Page 121 - 2026 SMOG

EPINEPHRINE 1mg/mL (EPIPEN/EPIPEN JR)
Class/Mechanism of Action
• Alpha and Beta Agonist
Sympathomimetic stimulates both alpha- and beta-adrenergic receptors, causing relaxation of the
bronchial tree, inducing systemic vasoconstriction, and increasing heart rate and contractility.
Indications
• Labeled Indications
˚ Allergic Reactions, anaphylaxis
˚ Asthma (Bronchoconstriction)
Contraindications
• There are no absolute contraindications to the use of intranasal or injectable epinephrine in a life-
threatening situation.
• Hypersensitivity to sympathomimetic amines, glaucoma, and non-anaphylactic shock
• Not for IV use; must first dilute into a 10mL NS syringe for Cardiac/IV use.
Adverse Reactions/Precautions
• No applicable use in hemorrhagic shock unless fluid replacement therapy is maximized!
Maximize the use of blood products/crystalloids before considering their use in hemorrhagic
shock.
• Chest pain, tachycardia, arrhythmias, palpitations, and sudden death
• Anxiety, cerebral hemorrhage, headache
• Vesicant: Avoid extravasation; will cause tissue damage/necrosis
• Use with caution in patients taking tricyclic antidepressants; effects of epinephrine may be increased
• Pregnancy: Category C
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Bronchodilator Acute Severe Asthma Exacerbation
• SubQ/IM • SubQ
˚ 0.3–0.5mg q5–10min ˚ 0.01mg/kg (0.01mL/kg of 1mg/mL
• Nebulization concentration) q20min for 3 doses prn
Maximum SINGLE dose: 0.5mg
˚ Add 0.5mL to the nebulizer and dilute with Croup/Bronchiolitis
■
3mL of NS; administer over 15min
Anaphylaxis/Hypersensitivity Reaction • Nebulization
• IM ˚ 3mg (3mL of the 1mg/mL concentration)
˚ 0.3–0.5mg in mid-outer thigh q5–10min Anaphylaxis/Hypersensitivity Reaction
mixed with 3mL NS
until clinical improvement
• IV • IM
˚ Initiate with an infusion at 5–15mcg/min ˚ 0.01mg/kg (0.01mL/kg of 1mg/mL
(with crystalloid) (See infusion chart next
concentration) q10–15min prn to control
page) symptoms (max SINGLE dose: 0.3mg)
Acute Hemolytic Reaction • Autoinjector, Children <15kg
• IM ˚ 0.15mg. If anaphylactic symptoms persist,
˚ 0.5mg in lateral thigh. Repeat q5–15min for the dose may be repeated in 5–15min using
moderate bronchospasm or facial/laryngeal
an additional EpiPen Jr
edema. • Autoinjector, Children ≥15kg
˚ 0.3mg. If anaphylactic symptoms persist, the
dose may be repeated in 5–15min using an
additional EpiPen.
2026 Standard Medical Operating Guidelines (SMOG) • 113