1-2 minutes), 5-10 minutes after SC administration (maximum effect after 20 minutes), with IM injection, the time of onset of the effect is variable.

    Pharmacokinetics:

    When intramuscular or subcutaneous injection is well absorbed. Also absorbed in endotracheal and conjunctival administration. The time to reach the maximum concentration in the plas (TCmah) with subcutaneous and intramuscular injection - 3-10 minutes. Penetrates through the placenta, into breast milk, does not penetrate the blood-brain barrier.

    Metabolized mainly monoamine oxidase and catechol-O-methyltransferase in the endings of sympathetic nerves and other tissues, as well as in the liver with the formation of inactive metabolites.Half-life with intravenous administration - 1-2 minutes.

    It is excreted by the kidneys in the basic form of metabolites: vanillmindalic acid, sulfates, glucuronides; as well as in a small amount - unchanged.

    Indications:Allergic reactions of immediate type (including urticaria, angioedema, anaphylactic shock), bronchial asthma (astigmatic arrest), bronchospasm during anesthesia; the need to lengthen the action of local anesthetics
    Contraindications:

    Hypersensitivity, hypertrophic obstructive cardiomyopathy, pheochromocytoma, arterial hypertension, tachyarrhythmia, ischemic heart disease, ventricular fibrillation, pregnancy, lactation.

    Carefully:Metabolic acidosis, hypercapnia, hypoxia, atrial fibrillation, ventricular arrhythmia, pulmonary hypertension, hypovolemia, myocardial infarction, shock of non-allergic genesis (including cardiogenic, traumatic, hemorrhagic), thyrotoxicosis, occlusive vascular diseases (including in anamnesis - arterial embolism, atherosclerosis, Buerger's disease, cold trauma, diabetic endarteritis, Raynaud's disease), cerebral atherosclerosis,closed-angle glaucoma, diabetes mellitus, Parkinson's disease, seizure syndrome, prostatic hypertrophy; simultaneous use of inhalation for general anesthesia (fluorotan, cyclopropane, chloroform), advanced age, children's age.
    Dosing and Administration:

    Subcutaneously, intramuscularly, sometimes intravenously drip.

    Anaphylactic shock: intravenously slowly 0.1-0.25 mg diluted in 10 ml with 0.9% sodium chloride solution, if necessary continue intravenous drip injection at a concentration of 1: 10,000. If the patient's condition allows, intramuscular or subcutaneous administration of 0.3-0.5 mg in diluted or undiluted form is preferable, if necessary, repeated administration - 10-20 minutes up to 3 times.

    Bronchial asthma: subcutaneously 0.3-0.5 mg in diluted or undiluted form, if necessary repeat doses can be administered every 20 minutes up to 3 times, or intravenously by 0.1-0.25 mg in a diluted concentration of !: 10000 species.

    To lengthen the action of local anesthetics: in a concentration of 0.005 mg / ml (the dose depends on the type of anesthetic used), for spinal anesthesia - 0.2-0.4 mg.

    Children with anaphylactic shock: subcutaneously or intramuscularly - 10 μg / kg (maximum - 0.3 mg), if necessary, the administration of these doses is repeated every 15 minutes (up to 3 times).

    Children with bronchospasm: subcutaneously 0.01 mg / kg (maximum - 0.3 mg), doses are repeated every 15 minutes to 3-4 times or every 4 hours.

    When intravenous drip introduction should use infuzomat for the purpose of precise regulation of the rate of administration. Infusion should be carried out in a large (better in the central) vein

    Side effects:

    From the side of the cardiovascular system: less often - angina, bradycardia or tachycardia, palpitation, increase or decrease in blood pressure, arrhythmia, chest pain; at high doses - ventricular arrhythmias.

    From the nervous system: headache, tremor; dizziness, anxiety, general fatigue, psychomotor agitation, disorientation, memory disorders, increased irritability, anger, sleep disturbance, muscle twitching.

    From the digestive system: nausea, vomiting.

    From the side of the urinary system: difficulty and painful urination (with prostatic hyperplasia).

    Local Reactions: pain or burning at the injection site.

    Allergic reactions: angioedema, bronchospasm, skin rash, erythema multiforme.

    Other: hypokalemia, increased sweating.

    Overdose:Symptoms: excessive increase in blood pressure, tachycardia, followed by bradycardia, rhythm disturbances (including atrial and ventricular fibrillation), coldness and pallor of the skin, vomiting, headache, metabolic acidosis, myocardial infarction, craniocerebral hemorrhage (especially in elderly patients ), pulmonary edema, death.
    Treatment: stop the introduction, symptomatic therapy
    Interaction:

    Antagonists of epinephrine are blockers of alpha and beta-adrenergic receptors. Weakens the effects of narcotic analgesics and hypnotics.

    When used concomitantly with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, agents for inhalation anesthesia (chloroform, enflurane, halothane, isoflurane, methoxyflurane), the risk of arrhythmias increases with cocaine (together it should be used very carefully or not at all); with other sympathomimetic drugs - increased severity of side effects withthe side of the cardiovascular system; with antihypertensive drugs (including with diuretics) - a decrease in their effectiveness.

    Simultaneous administration with MAO inhibitors (including furazolidone, procarbazine, selegiline) can cause a sudden and pronounced increase in blood pressure, hyperpyretic crisis, headache, cardiac arrhythmias, vomiting; with nitrates - weakening of their therapeutic effect; with phenoxybenzamine - increased hypotensive effect and tachycardia; with phenytoin - a sudden decrease in blood pressure and bradycardia (depends on the dose and rate of administration); with preparations of thyroid hormones - mutual reinforcement of action; with drugs that extend Q-T-Interval (including astemisol, cisapride, terfenadine), - lengthening Q-T-Interval; with diatrizoats, iotalamic or yoksaglovo acids - intensification of neurological effects; with alkaloids of ergot - increased vasoconstrictor effect (up to pronounced ischemia and development of gangrene).

    Reduces the effect of insulin and other hypoglycemic drugs.

    Special instructions:

    During the treatment it is recommended to determine the concentration of K + in the blood serum, the measurement of blood pressure, diuresis,minute volume of blood flow, ECG, central venous pressure, pulmonary artery pressure and wedging pressure in the pulmonary capillaries.

    Excessive doses of myocardial infarction can increase ischemia by increasing myocardial oxygen demand.

    Increases the level of glucose in the blood plasma, which is why diabetes requires higher doses of insulin and sulfonylurea derivatives.

    Epinephrine is inexpedient to apply for a long time (narrowing of peripheral vessels, leading to the possible development of necrosis or gangrene).

    Use to correct hypotension during labor is not recommended, since it can delay the second stage of labor; when administered in large doses to reduce uterine contractions, can cause a prolonged atony of the uterus with bleeding.

    At the termination of treatment of a dose it is necessary to reduce gradually, since sudden withdrawal of therapy can lead to severe hypotension.

    Easily destroyed by alkalis and oxidizing agents
    Form release / dosage:Solution for injection 1 mg / ml.
    Packaging:

    1 ml per ampoule of neutral light-protective glass. 5 ampoules per contour cell pack. One contour pack with instructions for use in a cardboard box.

    Storage conditions:

    List B. In the dark place at a temperature of 15 to 25 ° C. Keep out of the reach of children.

    Shelf life:

    3 years.

    Do not use after the expiration date printed on the package.

    Terms of leave from pharmacies:On prescription
    Registration number:LSR-000780/08
    Date of registration:15.02.2008
    Expiration Date:Unlimited
    The owner of the registration certificate:VIAL, LLC VIAL, LLC Russia
    Manufacturer: & nbsp
    Representation: & nbspVIAL, LLCVIAL, LLC
    Information update date: & nbsp04.02.2017
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