What is the recommended dose of adrenaline (epinephrine) for anaphylaxis?

Epinephrine Dosing for Anaphylaxis

For anaphylaxis, administer epinephrine intramuscularly at a dose of 0.3-0.5 mg (0.3-0.5 mL of 1:1000 concentration) for adults and children ≥30 kg, or 0.01 mg/kg (maximum 0.3 mg) for children <30 kg, injected into the anterolateral aspect of the mid-thigh. 1, 2

Dosing Guidelines

Adults and Children ≥30 kg (66 lbs):

• Dose: 0.3-0.5 mg
• Concentration: 1:1000 (1 mg/mL)
• Volume: 0.3-0.5 mL
• Route: Intramuscular (IM) injection into anterolateral thigh
• Frequency: Can be repeated every 5-10 minutes as necessary 1, 2

Children <30 kg (66 lbs):

• Dose: 0.01 mg/kg (maximum 0.3 mg)
• Concentration: 1:1000 (1 mg/mL)
• Volume: 0.01 mL/kg (maximum 0.3 mL)
• Route: Intramuscular (IM) injection into anterolateral thigh
• Frequency: Can be repeated every 5-10 minutes as necessary 1, 2

Administration Route

• The intramuscular route in the anterolateral thigh is preferred for initial treatment due to:
  • Faster absorption compared to subcutaneous injection
  • Better safety profile compared to intravenous administration
  • Ease of administration in emergency settings 1, 3

Alternative Routes in Special Circumstances

Intravenous Administration

• When an IV line is already in place and the patient is in anaphylactic shock, IV epinephrine may be considered
• IV dose: 0.05 to 0.1 mg (5-10% of the cardiac arrest dose)
• Concentration: 0.1 mg/mL (1:10,000) 4

Continuous Infusion

• For persistent anaphylactic shock or recurrence of symptoms
• IV infusion at 5-15 μg/min
• Allows for careful titration and avoidance of overdosing 4

Important Clinical Considerations

Timing of Administration

• Administer immediately upon recognition of anaphylaxis
• Delays in administration may be fatal
• No absolute contraindications for epinephrine use in anaphylaxis 1, 3, 5

Special Populations

• Elderly patients and those with cardiac disease, hyperthyroidism, Parkinson's disease, diabetes, or pheochromocytoma require caution but should still receive epinephrine for anaphylaxis 1

Common Pitfalls to Avoid

1. Incorrect route selection: Avoid injecting into buttocks, digits, hands, or feet 2
2. Delayed administration: Failure to promptly administer epinephrine is associated with increased mortality 3
3. Incorrect dose calculation: Studies show many healthcare providers are unfamiliar with correct dosing 6, 7
4. Inappropriate needle length: Standard auto-injector needles may be too short for obese patients or too long for small children 8
5. Confusion with cardiac arrest dosing: The anaphylaxis dose is different from cardiac arrest dosing 6

Monitoring and Follow-up

• Observe patients for at least 4-6 hours after symptom resolution
• Extended observation (8-24 hours) for severe reactions or those requiring multiple epinephrine doses
• Monitor vital signs including blood pressure, heart rate, and oxygen saturation 1

Remember that epinephrine is the cornerstone of anaphylaxis management, and prompt administration can be life-saving. The intramuscular route in the anterolateral thigh provides the optimal balance of rapid absorption and safety.