What is the recommended dose and administration of push dose epinephrine (adrenaline)?

From the Guidelines

Push dose epinephrine should be administered as 0.2 to 0.5 mg (1:1000) intramuscularly, to be repeated every 5 to 15 minutes as needed, according to the most recent guidelines 1. The recommended dose and administration of push dose epinephrine is crucial in the treatment of anaphylaxis.

• The dose of 0.2 to 0.5 mg (1:1000) intramuscularly is recommended for adults, while children should receive 0.01 mg/kg, up to 0.3 mg, depending on the severity of the reaction 1.
• The intramuscular injection in the anterolateral thigh is preferred over subcutaneous or intramuscular injection in the arm, as it achieves a more rapid and higher plasma concentration of epinephrine 1.
• Repeat dosing may be required for persistent or recurrent symptoms, and the optimal dosing interval for repeated dosing has not been studied prospectively 1.
• Caution should be exercised in patients with coronary artery disease, arrhythmias, or hypertension, as epinephrine can exacerbate these conditions 1.
• Monitoring of the patient's blood pressure, heart rate, and ECG is essential during administration of push dose epinephrine 1. The use of epinephrine in the treatment of anaphylaxis is well-established, and its benefits outweigh the risks, even in patients with cardiovascular disease 1.
• The risk of a life-threatening anaphylactic reaction is judged to exceed the risk of administering epinephrine in such patients, and there is no absolute contraindication to the use of epinephrine in a life-threatening situation, such as anaphylaxis 1.
• Antihistamines and corticosteroids should not be considered substitutes for epinephrine in the treatment of anaphylaxis 1. Overall, the administration of push dose epinephrine should be guided by the most recent guidelines and should take into account the individual patient's needs and medical history.

From the FDA Drug Label

1. DOSAGE & ADMINISTRATION 2.1 General Considerations Inspect visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use if the solution is colored or cloudy, or if it contains particulate matter. Discard all unused drug. 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 recommended dose and administration of push dose epinephrine is not explicitly stated in the provided drug label. The label provides information on the administration of epinephrine for hypotension associated with septic shock, but it does not mention "push dose" specifically.

• Key points:
  • The label recommends an infusion rate of 0.05 mcg/kg/min to 2 mcg/kg/min for septic shock associated hypotension.
  • The dosage may be adjusted periodically to achieve the desired blood pressure goal.
  • There is no information on "push dose" administration 2.

From the Research

Push Dose Epinephrine Administration

• The recommended dose and administration of push dose epinephrine (adrenaline) vary depending on the medical emergency being treated 3, 4, 5.
• For anaphylaxis, epinephrine is typically given intramuscularly at a low dose, whereas for cardiac arrest, a higher dose is required intravenously 3.
• In the case of hypotension during critical care transport, push dose epinephrine may be administered intravenously at a dose of 10-20 μg of 1:100,000 epinephrine every 2 minutes until the systolic blood pressure is at least 90 mmHg or the mean arterial pressure is 65 mmHg or greater 4.
• The optimal dose of epinephrine during cardiopulmonary resuscitation in humans is unknown, but studies suggest that a dose of 1-5 mg may be required to produce the beneficial pharmacologic effects observed in animal models 5.

Potential Risks and Complications

• Inappropriate dosing of epinephrine can lead to iatrogenic errors and potentially lethal complications, such as transient severe systolic dysfunction and myocardial ischemia 3, 6.
• Physicians should be aware of the potential risks and complications associated with epinephrine administration and closely monitor patients for adverse effects 3, 6.

Clinical Guidelines and Recommendations

• The administration of epinephrine should be guided by established protocols and clinical guidelines to minimize the risk of errors and adverse effects 3, 4.
• Further research is needed to establish optimal dosing and to evaluate the use of push dose epinephrine in different clinical settings 4, 7.