From the Guidelines
For anaphylaxis, the recommended epinephrine dosage is 0.01 mg/kg of a 1:1000 solution to a maximum of 0.5 mg in adults and 0.3 mg in children, administered intramuscularly in the anterolateral thigh. This dosage is based on the most recent and highest quality study available, which emphasizes the importance of prompt administration of epinephrine in the treatment of anaphylaxis 1. The dose can be repeated every 5-15 minutes if symptoms persist or worsen.
Key Considerations
- Epinephrine is the first-line treatment for anaphylaxis, and its administration should not be delayed 1.
- The recommended route of administration is intramuscularly in the anterolateral thigh, as this may achieve a more rapid and higher plasma concentration than subcutaneous or intramuscular injection in the arm 1.
- Auto-injectors are available in fixed doses, but the dosage should be individualized based on the patient's weight and the severity of the reaction 1.
- Patients with cardiovascular disease should still receive epinephrine for anaphylaxis, as the risk of a life-threatening anaphylactic reaction is judged to exceed the risk of administering epinephrine in such patients 1.
Administration and Follow-up
- Epinephrine should be administered immediately upon recognition of anaphylaxis symptoms, and the patient should seek immediate medical attention even if symptoms improve, as biphasic reactions can occur 1.
- Antihistamines and corticosteroids are not a substitute for epinephrine in the treatment of anaphylaxis, although they may be used as adjunctive therapy 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 recommended dosage of epinephrine for 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.
From the Research
Epinephrine Dosage for Anaphylaxis
- The recommended dosage of epinephrine for anaphylaxis is 0.01-mg/kg (maximum 0.3-0.5 mg) 3, 4.
- For children, the dosage is 0.01 mg/kg, given intramuscularly in the lateral thigh 5.
- For adults, the dosage is 0.3 to 0.5 mL of 1:1000 dilution intramuscularly 5.
- It is essential to note that the dosage may vary depending on the patient's weight, with underdosing potentially contributing to mortality in anaphylaxis, particularly in heavy adult patients 4.
Special Considerations
- For patients weighing less than 15 kg, a lower dose of 0.1 mg may be more suitable, and a newly available 0.1 mg EAI with a shorter needle may be more appropriate 3.
- For obese patients weighing more than 30 kg, the 0.3 mg EAI needles may be too short, and alternative administration methods, such as vials and syringes, may be considered 3.
Administration and Safety
- Intramuscular delivery of epinephrine is the standard, and auto-injectors are available in various strengths (0.1,0.15,0.3, and 0.5 mg) 4.
- Cardiovascular adverse events are the greatest safety concern with epinephrine, but the potential harm of delaying or withholding epinephrine treatment for anaphylaxis far outweighs the potential risk of adverse events 6.