epinephrine 1 mg/mL Injection, Solution, Concentrate, 25 vials
Other active recalls for Epinephrine (different manufacturers) — 2 · tap to view
🆔 Identity & classification
Where does this data come from?
🏷️ RxNorm drug class
This medicine belongs to the alpha-Adrenergic Agonist class.
Where does this data come from?
🏭 Manufacturer & labeler
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🩺 Clinical
- Epinephrine works fast but wears off quickly — sometimes in as little as 15 to 20 minutes. Anaphylaxis can come back (this is called a biphasic reaction), and you may need addition...
- Why do I need to go to the ER after using my EpiPen or Auvi-Q if I already feel better?
- Yes, it absolutely matters. Inject into the outer thigh — you can even go through your clothing if needed. Never inject into the buttocks (that spot carries a risk of serious infec...
- Where exactly do I inject it, and does it matter?
Patient education
Supplement & herbal interactions
Some supplements/herbs that may interact with Epinephrine — tap one for details:
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Ask a licensed pharmacist directly — free, answered by our team.
🧪 Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.
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UNII 2968PHW8QP
A weak organic acid derived from citrus fruits or made through fermentation. It works as a buffer to control pH, a preservative to extend shelf life, and a flavoring agent in medications.
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UNII 7FLD91C86K
Edetate disodium is a chemical compound that binds and removes certain metal ions. In medicines, it acts as a preservative and stabilizer by preventing metals like calcium from interfering with the product's shelf life and consistency.
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UNII QTT17582CB
A strong acid used to adjust and maintain the proper pH level in liquid medicines, ensuring stability and preventing breakdown of active ingredients.
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UNII AE28F7PNPL
Methionine is an amino acid used as a nutrient supplement and pH buffer in medicines. It helps stabilize the formulation and supports the product's overall composition.
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7.59 mg / 1 mL
UNII 451W47IQ8X
Sodium chloride is common table salt. It's used in medicines as a buffer to maintain proper pH, as a filler to add bulk, or to adjust the osmotic balance in liquid formulations.
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UNII 4VON5FNS3C
Sodium metabisulfite is a preservative derived from sulfur compounds. It prevents microbial growth and oxidation in medicines, helping extend shelf life and maintain product stability.
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UNII B22547B95K
A salt derived from citric acid that helps maintain the proper acid-base balance in the medicine. It's used as a buffer to keep the product stable and at the right pH level.
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UNII 059QF0KO0R
Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.
8 inactive ingredients listed in the exact product block matched to this NDC.
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ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.Inactive ingredient FAQ
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💲 Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per mL | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | Not in the retail survey — common for institutional, discontinued, or low-volume packs. | |
| Medicaid paysCMS SDUD · 12 mo | No recent Medicaid claims on file for this NDC — rare and low-volume NDCs are suppressed in the public data. | |
| Medicare drug plans payPart D · quarterly | No Part D plan price is available for this NDC in our data. | |
Where does this data come from?
🔁 Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Adrenalin 1 mg/mL 42023-0159-25 | Par | 25 vials | $7.796 | AP | Availability likely | — |
| Epinephrine 1 mg/mL 00143-9476-25 | Hikma | 25 ampules | — | AP | FDA listed | — |
| Adrenalin 1 mg/mL 00404-9810-01 | Henry | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 00404-9857-01 | Henry | 1 ampule | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 00517-1171-10 | American | 10 ampules | — | — | FDA listed | — |
| Epinephrine Professional 24357-0011-13 | Focus | 1 kit | — | AP | FDA listed | — |
| epinephrine 1 mg/mLthis 43066-0803-25 | Baxter | 25 vials | — | — | FDA listed | — |
| Epinephrine 1 mg/mL 50090-3039-00 | A-S | 25 ampules | — | AP | Discontinued | — |
| Adrenalin (Epinephrine) 1 mg/mL 51662-1290-01 | HF | 1 ml | — | AP | FDA listed | — |
| Epinephrine Convenience Kit 51662-1507-01 | HF | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 54288-0103-10 | BPI | 10 ampules | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 54288-0119-10 | BPI | 10 vials | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 63323-0696-25 | Fresenius | 25 vials | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 68083-0591-10 | Gland | 10 ampules | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 68462-0933-10 | GLENMARK | 10 ampules | — | AP | FDA listed | — |
| Adrenalin Vials 1 mg/mL 70385-2024-02 | Sina | 2 vials | — | AP | FDA listed | — |
| Adrenalin 1 mg/mL 70518-1342-00 | REMEDYREPACK | 25 vials | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 70518-4156-00 | REMEDYREPACK | 25 vials | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 70518-4274-00 | REMEDYREPACK | 25 vials | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 71872-7117-01 | Medical | 1 ampule | — | AP | FDA listed | — |
| Adrenalin 1 mg/mL 71872-7223-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 71872-7360-01 | Medical | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 72572-0235-25 | CIVICA, | 25 vials | — | AP | Discontinued | — |
| Epinephrine 1 mg/mL 80830-1659-02 | Amneal | 25 vials | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 84549-0103-10 | ProPharma | 1 ml | — | AP | FDA listed | — |
| Adrenalin 1 mg/mL 84549-0159-25 | ProPharma | 1 ml | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 63323-0698-30 | Fresenius | 1 vial | — | — | FDA listed | — |
| Epinephrine 1 mg/mL 54288-0600-01 | BPI | 1 vial | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 68083-0633-01 | Gland | 1 vial | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 68462-0760-10 | GLENMARK | 1 vial | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 43066-0801-02 | Baxter | 1 vial | — | — | FDA listed | — |
| Epinephrine 1 mg/mL 54288-0120-01 | BPI | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 72572-0238-01 | CIVICA, | 1 vial | — | — | FDA listed | — |
| Adrenalin 1 mg/mL 42023-0168-01 | Par | 1 vial | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 68462-0761-30 | GLENMARK | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 00517-3030-01 | American | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 76329-9060-00 | International | 1 vial | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 70121-1660-02 | Amneal | 1 vial | — | AP | FDA listed | — |
| epinephrine 1 mg/mL 68083-0685-01 | Gland | 1 vial | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 51662-1706-01 | HF | 1 ml | — | AP | FDA listed | — |
| Epinephrine 1 mg/mL 51662-1708-01 | HF | 1 ml | — | AP | FDA listed | — |
Where does this data come from?
⏳ Availability & generic status
The FDA lists approved generic versions of this medicine, but that does not always mean a pharmacy can get one today. Patent rules, launch agreements, supply and pricing can affect when generics actually arrive.
Where does this data come from?
📊 Medicare Part D spend CMS · PART D · 2026 (Q1)
🔬 Reported adverse events (FAERS)
Top reported reactions
Age at onset
Reporter sex
Serious outcomes
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📦 Packaging — all sizes for this product
| Package NDC | Description | Marketing start | Status |
|---|---|---|---|
| 43066-0803-25 You're viewing this | 25 VIAL, SINGLE-DOSE in 1 CARTON (43066-803-25) / 1 mL in 1 VIAL, SINGLE-DOSE (43066-803-01) | 2026-03-30 | Active |
🧭 About this NDC listing & data coverage
What data is (and isn’t) available for this NDC — tap to expand
| NDC identity (package / product / labeler codes) | ✓ Available |
| Labeler | ✓ Available |
| Product & package description | ✓ Available |
| Marketing category & status | ✓ Available |
| Active ingredient / dosage form / route | ✓ Available |
| FDA label (SPL via DailyMed) | ✓ Available |
| Package photos | ✓ Available |
| Inactive ingredients (structured) | ✓ Available |
| NADAC pharmacy acquisition price (CMS) | — Not published for this NDC CMS publishes NADAC only for NDCs reported in its retail-pharmacy survey. |
| Orange Book / therapeutic-equivalence data | — Not published for this NDC Applies only to products approved under an NDA/ANDA; many listings are out of scope. |
| HCPCS J-code billing crosswalk | — Not published for this NDC Most self-administered / retail products have no J-code — that is normal. |
| Medicaid utilization (CMS SDUD) | — Not published for this NDC CMS reports utilization only for NDCs with Medicaid claims above its privacy threshold. |
Questions about this listing
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📄 Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Epinephrine is a non-selective alpha and beta adrenergic agonist indicated: • To increase mean arterial blood pressure in adult patients with hypotension associated with septic shock. ( 1.1 ) • For emergency treatment of type 1 allergic reactions, including anaphylaxis in adult and pediatric patients. ( 1.2 )
1.1Hypotension associated with Septic Shock Epinephrine Injection is indicated to increase mean arterial blood pressure in adult patients with hypotension associated with septic shock.
1.2Anaphylaxis Epinephrine Injection is indicated for emergency treatment of type I allergic reactions, including anaphylaxis in adult and pediatric patients.
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION • Hypotension associated with septic shock ( 2.2 ): o Dilute epinephrine in 5% Dextrose Injection or 5% Dextrose and 0.9% Sodium Chloride Injection prior to infusion. o Infuse epinephrine into a large vein. o Titrate 0.05 mcg/kg/min to 2 mcg/kg/min to achieve desired blood pressure. o Wean gradually. • Anaphylaxis ( 2.3 ): o Administer undiluted Epinephrine Injection intramuscularly or subcutaneously into anterolateral thigh every 5 to 10 minutes as needed o Adult and pediatric patients 30 kg or greater: 0.3 mg to 0.5 mg (0.3 mL to 0.5 mL) o Pediatric patients under 30 kg: 0.01 mg/kg (0.01 mL/kg)
2.1General Considerations Inspect visually for particulate matter and discoloration prior to administration, solution should be clear and colorless. Do not use if the solution is colored or cloudy, or if it contains particulate matter. Discard any unused portion.
2.2Recommended Dosage and Administration Instructions for Hypotension associated with Septic Shock Dilute 1 mL of epinephrine 1 mg/mL (1 mg) in 1,000 mL of 5% Dextrose Injection or 5% Dextrose and 0.9% Sodium Chloride Injection to produce a 1 mcg per mL dilution. The diluted solutions can be stored for up to 6 hours at room temperature (20°C to 25°C) or 24 hours under refrigerated conditions (2°C to 8°C). Administration in 0.9% Sodium Chloride Injection alone is not recommended.
If indicated, administer whole blood or plasma separately. Whenever possible, give infusions of epinephrine into a large vein. Avoid using a catheter tie-in technique, because the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug.
Avoid the veins of the leg in elderly patients or in those suffering from occlusive vascular disorders. To provide hemodynamic support in septic shock associated hypotension in adult patients, the suggested dosing infusion rate of intravenously administered epinephrine is 0.05 mcg/kg/min to 2 mcg/kg/min and is titrated to achieve a desired mean arterial pressure (MAP). The dosage may be adjusted periodically, such as every 10 to 15 minutes, in increments of 0.05 mcg/kg/min to 0.2 mcg/kg/min, to achieve the desired blood pressure goal.
The ideal body weight (IBW) should be used as the weight parameter for dosing epinephrine in adult patients with septic shock associated hypotension. After hemodynamic stabilization, wean incrementally over time, such as by decreasing doses of epinephrine every 30 minutes over a 12 to 24 hour period.
2.3Recommended Dosage and Administration Instructions for Anaphylaxis The recommended dosage of Epinephrine Injection is based on weight and is provided in Table 1. Administer undiluted Epinephrine Injection intramuscularly or subcutaneously in the anterolateral aspect of the thigh. Table 1 Recommended Dosage of Epinephrine Injection in Adult and Pediatric Patients for Anaphylaxis Dosage Maximum Dosage Adult and Pediatric Patients Weighing 30 kg or Greater 0.3 mg to 0.5 mg (0.3 mL to 0.5 mL) of undiluted Epinephrine Injection 0.5 mg (0.5 mL) per injection Pediatric Patients Weighing Less Than 30 kg 0.01 mg/kg (0.01 mL/kg) of undiluted Epinephrine Injection 0.3 mg (0.3 mL) per injection • In the absence of clinical improvement or if symptoms worsen after the initial treatment, additional doses of Epinephrine Injection may be repeated every 5 to 10 minutes as necessary. • Monitor clinically for cardiac effects.
Administration Instructions • For intramuscular administration, use a needle long enough (at least 1/2 inch to 5/8 inch) to ensure the injection is administered into the muscle. • To minimize the risk of injection related injury to a pediatric patient, hold the leg firmly in place and limit movement prior to and during an injection. • Inject Epinephrine Injection intramuscularly or subcutaneously into the anterolateral aspect of the thigh, through clothing if necessary. Do not inject intravenously, and do not inject into buttocks, into digits, hands or feet…
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Injection: Epinephrine Injection, USP is a sterile, nonpyrogenic, clear and colorless solution supplied as 1 mg/mL in a single-dose clear glass vial and as 30 mg/30 mL (1 mg/mL) in a multiple-dose amber glass vial. Injection: 1 mg/mL, single-dose vial and 30 mg/30 mL (1 mg/mL), multiple-dose vial ( 3 )
⛔ Contraindications ▾
4 CONTRAINDICATIONS None. None ( 4 )
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS • Do not inject intravenously, into buttocks, digits, hands, or feet. ( 5.1 ) • Rare cases of serious skin and soft tissue infections have been reported following epinephrine injection ( 5.2 ) • Avoid extravasation into tissues, which can cause local necrosis. ( 5.3 ) • Monitor patient for acute severe hypertension.
( 5.4 ) • Potential for pulmonary edema, which may be fatal. ( 5.5 ) • May constrict renal blood vessels and decrease urine formation. ( 5.6 ) • May induce potentially serious cardiac arrhythmias or aggravate angina pectoris, particularly in patients with underlying heart disease.
( 5.7 ) • Presence of sulfite in this product should not deter use. ( 5.8 )
5.1Injection-Related Complications for Anaphylaxis Injection into the anterolateral aspect of the thigh (vastus lateralis muscle) is the most appropriate location for administration because of its location, size, and available blood flow. Injection into (or near) smaller muscles, such as in the deltoid, is not recommended. Do not administer repeated injections of epinephrine at the same site, as the resulting vasoconstriction may cause tissue necrosis.
Do Not Inject Intravenously Large doses or accidental intravenous injection of undiluted epinephrine may result in cerebral hemorrhage due to sharp rise in blood pressure. Rapidly acting vasodilators can counteract the marked pressor effects of epinephrine if there is such inadvertent administration. Do not inject into buttock.
Injection into the buttock may not provide effective treatment of anaphylaxis and has been associated with the development of Clostridial infections (gas gangrene). Do not inject into digits, hands, or feet. Epinephrine is a strong vasoconstrictor.
Accidental injection into the digits, hands or feet may result in loss of blood flow to the affected area and tissue necrosis.
5.2Serious Infections at the Injection Site Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene), have been reported at the injection site following epinephrine injection for anaphylaxis. Advise patients to seek medical care if they develop signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at the epinephrine injection site.
5.3Extravasation and Tissue Necrosis with Intravenous Infusion Avoid extravasation of epinephrine into the tissues, to prevent local necrosis. When Epinephrine Injection is administered intravenously, the infusion site should be checked frequently for free flow. Blanching along the course of the infused vein, sometimes without obvious extravasation, may be attributed to vasa vasorum constriction with increased permeability of the vein wall, permitting some leakage.
This also may progress on rare occasions to superficial slough. Hence, if blanching occurs, consider changing the infusion site at intervals to allow the effects of local vasoconstriction to subside. There is a potential for gangrene in a lower extremity when infusions of catecholamine are given in an ankle vein.
Antidote for Extravasation Ischemia: To prevent sloughing and necrosis in areas in which extravasation has taken place, infiltrate the area with 10 mL to 15 mL of saline solution containing from 5 mg to 10 mg of phentolamine, an adrenergic blocking agent. Use a syringe with a fine hypodermic needle, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, and pallid appearance. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours.
5.4Hypertension Because individual response to epinephrine may vary significantly, monitor blood pressure frequently and titrate to avoid excessive increases in blood pressure. Patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of the triptyline or imipramine types may experience severe, p…
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS The following adverse reactions associated with the use of epinephrine were identified in clinical use, observational trials, case reports, or postmarketing reports. Because some of these reactions were reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Adverse reactions are listed below by body system: Cardiovascular : angina, arrhythmias, cerebral hemorrhage (particularly in elderly patients with cardiovascular disease), hypertension, pallor, palpitations, tachyarrhythmia, tachycardia, vasoconstriction, ventricular ectopy and stress cardiomyopathy.
Gastrointestinal: nausea, vomiting Metabolism and Nutrition Disorders: transient hyperglycemia, sweating Neurological : disorientation, dizziness, headache, impaired memory, panic, psychomotor agitation (particularly in patients with Parkinson’s disease), sleepiness, tingling, tremor, weakness Psychiatric : anxiety, apprehensiveness, restlessness Respiratory: respiratory difficulties Skin and subcutaneous tissue disorders: skin and soft tissue infections, necrotizing fasciitis, myonecrosis (gas gangrene) Most common adverse reactions to systemically administered epinephrine are headache; anxiety; apprehensiveness; restlessness; tremor; weakness; dizziness; sweating; palpitations; pallor; nausea/vomiting; and/or respiratory difficulties.
Arrhythmias, including fatal ventricular ectopy, and cerebral hemorrhage. ( 6 ) To report SUSPECTED ADVERSE REACTIONS, contact Baxter Healthcare Corporation at 1-877-725-2747 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS • Drugs that counter the pressor effects of epinephrine include alpha blockers, vasodilators such as nitrates, diuretics, antihypertensives, ergot alkaloids, and phenothiazine antipsychotics. ( 7.1 ) • Drugs that potentiate the effects of epinephrine include sympathomimetics, beta blockers, tricyclic antidepressants, MAO inhibitors, COMT inhibitors, clonidine, doxapram, oxytocin, levothyroxine sodium, and certain antihistamines. ( 7.2 ) • Drugs that increase the arrhythmogenic potential of epinephrine include beta blockers, cyclopropane and halogenated hydrocarbon anesthetics, quinidine, antihistamines, exogenous thyroid hormones, diuretics, and cardiac glycosides.
Observe for development of cardiac arrhythmias. ( 7.3 ) • Potassium-depleting drugs, including corticosteroids, diuretics, and theophylline, potentiate the hypokalemic effects of epinephrine. ( 7.4 )
7.1Drugs Antagonizing Pressor Effects of Epinephrine • α-blockers, such as phentolamine • Vasodilators, such as nitrates • Diuretics • Antihypertensives • Ergot alkaloids • Phenothiazine antipsychotics
7.2Drugs Potentiating Pressor Effects of Epinephrine • Sympathomimetics • β-blockers, such as propranolol • Tricyclic anti-depressants • Monoamine oxidase inhibitors (MAOI) • Catechol-O-methyl transferase (COMT) inhibitors, such as entacapone • Clonidine • Doxapram • Oxytocin
7.3Drugs Potentiating Arrhythmogenic Effects of Epinephrine Cardiac arrhythmias are more common among patients receiving any of the following drugs [see Warnings and Precautions (5.7) and Adverse Reactions (6) ]. • β-blockers, such as propranolol • Cyclopropane or halogenated hydrocarbon anesthetics, such as halothane • Antihistamines • Thyroid hormones • Diuretics • Cardiac glycosides, such as digitalis glycosides • Quinidine
7.4Drugs Potentiating Hypokalemic Effects of Epinephrine • Potassium depleting diuretics • Corticosteroids • Theophylline
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS • Pregnancy: May cause fetal harm. ( 8.1 ) • Elderly patients and pregnant women may be at greater risk of developing adverse reactions when epinephrine is administered parenterally. ( 8.1 , 8.5 )
8.1Pregnancy Risk Summary Prolonged experience with epinephrine use in pregnant women over several decades, based on published literature, does not identify a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. There are risks to the mother and fetus associated with anaphylaxis and hypotension associated with shock, and treatment with epinephrine should not be delayed (see Clinical Considerations ). In animal reproduction studies, epinephrine administered by the subcutaneous route to pregnant rabbits, mice, and hamsters, during the period of organogenesis, resulted in adverse developmental effects (including gastroschisis, embryonic lethality, and delayed skeletal ossification) at doses approximately 2 times the maximum recommended daily intramuscular, subcutaneous, or intravenous dose (see Data ).
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the United States general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Clinical Considerations Disease-associated maternal and/or embryo/fetal risk During pregnancy, anaphylaxis can be catastrophic and can lead to hypoxic-ischemic encephalopathy and permanent central nervous system damage or death in the mother and, more commonly, in the fetus or neonate. Treatment of anaphylaxis during pregnancy should not be delayed. Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated.
Delaying treatment in pregnant women with hypotension associated with septic shock may increase the risk of maternal and fetal morbidity and mortality. Life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of epinephrine on the fetus. Labor or Delivery Anaphylaxis Epinephrine is the first line-medication of choice for treatment of anaphylaxis; it should be used in the same manner for patients in labor or delivery.
Hypotension Associated with Septic Shock Epinephrine usually inhibits spontaneous or oxytocin induced contractions of the pregnant human uterus and may delay the second stage of labor. Avoid epinephrine during the second stage of labor. In dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage.
Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg. Although epinephrine may improve maternal hypotension associated with septic shock, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia. Data Animal Data In an embryofetal development study with pregnant rabbits dosed during the period of organogenesis (on days 3 to 5, 6 to 7, or 7 to 9 of gestation), epinephrine caused teratogenic effects (including gastroschisis) at doses approximately 15 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at a maternal subcutaneous dose of 1.2 mg/kg/day for 2 to 3 days).
Animals treated on days 6 to 7 had decreased number of implantations. In an embryofetal development study, pregnant mice were administered epinephrine (0.1 to 10 mg/kg/day) on Gestation Days 6 to 15. Teratogenic effects, embryonic lethality, and delays in skeletal ossification were observed at approximately 3 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at maternal subcutaneous dose of 1 mg/kg/day for 10 days).
These effects were not seen in mice at approximately 2 times the maximum…
🤰 Pregnancy ▾
8.1Pregnancy Risk Summary Prolonged experience with epinephrine use in pregnant women over several decades, based on published literature, does not identify a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. There are risks to the mother and fetus associated with anaphylaxis and hypotension associated with shock, and treatment with epinephrine should not be delayed (see Clinical Considerations ). In animal reproduction studies, epinephrine administered by the subcutaneous route to pregnant rabbits, mice, and hamsters, during the period of organogenesis, resulted in adverse developmental effects (including gastroschisis, embryonic lethality, and delayed skeletal ossification) at doses approximately 2 times the maximum recommended daily intramuscular, subcutaneous, or intravenous dose (see Data ).
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the United States general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.
Clinical Considerations Disease-associated maternal and/or embryo/fetal risk During pregnancy, anaphylaxis can be catastrophic and can lead to hypoxic-ischemic encephalopathy and permanent central nervous system damage or death in the mother and, more commonly, in the fetus or neonate. Treatment of anaphylaxis during pregnancy should not be delayed. Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated.
Delaying treatment in pregnant women with hypotension associated with septic shock may increase the risk of maternal and fetal morbidity and mortality. Life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of epinephrine on the fetus. Labor or Delivery Anaphylaxis Epinephrine is the first line-medication of choice for treatment of anaphylaxis; it should be used in the same manner for patients in labor or delivery.
Hypotension Associated with Septic Shock Epinephrine usually inhibits spontaneous or oxytocin induced contractions of the pregnant human uterus and may delay the second stage of labor. Avoid epinephrine during the second stage of labor. In dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage.
Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg. Although epinephrine may improve maternal hypotension associated with septic shock, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia. Data Animal Data In an embryofetal development study with pregnant rabbits dosed during the period of organogenesis (on days 3 to 5, 6 to 7, or 7 to 9 of gestation), epinephrine caused teratogenic effects (including gastroschisis) at doses approximately 15 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at a maternal subcutaneous dose of 1.2 mg/kg/day for 2 to 3 days).
Animals treated on days 6 to 7 had decreased number of implantations. In an embryofetal development study, pregnant mice were administered epinephrine (0.1 to 10 mg/kg/day) on Gestation Days 6 to 15. Teratogenic effects, embryonic lethality, and delays in skeletal ossification were observed at approximately 3 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at maternal subcutaneous dose of 1 mg/kg/day for 10 days).
These effects were not seen in mice at approximately 2 times the maximum recommended daily intramuscular or subcutaneous dose (on a mg/m 2 basis at a subcutaneous maternal dose of 0.5 mg/kg/day for 10 days). In an embryofetal development study with pregnant hamsters dosed during the period of organo…
🧒 Pediatric Use ▾
8.4Pediatric Use Anaphylaxis The safety and effectiveness of Epinephrine Injection for the emergency treatment of type I allergic reactions, including anaphylaxis, have been established in pediatric patients. The use of Epinephrine Injection for this indication is supported by clinical use data, which support weight-based dosing for treatment of anaphylaxis in pediatric patients, and other reported clinical experience with the use of epinephrine suggests that the adverse reactions seen in pediatric patients are similar in nature and extent to those both expected and reported in adults.
Hypotension Associated with Septic Shock Safety and effectiveness of epinephrine in pediatric patients with septic shock have not been established.
🧓 Geriatric Use ▾
8.5Geriatric Use Anaphylaxis Clinical studies for the emergency treatment of type I allergic reactions, including anaphylaxis have not been performed in subjects aged 65 and over to determine whether they respond differently from younger subjects. However, other reported clinical experience with use of epinephrine for the emergency treatment of type I allergic reactions, including anaphylaxis, has identified that geriatric patients may be particularly sensitive to the effects of epinephrine. Therefore, for the emergency treatment of type I allergic reactions, including anaphylaxis, consider monitoring geriatric patients for adverse reactions to take into account potential concomitant disease or other drug therapy.
Hypotension Associated with Septic Shock Clinical studies of epinephrine for the treatment of hypotension associated with septic shock did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, due to the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy, consider monitoring geriatric patients for adverse reactions.
Avoid the veins in the leg in geriatric patients.
🆘 Overdosage ▾
10 OVERDOSAGE Overdosage of epinephrine may produce extremely elevated arterial pressure, which may result in cerebrovascular hemorrhage, particularly in elderly patients. Overdosage may also result in pulmonary edema because of peripheral vascular constriction together with cardiac stimulation. Epinephrine overdosage may also cause transient bradycardia followed by tachycardia and these may be accompanied by potentially fatal cardiac arrhythmias.
Premature ventricular contractions may appear within one minute after injection and may be followed by multifocal ventricular tachycardia (prefibrillation rhythm). Subsidence of the ventricular effects may be followed by atrial tachycardia and occasionally by atrioventricular block. Myocardial ischemia and infarction, cardiomyopathy, extreme pallor and coldness of the skin, metabolic acidosis due to elevated blood lactic acid levels, and renal insufficiency and failure have also been reported.
Epinephrine is rapidly inactivated in the body and treatment following overdose with epinephrine is primarily supportive. Treatment of pulmonary edema consists of a rapidly acting alpha-adrenergic blocking drug (such as phentolamine mesylate) and respiratory support. Treatment of epinephrine associated arrhythmias consists of administration of a beta-adrenergic blocking drug (such as propranolol).
If necessary, pressor effects may be counteracted by rapidly acting vasodilators or alpha-adrenergic blocking drugs. If prolonged hypotension follows such measures, it may be necessary to administer another pressor drug.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Anaphylaxis Epinephrine acts on both alpha- and beta-adrenergic receptors. Through its action on alpha-adrenergic receptors, epinephrine lessens the vasodilation and increased vascular permeability that occurs during anaphylaxis, which can lead to loss of intravascular fluid volume and hypotension. Through its action on beta-adrenergic receptors, epinephrine causes bronchial smooth muscle relaxation and helps alleviate bronchospasm, wheezing and dyspnea that may occur during anaphylaxis.
Epinephrine also alleviates pruritus, urticaria, and angioedema and may relieve gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxer effects on the smooth muscle of the stomach, intestine, uterus and urinary bladder. Hypotension Epinephrine acts on both alpha and beta-adrenergic receptors. The mechanism of the rise in blood pressure is 3-fold: a direct myocardial stimulation that increases the strength of ventricular contraction (positive inotropic action), an increased heart rate (positive chronotropic action), and peripheral vasoconstriction.
12.2Pharmacodynamics Epinephrine increases glycogenolysis, reduces glucose up take by tissues, and inhibits insulin release in the pancreas, resulting in hyperglycemia and increased blood lactic acid. Intravenous use for hypotension associated with septic shock When administered parenterally, epinephrine has a rapid onset and short duration of action. Following intravenous administration of epinephrine, increases in systolic blood pressure and heart rate are observed.
Decreases in systemic vascular resistance and diastolic blood pressure are observed at low doses of epinephrine because of β 2 -mediated vasodilation, but are overtaken by α 1 -mediated peripheral vasoconstriction at higher doses leading to increase in diastolic blood pressure. The onset of blood pressure increase following an intravenous dose of epinephrine is < 5 minutes and the time to offset blood pressure response occurs within 20 min. Most vascular beds are constricted including renal, splanchnic, mucosal and skin.
Epinephrine causes mydriasis when administered parenterally.
12.3Pharmacokinetics Absorption Following intravenous injection, epinephrine is rapidly cleared from the plasma with an effective half-life of < 5 min. A pharmacokinetic steady-state following continuous intravenous infusion is achieved within 10 to 15 min. In patients with septic shock, epinephrine displays dose-proportional pharmacokinetics in the infusion dose range of 0.03 to 1.7 mcg/kg/min.
Metabolism Epinephrine is extensively metabolized with only a small amount excreted unchanged. Epinephrine is rapidly degraded to vanillylmandelic acid, an inactive metabolite, by monoamine oxidase and catechol-O-methyltransferase that are abundantly expressed in the liver, kidneys and other extraneuronal tissues. Elimination The tissues with the highest contribution to removal of circulating exogenous epinephrine are the liver (32%), kidneys (25%), skeletal muscle (20%), and mesenteric organs (12%).
Specific Populations Age In a pharmacokinetic study of 45-minute epinephrine infusions given to healthy men aged 20 to 25 years and healthy men aged 60 to 65 years, the mean plasma metabolic clearance rate of epinephrine at steady-state was greater among the older men (144.8 versus 78 mL/kg/min for a 0.0143 mcg/kg/min infusion). Body Weight Body weight has been found to influence epinephrine pharmacokinetics. Higher body weight was associated with a higher plasma epinephrine clearance and a lower concentration plateau.
🧬 Mechanism of Action ▾
12.1Mechanism of Action Anaphylaxis Epinephrine acts on both alpha- and beta-adrenergic receptors. Through its action on alpha-adrenergic receptors, epinephrine lessens the vasodilation and increased vascular permeability that occurs during anaphylaxis, which can lead to loss of intravascular fluid volume and hypotension. Through its action on beta-adrenergic receptors, epinephrine causes bronchial smooth muscle relaxation and helps alleviate bronchospasm, wheezing and dyspnea that may occur during anaphylaxis.
Epinephrine also alleviates pruritus, urticaria, and angioedema and may relieve gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxer effects on the smooth muscle of the stomach, intestine, uterus and urinary bladder. Hypotension Epinephrine acts on both alpha and beta-adrenergic receptors. The mechanism of the rise in blood pressure is 3-fold: a direct myocardial stimulation that increases the strength of ventricular contraction (positive inotropic action), an increased heart rate (positive chronotropic action), and peripheral vasoconstriction.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING Epinephrine Injection, USP, 1 mg/mL is a sterile clear colorless solution each mL containing 1 mg epinephrine, USP and supplied as below: Strength Fill Volume NDC NUMBER 1 mg/mL 1 mL Single-dose vial (Discard unused portion) 43066-803-25 (Pack of 25) 30 mg/30 mL (1 mg/mL) 30 mL Multiple-dose vial (Vial and contents must be discarded 30 days after initial use.) 43066-801-02 (Pack of 1) Epinephrine is light sensitive. Protect from light until ready to use. Do not refrigerate.
Protect from freezing. Store at room temperature, between 20°C to 25°C (68°F to 77°F) [see USP Controlled Room Temperature]. Protect from alkalis and oxidizing agents.
📋 Description ▾
11 DESCRIPTION Epinephrine is an alpha and beta adrenergic agonist. The chemical name of epinephrine is: 1,2-Benzenediol, 4-[1-hydroxy-2-(methylamino)ethyl]-, ( R )- or (−)-3,4-Dihydroxy-α-[(methylamino)methyl]benzyl alcohol. It is a white to practically white, odorless, microcrystalline powder or granules.
The structural formula of epinephrine is: The molecular weight of epinephrine is 183.20 and molecular formula is C 9 H 13 NO 3 . It is very slightly soluble in water and in alcohol. Epinephrine Injection, USP is a clear, colorless, sterile solution containing 1 mg/mL epinephrine, packaged as 1 mL of solution in a single-dose clear glass vial and 30 mL of solution in a multiple-dose amber glass vial.
The pH range of the solution is 3.0 to 4.0. Epinephrine Injection, USP, 1 mg/mL single-dose vial: Each mL contains 1 mg epinephrine, USP as the active ingredient and the following inactive ingredients: citric acid monohydrate 2.6 mg, edetate disodium (as dihydrate) 0.2 mg, hydrochloric acid for pH adjustment, L-methionine 1.5 mg, sodium chloride 7.59 mg, sodium citrate dihydrate 1 mg, sodium metabisulfite 0.05 mg, and water for injection q.s. Epinephrine Injection, USP, 30 mg/30 mL (1 mg/mL) multiple-dose vial: Each mL contains 1 mg epinephrine, USP as the active ingredient and the following inactive ingredients: chlorobutanol hemihydrate 5.52 mg as preservative, citric acid monohydrate 2.6 mg, edetate disodium (as dihydrate) 0.2 mg, hydrochloric acid for pH adjustment, L-methionine 1.5 mg, sodium chloride 6.39 mg, sodium citrate dihydrate 1 mg, sodium metabisulfite 0.05 mg, and water for injection q.s.
Solution must be diluted prior to intravenous use. Epinephrine solution deteriorates rapidly on exposure to air or light, turning pink from oxidation to adrenochrome and brown from the formation of melanin. structural-formula-epinephrine-1
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION Risk of Recurrent Symptoms of Anaphylaxis Warn patients with a good response to initial treatment about the possibility of recurrence of symptoms and instruct patients to obtain proper medical attention if symptoms return. Transient Hyperglycemia Advise patients with diabetes that they may develop increased blood glucose levels following epinephrine administration [see Adverse Reactions (6) and Clinical Pharmacology (12.2) ] . Serious Infection at Injection Site Rare cases of serious skin and soft tissue infections, including necrotizing fasciitis and myonecrosis caused by Clostridia (gas gangrene), have been reported at the injection site following epinephrine injection for anaphylaxis.
Advise patients to seek medical care if they develop signs or symptoms of infection, such as persistent redness, warmth, swelling, or tenderness, at the epinephrine injection site [see Warnings and Precautions (5.2) ] . Manufactured by: UBI Pharma Inc. 45, Guangfu N.
Rd., Hukou, Hsinchu 303036, Taiwan (TWN) Manufactured for: Baxter Healthcare Corporation Deerfield, IL 60015 USA L542-07 Baxter is a registered trademark of Baxter International Inc.