Epinephrine Drip Dosage and Administration Protocol
For hypotension associated with septic shock in adults, epinephrine should be administered as an intravenous infusion at 0.05 mcg/kg/min to 2 mcg/kg/min, titrated to achieve the desired mean arterial pressure (MAP). 1
Preparation and Administration
Dilution Protocol
- Dilute 10 mL (1 mg) of epinephrine in 1,000 mL of 5% dextrose solution or 5% dextrose and sodium chloride solution to produce a 1 mcg/mL concentration 1
- The diluted solution can be stored for:
- Up to 4 hours at room temperature
- Up to 24 hours under refrigerated conditions
Administration Guidelines
- Administer into a large vein to minimize risk of extravasation 1
- Avoid catheter tie-in techniques that may obstruct blood flow and cause increased local drug concentration 1
- Avoid using veins of the leg in elderly patients or those with occlusive vascular diseases 1
Dosing Titration
- Initial dose: Start at 0.05 mcg/kg/min 1
- Titration: Adjust dosage every 10-15 minutes in increments of 0.05-0.2 mcg/kg/min to achieve target MAP 1
- Maximum dose: Up to 2 mcg/kg/min 1
Weaning Protocol
- After hemodynamic stabilization, wean incrementally over time
- Decrease doses every 30 minutes over a 12-24 hour period 1
Monitoring During Administration
- Continuous monitoring of:
- Blood pressure (target MAP)
- Heart rate
- Cardiac rhythm
- Signs of tissue perfusion
- Signs of extravasation at infusion site
Important Precautions and Potential Adverse Effects
Major Precautions
- Monitor for acute severe hypertension 1
- Watch for signs of pulmonary edema, which may be fatal 1
- Be alert for cardiac arrhythmias and myocardial ischemia, particularly in patients with underlying heart disease 1
- Avoid extravasation into tissues, which can cause local necrosis 1
- Monitor for oliguria or renal impairment 1
Common Adverse Reactions
- Headache, anxiety, restlessness, tremor, weakness, dizziness
- Diaphoresis, nausea/vomiting, respiratory difficulties
- Arrhythmias (including potentially fatal ventricular fibrillation)
- Rapid blood pressure rises that may cause cerebral hemorrhage
- Angina 1
Drug Interactions
- Drugs that counter epinephrine's effects: alpha blockers, vasodilators, diuretics, antihypertensives, ergot alkaloids 1
- Drugs that potentiate epinephrine's effects: sympathomimetics, beta blockers, tricyclic antidepressants, MAO inhibitors, COMT inhibitors 1
- Drugs that increase arrhythmogenic potential: beta blockers, certain anesthetics, quinidine, antihistamines, thyroid hormones, diuretics, cardiac glycosides 1
- Potassium-depleting drugs (corticosteroids, diuretics, theophylline) potentiate hypokalemic effects 1
Clinical Pearls
- Visually inspect solution before administration; do not use if colored, cloudy, or contains particulate matter 1
- Administration in saline solution alone is not recommended 1
- If whole blood or plasma is indicated, administer separately 1
- Elderly patients and pregnant women may be at greater risk of developing adverse reactions 1