From the Guidelines
For anaphylaxis, the recommended dose of epinephrine is 0.2 to 0.5 mg (1:1000) intramuscularly, which is equivalent to 0.2 to 0.5 cc of a 1:1000 solution, administered immediately upon recognition of anaphylaxis. This dose should be repeated every 5 to 15 minutes as needed, as recommended by the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The intramuscular route in the mid-outer thigh is preferred because it provides the fastest absorption and most reliable blood levels.
Key Considerations
- Epinephrine works by constricting blood vessels to increase blood pressure, relaxing smooth muscles in the lungs to improve breathing, and reducing swelling and hives.
- Patients with known severe allergies should carry epinephrine auto-injectors (like EpiPen or Auvi-Q) for immediate use.
- After administration, seek emergency medical care immediately as the effects of epinephrine are temporary, and a second dose may be needed if symptoms persist or return.
Additional Recommendations
- In patients with anaphylactic shock, close hemodynamic monitoring is recommended 1.
- Given the potential for the rapid development of oropharyngeal or laryngeal edema, immediate referral to a health professional with expertise in advanced airway placement, including surgical airway management, is recommended 1.
- When an IV line is in place, it is reasonable to consider the IV route for epinephrine in anaphylactic shock, at a dose of 0.05 to 0.1 mg (0.1 mg/mL, aka 1:10 000) 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 dose of epinephrine for anaphylaxis is:
- 0.3 to 0.5 mL for adults and children 30 kg (66 lbs) or more
- 0.01 mL/kg (up to 0.3 mL) for children less than 30 kg (66 lbs) 2
From the Research
Epinephrine Dosage for Anaphylaxis
- The recommended dose of epinephrine for anaphylaxis is 0.01 mg/kg, with a maximum dose of 0.3-0.5 mg for adults 3, 4, 5.
- For children, the dose is 0.01 mg/kg, with a maximum dose of 0.3-0.5 mg 3, 4.
- Epinephrine auto-injectors are available with doses of 0.15,0.30, and 0.50 mg, and needle lengths vary from 1.17 to 2.50 cm 6.
- A newly available 0.1 mg epinephrine auto-injector has a lower dose and shorter needle, making it more suitable for patients weighing 7.5 to 15 kg 4.
Administration Route and Site
- The recommended route of administration is intramuscularly, with the lateral thigh being the preferred site 3, 4, 5.
- The intramuscular route and lateral thigh site are considered superior due to the rapid absorption of epinephrine 4.