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

Recommended Epinephrine Dosing for Adults

The recommended dose of epinephrine for adults with anaphylaxis is 0.3 to 0.5 mg (1:1000 concentration) administered intramuscularly into the anterolateral aspect of the thigh, to be repeated every 5 to 15 minutes as needed. 1, 2

Route of Administration and Dosing

Intramuscular (IM) Route - First Line

• IM epinephrine is the preferred initial route due to ease of administration, effectiveness, and safety profile 3
• Adult dose: 0.3 to 0.5 mg (0.3 to 0.5 mL of 1:1000 concentration) 1, 2
• Administration site: anterolateral aspect of the thigh (vastus lateralis) 2, 4
• Frequency: can be repeated every 5 to 15 minutes as needed 1
• Auto-injectors deliver 0.3 mg of epinephrine for adults 1

Intravenous (IV) Route - Second Line

• IV epinephrine should only be considered when:

  • An IV line is already in place 1, 3
  • The patient has profound hypotension unresponsive to IM epinephrine 3, 5
  • The patient has failed to respond to several IM doses 3

• IV bolus dosing:

  • 0.05 to 0.1 mg (5-10% of the cardiac arrest dose) 1, 3
  • Must be administered slowly over several minutes to minimize adverse effects 3
  • Use 1:10,000 concentration (0.1 mg/mL) for IV administration 1, 3

IV Infusion - Alternative to Repeated Boluses

• Preparation options:
  • Add 1 mg (1 mL) of 1:1000 epinephrine to 250 mL of D5W (concentration: 4 μg/mL) 3, 5
  • Add 1 mg (1 mL) of 1:1000 epinephrine to 100 mL of saline (concentration: 10 μg/mL) 3, 5
• Initial infusion rate: 1-4 mcg/min, titrated up to a maximum of 10 mcg/min 5
• Alternative dosing: 5-15 μg/min (30-100 mL/hr of a 1:100,000 solution) 1, 5

Monitoring and Safety Considerations

• Continuous hemodynamic monitoring is essential when administering IV epinephrine 1, 3, 5

• In settings without advanced monitoring, use:

  • Every-minute blood pressure measurements 3
  • Continuous pulse monitoring 3
  • ECG monitoring if available 3

• Potential adverse effects include:

  • Tachyarrhythmias/ectopic beats 3, 5
  • Hypertension 3, 5
  • Risk of potentially lethal arrhythmias, particularly in patients with underlying heart disease 3, 6, 7
  • Extravasation causing severe skin injury with IV administration 3, 5

Common Pitfalls to Avoid

• Using incorrect concentration (1:1000 vs. 1:10,000) for IV administration 3, 6
  • 1:1000 (1 mg/mL) is for IM use
  • 1:10,000 (0.1 mg/mL) is for IV use
• Administering IV epinephrine too rapidly, increasing risk of adverse cardiovascular effects 3, 7
• Confusing anaphylaxis dosing with cardiac arrest dosing (cardiac arrest dosing is much higher) 6, 8
• Delaying epinephrine administration while focusing on second-line treatments like antihistamines or steroids 3, 9
• Injecting into buttocks, digits, hands, or feet, which can lead to poor absorption or tissue damage 2

Special Considerations

• For patients on β-blockers with refractory symptoms, consider glucagon (1-5 mg IV) 3
• For refractory hypotension despite epinephrine, consider alternative vasopressors such as dopamine 3
• In cardiac arrest secondary to anaphylaxis, standard resuscitative measures and immediate administration of epinephrine should take priority 1