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

Adrenaline Dosing in Anaphylaxis

Administer 0.3-0.5 mg of intramuscular epinephrine (1:1000 concentration) for adults and 0.01 mg/kg (maximum 0.3 mg) for children under 30 kg, injected into the anterolateral thigh, and repeat every 5-15 minutes as needed. 1, 2, 3

Adult Dosing

• The standard dose is 0.3-0.5 mg of epinephrine (1:1000 concentration) administered intramuscularly into the anterolateral aspect of the thigh. 1, 2, 3
• Repeat doses every 5-15 minutes based on patient response, with approximately 6-19% of patients requiring a second dose. 1
• The FDA-approved dosing interval is every 5-10 minutes, though clinical guidelines extend this to 5-15 minutes. 3, 1

Pediatric Dosing

• For children weighing less than 30 kg (66 lbs), administer 0.01 mg/kg (0.01 mL/kg of 1:1000 concentration) up to a maximum of 0.3 mg intramuscularly. 1, 3
• For children weighing 30 kg or more, use the adult dose of 0.3-0.5 mg. 3
• Repeat every 5-10 minutes as necessary. 3

Route of Administration: Critical Considerations

Intramuscular injection into the anterolateral thigh (vastus lateralis muscle) is the only appropriate first-line route. 1, 2

Why IM is Superior:

• Produces rapid peak plasma concentrations compared to subcutaneous administration. 1
• Subcutaneous injection has delayed onset of action and is less effective. 4
• Never inject into buttocks, digits, hands, or feet due to risk of tissue necrosis. 3

When to Consider IV Epinephrine:

• Reserve intravenous epinephrine exclusively for patients in anaphylactic shock when IV access is already established, or for cardiac arrest/profound hypotension unresponsive to IM epinephrine and fluid resuscitation. 1, 2
• IV dosing: 0.05-0.1 mg (1:10,000 concentration) administered slowly. 2
• For continuous infusion: Add 1 mg epinephrine to 1000 mL normal saline, starting at 2 μg/min and titrating up to 10 μg/min based on hemodynamics. 1

Critical Safety Points

There are no absolute contraindications to epinephrine use in anaphylaxis, even in elderly patients with cardiac comorbidities. 1

Common Pitfall to Avoid:

• Withholding epinephrine due to fear of adverse effects is dangerous and not recommended—the benefits far outweigh the risks. 1
• Common adverse effects (transient pallor, tremor, anxiety, palpitations) are acceptable given the life-threatening nature of anaphylaxis. 1, 3

Special Populations:

• Patients on beta-blockers who are unresponsive to epinephrine should receive glucagon: 1-5 mg IV over 5 minutes, followed by infusion of 5-15 μg/min. 2
• Elderly patients and pregnant women may have increased risk of adverse reactions but should still receive full doses. 3

Timing is Everything

Epinephrine is most effective when given immediately after symptom onset—delays in administration may be fatal. 4, 5

• Failure to inject epinephrine promptly is a major contributor to anaphylaxis fatalities. 4
• This is the only medication with life-saving pharmacologic effects across multiple organ systems, preventing and relieving both airway obstruction and shock. 4