What is the dose of epinephrine (adrenaline) in the treatment of anaphylaxis?

From the Guidelines

The recommended dose of epinephrine for anaphylaxis is 0.01 mg/kg of a 1:1000 solution, with a maximum dose of 0.5 mg in adults and 0.3 mg in children, administered intramuscularly in the anterolateral thigh. This dose is based on the most recent and highest quality study, which provides a comprehensive review of anaphylaxis management 1. The study emphasizes the importance of prompt epinephrine administration in anaphylaxis, highlighting its role as the cornerstone of treatment.

Key Considerations

• The dose of epinephrine should be individualized based on the patient's weight, with a maximum dose of 0.5 mg in adults and 0.3 mg in children.
• The intramuscular route is preferred over subcutaneous administration due to faster absorption and higher plasma concentrations.
• Epinephrine should be administered immediately upon recognition of anaphylaxis, and can be repeated every 5-15 minutes if symptoms persist or worsen.
• Auto-injectors come in fixed doses of 0.15 mg, 0.3 mg, and 0.5 mg, and the choice of auto-injector should be based on the patient's weight and clinical history.

Administration and Monitoring

• After administering epinephrine, the patient should be placed in a supine position with legs elevated (unless respiratory distress is present), and emergency medical services should be called.
• Caregivers should be aware of the potential side effects of epinephrine, including pallor, tremor, anxiety, and palpitations, and avoid unnecessary repeat dosing.
• The patient should be monitored closely for signs of anaphylaxis resolution or worsening, and additional treatment should be provided as needed.

Special Considerations

• In children weighing less than 30 kg, the dose of epinephrine should be adjusted based on their weight, with a dose of 0.01 mg/kg of a 1:1000 solution.
• In patients with a history of asthma, previous anaphylaxis, or other high-risk conditions, a higher dose of epinephrine may be considered, and the patient should be monitored closely for signs of anaphylaxis worsening.

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 (adrenaline) in the treatment of 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.
• 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.

From the Research

Dose of Epinephrine in Anaphylaxis Treatment

• The initial recommended adult dose of epinephrine for anaphylaxis treatment is 0.3-0.5 mg, injected intramuscularly in the anterolateral aspect of the mid-thigh 3, 4.
• For children, the dose is 0.01 mg/kg 4 or 0.15 mg for children less than 25 kg and 0.3 mg for children ≥ 25 kg 5.
• The dose and route of administration of epinephrine are crucial, with intramuscular injection being the preferred route 3, 4, 5.
• Repeated smaller doses of adrenaline may be preferred over a single large dose 5.

Administration and Education

• Epinephrine auto-injectors are recommended for patients with known anaphylactic reactivity to be carried at all times for treatment of potential recurrences 4.
• Education of the patient or parent regarding the proper use of epinephrine auto-injectors is essential 4, 6.
• Junior doctors may require education and access to appropriate drugs to improve management of anaphylaxis 7.

Management of Anaphylaxis

• Anaphylaxis management involves removal of the trigger, early administration of intramuscular epinephrine, and supportive care for the patient's airway, breathing, and circulation 6.
• Adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered after epinephrine administration 6.