What is the dose of epinephrine (Epi)?

From the Guidelines

The dose of epinephrine (also known as adrenaline) for an adult is typically 0.3 to 0.5 milligrams (mg) administered intramuscularly (IM) or intravenously (IV) as a single dose 1.

Key Points

• For children, the dose is usually 0.01 mg/kg of body weight, with a minimum dose of 0.1 mg for infants and a maximum dose of 0.3 mg for children under 8 years old 1.
• The dose may be repeated every 5 to 15 minutes as needed, with a maximum of 3 doses 1.
• Epinephrine auto-injectors, such as EpiPen or Auvi-Q, typically contain a single dose of 0.3 mg or 0.15 mg for children between 15 kg and 30 kg 1.

Administration Route

• The intramuscular (IM) route is preferred for anaphylaxis, with the anterolateral thigh being the recommended injection site 1.
• The dose can also be administered subcutaneously (SC) or intravenously (IV) in certain situations, but IM is the most common and recommended route 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Anaphylaxis: Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0. 5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0. 3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary

The dose of epinephrine (Epi) for anaphylaxis is:

• 0.3 to 0.5 mg for adults and children 30 kg (66 lbs) or more, administered intramuscularly or subcutaneously every 5 to 10 minutes as necessary 2
• 0.01 mg/kg, up to 0.3 mg, for children 30 kg (66 lbs) or less, administered intramuscularly or subcutaneously every 5 to 10 minutes as necessary 2 For hypotension associated with septic shock, 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) 3

From the Research

Epinephrine Dosing

The dose of epinephrine (Epi) is typically administered intramuscularly in the anterolateral thigh at a dose of 0.01 mg/kg of 1:1000 (1 mg/ml) solution to a maximum initial dose of 0.5 mg 4.

Available Doses

Epinephrine autoinjectors (EAI) are available in three doses, 0.15 mg, 0.30 mg, and 0.50 mg 4.

• 0.15 mg: typically used for pediatric patients
• 0.30 mg: commonly used for adult patients
• 0.50 mg: recommended for individuals who weigh ≥ 45 kg 4

Studies on Optimal Dosing

A study found that a 500 μg dose of adrenaline resulted in a higher and more prolonged peak concentration compared to a 300 μg dose, with no difference in adverse events 5. Another study suggested that an escalating epinephrine dosage concept may be beneficial, as it allows for titration of the drug to an effective level and meets the needs of the individual patient 6.

Key Points

• The standard dose of epinephrine is 0.01 mg/kg of 1:1000 (1 mg/ml) solution to a maximum initial dose of 0.5 mg 4
• Available doses of epinephrine autoinjectors are 0.15 mg, 0.30 mg, and 0.50 mg 4
• A 500 μg dose of adrenaline may be more effective than a 300 μg dose in treating anaphylaxis in individuals > 40 kg 5