From the Guidelines
For anaphylaxis, there is no predetermined limit to the number of epinephrine doses that can be administered, and additional doses of intramuscular epinephrine should be given every 5 to 15 minutes if anaphylaxis signs or symptoms persist 1. The initial dose of epinephrine for anaphylaxis is 0.01 mg/kg of 1 mg/mL (1:1000), up to 0.5 mg in adults and 0.3 mg in children and teenagers, administered intramuscularly into the vastus lateralis (antero-lateral thigh) 1. Some key points to consider when administering epinephrine for anaphylaxis include:
- Epinephrine is the first-line treatment for anaphylaxis and should be used early when treating systemic reactions 1
- There are no absolute contraindications to the use of epinephrine in a life-threatening situation, such as anaphylaxis 1
- Antihistamines and glucocorticoids should not be administered before, or in place of, epinephrine, as they have no proven role in the treatment of an acute reaction due to their slow onset of action 1
- Patients with severe anaphylaxis may require multiple doses of epinephrine before improvement occurs, and extended clinical observation is suggested in a setting capable of managing anaphylaxis to detect a biphasic reaction 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 ( 2) 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 ( 2)
The number of epinephrine doses in an anaphylaxis situation is not limited, as the drug label states that doses can be administered every 5 to 10 minutes as necessary 2.
- Key points:
- Dose interval: every 5 to 10 minutes
- Administration: intramuscularly or subcutaneously into anterolateral aspect of the thigh
- Dose: 0.3 to 0.5 mg for adults and children 30 kg or more, and 0.01 mg/kg (up to 0.3 mg) for children less than 30 kg.
From the Research
Epinephrine Doses in Anaphylaxis
- The initial recommended adult dose of epinephrine is 0.3-0.5 mg, injected intramuscularly in the anterolateral aspect of the mid-thigh 3.
- Weight-appropriate doses of epinephrine are available with auto-injectors that are prefilled with 0.15,0.30, and 0.50 mg 4.
- For children, the dose is 0.01 mg/kg, given in the lateral thigh 5.
- In some cases, a second dose of epinephrine may be required to further mitigate symptoms and preserve life 6.
- Studies have found that two or more doses of epinephrine were required in 8% to 28% of patients with anaphylaxis requiring treatment with epinephrine 6.
Administration of Epinephrine
- Epinephrine should be administered immediately upon evidence of the occurrence of anaphylaxis 3, 7, 5.
- The most appropriate administration is intramuscularly in the anterolateral thigh 3, 7, 5.
- Epinephrine auto-injectors are available for patients with known anaphylactic reactivity to be carried at all times for treatment of potential recurrences 4, 5.