From the Guidelines
Epinephrine for vasopressor support is typically administered at a dose range of 0.1–0.5 mcg/kg/min, which translates to approximately 7–35 mcg/min for a 70-kg adult, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The dose range for epinephrine as a vasopressor can vary depending on the clinical context and the patient's response to treatment.
- Key considerations when administering epinephrine include:
- Starting at the lower end of the dose range and titrating upward based on the patient's blood pressure response and hemodynamic parameters
- Continuous monitoring of blood pressure, heart rate, cardiac rhythm, and tissue perfusion
- Awareness of potential side effects, such as excessive vasoconstriction, tachyarrhythmias, myocardial ischemia, and lactic acidosis
- Administration through a central venous catheter whenever possible to prevent tissue damage from extravasation
- The concentration of the infusion should typically be prepared in normal saline or D5W solution, with a recommended concentration of 4-16 mcg/mL.
- More recent guidelines, such as the 2017 Surviving Sepsis Campaign, recommend norepinephrine as the first-choice vasopressor, with epinephrine added or substituted as needed to maintain adequate blood pressure 1.
- However, the 2010 American Heart Association guidelines provide a more specific dose range for epinephrine, which is 0.1–0.5 mcg/kg/min, making it the most relevant and reliable source for this particular question 1.
From the FDA Drug Label
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). Intravenous infusion rate of 0.05 mcg/kg/min to 2 mcg/kg/min, titrated to achieve desired mean arterial pressure.
The dose range for epinephrine as a vasopressor is 0.05 mcg/kg/min to 2 mcg/kg/min, titrated to achieve the desired mean arterial pressure (MAP) 2 2.
From the Research
Dose Range for Epinephrine as a Vasopressor
The dose range for epinephrine (adrenaline) as a vasopressor can vary depending on the specific clinical context.
- In the context of cardiopulmonary resuscitation, the optimal dose of epinephrine is unknown, but studies suggest that a dose of 0.01 to 0.03 mg/kg may be effective 3.
- For adults, a dose of 1 mg of epinephrine has been used in out-of-hospital cardiopulmonary resuscitation 4.
- In some cases, continuous infusions of epinephrine (0.2-0.6 mg/min) may be indicated 5.
- The dose range for epinephrine in critically ill patients is not well established, but a weight-based dosing strategy has been evaluated in some studies 6.
Key Considerations
- The optimal dosing strategy for epinephrine as a vasopressor remains understudied 6.
- The effects of epinephrine can vary depending on the specific clinical context, such as the type of cardiac arrest (e.g. ventricular fibrillation, pulseless electrical activity, or asystole) 4.
- More research is needed to determine the optimal dose and route of administration of epinephrine in different clinical contexts 3.