From the Guidelines
Push dose epinephrine is typically prepared as 10 mcg/mL and administered as 10-20 mcg (1-2 mL) IV boluses every 1-5 minutes as needed for hypotension. To prepare push dose epinephrine, take 1 mL of cardiac epinephrine (1:10,000 or 0.1 mg/mL) and dilute it with 9 mL of normal saline in a 10 mL syringe, resulting in a 10 mcg/mL concentration. This medication provides rapid but short-acting vasopressor support during emergent situations like peri-intubation hypotension or while preparing continuous vasopressor infusions. The recommended dosage is based on the most recent and highest quality study available, which is from 2015 1. Push dose epinephrine works through alpha-adrenergic stimulation causing vasoconstriction and beta-adrenergic effects increasing heart rate and contractility. Caution should be exercised as excessive or too frequent dosing can cause tachyarrhythmias, hypertension, or myocardial ischemia. Vital signs should be monitored closely during administration, and a transition to continuous vasopressors should be considered for patients requiring ongoing hemodynamic support. Some key points to consider when administering push dose epinephrine include:
- Monitoring vital signs closely during administration
- Considering a transition to continuous vasopressors for patients requiring ongoing hemodynamic support
- Being cautious of potential side effects such as tachyarrhythmias, hypertension, or myocardial ischemia
- Administering the medication as needed for hypotension, typically every 1-5 minutes.
From the FDA Drug Label
- DOSAGE & ADMINISTRATION
The FDA drug label does not answer the question.
From the Research
Dosage for Push Dose Epi
- The dosage for push dose epinephrine is typically 10-20 µg of 1:100,000 epinephrine given intravenously every 2 minutes until the systolic blood pressure (SBP) is at least 90 mmHg or the mean arterial pressure (MAP) is 65 mmHg or greater 2.
- This dosage is used to correct documented hypotension in critically ill patients during critical care transport.
- The use of push dose epinephrine has been found to be effective in temporarily resolving hypotension, with a median increase in MAP of 13.0 mmHg and a resolution of hypotension in 58.5% of instances 2.
- The administration of push dose epinephrine should be guided by established protocols and should be used in conjunction with other treatments, such as fluid resuscitation and antihistamines, as needed 3, 4, 5.