Recommended Dose for Subcutaneous Epinephrine Administration in Adults
For subcutaneous administration of epinephrine in adults, the recommended dose is 0.3 to 0.5 mg (0.3 to 0.5 mL of 1:1000 solution) injected into the anterolateral thigh, which may be repeated every 5 to 10 minutes as needed. 1
Route of Administration Considerations
While subcutaneous administration is mentioned in the question, it's important to note that current evidence strongly favors intramuscular administration over subcutaneous for most emergency situations:
- Intramuscular injection in the lateral thigh (vastus lateralis) leads to significantly faster absorption with peak plasma concentrations reached in 8 ± 2 minutes 2
- Subcutaneous injection in the arm (deltoid) results in delayed absorption with peak plasma concentrations reached in 34 ± 14 minutes (range: 5-120 minutes) 2
- Studies have demonstrated higher and more rapid peak plasma levels with intramuscular injection compared to subcutaneous administration 3, 4
Dosing Guidelines for Subcutaneous Epinephrine
When subcutaneous administration is specifically required:
- Adults: 0.3 to 0.5 mg (0.3 to 0.5 mL of 1:1000 solution) 1
- Injection should be made into the anterolateral thigh rather than the arm for better absorption 1
- May repeat every 5 to 10 minutes as necessary based on clinical response 2, 1
- For severe asthma specifically: 0.01 mg/kg divided into 3 doses of approximately 0.3 mg administered at 20-minute intervals 2
Important Administration Considerations
Avoid injection into:
- Buttocks
- Digits (fingers/toes)
- Hands
- Feet 1
Monitor for:
- Acute severe hypertension
- Local tissue necrosis if extravasation occurs
- Cardiac arrhythmias, particularly in patients with underlying heart disease
- Pulmonary edema 1
Special Populations and Precautions
Use with caution in patients with:
- Underlying cardiac disease
- Hyperthyroidism
- Diabetes
- Patients taking sympathomimetics, cardiac glycosides, tricyclic antidepressants, MAO inhibitors, or beta-blockers 1
Elderly patients may be at greater risk of developing adverse reactions 1
Common Side Effects
- Headache, anxiety, restlessness, tremor
- Dizziness, sweating, palpitations
- Pallor, peripheral coldness
- Nausea/vomiting
- Respiratory difficulties 1
While subcutaneous administration is an option, the most recent evidence strongly suggests that intramuscular injection into the lateral thigh is the preferred route for epinephrine administration in emergency situations due to its superior pharmacokinetic profile 2, 4.