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

From the Guidelines

The recommended dose of epinephrine for the treatment of anaphylaxis is 0.01 mg/kg of a 1:1000 solution, with a maximum dose of 0.5 mg in adults and 0.3 mg in children, administered intramuscularly into the anterolateral thigh. This dose is based on the most recent and highest quality study, a 2020 practice parameter update, systematic review, and grading of recommendations, assessment, development and evaluation (GRADE) analysis published in the Journal of Allergy and Clinical Immunology 1.

Key Considerations

• The dose of epinephrine should be administered immediately upon recognition of anaphylaxis symptoms, as prompt treatment is crucial in preventing morbidity and mortality.
• The dose can be repeated every 5-15 minutes if symptoms persist or worsen, as anaphylaxis can be a biphasic reaction.
• Epinephrine autoinjectors, such as EpiPen, come in two standard doses: 0.3 mg for adults and children over 30 kg, and 0.15 mg for children 15-30 kg.
• After administering epinephrine, the patient should be placed in a supine position with legs elevated, unless respiratory distress is present, and emergency medical services should be called immediately.

Rationale

The use of epinephrine in anaphylaxis is supported by its rapid action in constricting blood vessels to increase blood pressure, relaxing airway muscles to improve breathing, and reducing hives and swelling 1. As the first-line treatment for anaphylaxis, epinephrine addresses all major pathophysiological aspects of this life-threatening reaction, including vasodilation, increased vascular permeability, and bronchospasm. Despite the lack of clear evidence supporting the role of antihistamines and glucocorticoids in anaphylaxis, epinephrine remains the cornerstone of anaphylaxis management and should be prioritized in treatment 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Anaphylaxis: Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary

The dose of epinephrine for the treatment of anaphylaxis is:

• 0.3 to 0.5 mg (0.3 to 0.5 mL) for adults and children 30 kg (66 lbs) or more, administered intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary.
• 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), for children 30 kg (66 lbs) or less, administered intramuscularly or subcutaneously into the anterolateral aspect of the thigh every 5 to 10 minutes as necessary 2.