Standard Epinephrine Dose for Anaphylaxis
For adults and children weighing ≥30 kg (66 lbs), administer 0.3 to 0.5 mL of epinephrine 1:1000 (1 mg/mL) intramuscularly into the anterolateral thigh; for children <30 kg, administer 0.01 mL/kg up to a maximum of 0.3 mL. 1
Adult Dosing
The standard dose is 0.3 to 0.5 mL of 1:1000 epinephrine (equivalent to 0.3 to 0.5 mg), administered intramuscularly into the anterolateral aspect of the thigh. 2, 1
This dose can be repeated every 5 to 10 minutes as clinically needed based on patient response. 1
The American Heart Association specifies that doses may be repeated every 5 to 15 minutes for persistent or recurrent symptoms. 2
Approximately 6-19% of patients require a second dose of epinephrine. 3
Pediatric Dosing
Children weighing less than 30 kg (66 lbs) should receive 0.01 mL/kg of 1:1000 epinephrine (0.01 mg/kg), up to a maximum of 0.3 mL (0.3 mg) per injection. 1
For children weighing 7.5 to 25 kg, a 0.15 mg autoinjector (0.15 mL equivalent) is recommended. 4
For children weighing ≥25 kg, a 0.3 mg autoinjector (0.3 mL equivalent) is recommended. 4
Repeat doses can be administered every 5 to 15 minutes if symptoms persist or recur. 4
Critical Administration Details
Route and site matter significantly for optimal outcomes:
Intramuscular injection into the anterolateral thigh (vastus lateralis muscle) is the preferred route, producing rapid peak plasma concentrations compared to subcutaneous administration. 3, 1
Use a needle long enough (at least 1/2 to 5/8 inch) to ensure intramuscular delivery. 1
The injection may be administered through clothing if necessary in emergency situations. 1
Do not inject into buttocks, digits, hands, or feet due to risk of tissue necrosis and poor absorption. 1
Do not administer repeated injections at the same site, as resulting vasoconstriction may cause tissue necrosis. 1
Understanding the Concentration
The 1:1000 concentration means 1 mg per 1 mL, so:
- 0.3 mL = 0.3 mg
- 0.5 mL = 0.5 mg
- This is the standard concentration for intramuscular/subcutaneous use in anaphylaxis. 1
When to Consider Intravenous Epinephrine
IV epinephrine should be reserved for patients in anaphylactic shock when an IV line is already in place, or for cardiac arrest or profound hypotension unresponsive to IM epinephrine and fluid resuscitation. 3
When IV administration is necessary, use 0.05 to 0.1 mg (0.5 to 1 mL of 1:10,000 solution, which is 0.1 mg/mL). 2
For continuous IV infusion, add 1 mg (1 mL of 1:1000) to 1000 mL of 0.9% normal saline, starting at 2 μg/min (120 mL/h) and titrating up to 10 μg/min (600 mL/h) based on blood pressure, heart rate, and oxygenation. 2
Critical Safety Points
There are no absolute contraindications to epinephrine use in anaphylaxis, even in elderly patients with cardiovascular disease or other comorbidities—the benefits far outweigh the risks. 2, 3
Inspect the solution before administration; do not use if colored, cloudy, or contains particulate matter. 1
Monitor patients clinically for reaction severity and potential cardiac effects, with repeat doses titrated to effect. 1
Common Pitfall to Avoid
The most dangerous error is confusing the 1:1000 (1 mg/mL) intramuscular dose with the 1:10,000 (0.1 mg/mL) intravenous dose used in cardiac arrest. 5 Administering the cardiac arrest dose (1 mg IV push) to an anaphylaxis patient can cause severe systolic dysfunction and potentially lethal cardiac complications. 5 Always verify you are using the correct concentration (1:1000 for IM) and correct volume (0.3-0.5 mL for adults, 0.01 mL/kg for children). 1