What is the dose of adrenaline (epinephrine) in anaphylaxis?

From the Guidelines

The recommended dose of adrenaline (epinephrine) for anaphylaxis is 0.01 mg/kg of 1 mg/mL (1:1000), up to 0.5 mg in adults and 0.3 mg in children, administered intramuscularly into the vastus lateralis (antero-lateral thigh). This dose can be repeated every 5 to 15 minutes if anaphylaxis signs or symptoms persist 1. For self-administration using an auto-injector, the specific device and dosage may vary based on patient weight and clinical guidelines. It is essential to note that epinephrine is the first-line treatment for anaphylaxis and should be administered promptly, as delayed use can be ineffective. After administering epinephrine, the patient should be placed in a comfortable position and emergency medical services should be called immediately, even if symptoms improve.

Key considerations for the administration of epinephrine in anaphylaxis include:

• The dose should be based on the patient's weight, with a maximum dose of 0.5 mg for adults and 0.3 mg for children.
• The injection should be given intramuscularly into the anterolateral thigh to achieve rapid absorption.
• Repeated doses may be necessary if symptoms persist or worsen, with the interval between doses typically ranging from 5 to 15 minutes.
• Antihistamines and glucocorticoids may be used as adjunctive therapy but should not be administered before or in place of epinephrine.

The most recent and highest quality study, published in 2024, supports the use of epinephrine as the first-line treatment for anaphylaxis, emphasizing its importance in managing this potentially life-threatening condition 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 adrenaline in anaphylaxis is:

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

From the Research

Adrenaline Dose in Anaphylaxis

• The initial recommended adult dose of adrenaline (epinephrine) for the treatment of anaphylaxis is 0.3-0.5 mg, injected intramuscularly in the anterolateral aspect of the mid-thigh 3.
• Another study recommends a dose of 300-600 µg for an adult or 10 µg/kg for a child, administered via intramuscular injection with an autoinjector 4.
• A more recent study suggests a dose of 0.01 mg/kg (up to 0.5 mg in adults) intramuscularly in the anterolateral thigh 5.

Administration Route

• Intramuscular injection is the preferred route of administration, as it has a more satisfactory therapeutic window compared to subcutaneous or intravenous injection 3, 4.
• Intravenous administration is recommended in patients who are refractory to intramuscular epinephrine and intravenous fluids, or those with cardiovascular collapse 5.

Repeated Doses

• Repeated doses of epinephrine may be necessary, and can be administered every 10-15 minutes until there is a response 4.
• Risk factors for biphasic reactions, which may affect 1-7% of patients with anaphylaxis, include severe initial presentation and repeated doses of epinephrine 5.