From the Guidelines
For bronchospasm, the recommended intravenous epinephrine dose is 100-500 micrograms (0.1-0.5 mg) administered slowly over 1-5 minutes in adults, as stated in the guidelines for anaphylaxis management 1, 2. This dose should be diluted to a 1:10,000 solution (0.1 mg/mL) for precise dosing.
- Start with the lower end of the dosing range (100 micrograms) and titrate based on clinical response.
- In severe cases, this may be repeated every 5-15 minutes as needed.
- Continuous monitoring of heart rate, blood pressure, and oxygen saturation is essential during administration due to potential cardiovascular side effects. Epinephrine works by stimulating both alpha and beta adrenergic receptors, with beta-2 stimulation causing bronchodilation to relieve bronchospasm.
- The beta-1 effects increase heart rate and contractility, while alpha effects cause vasoconstriction.
- Lower doses tend to favor beta effects (bronchodilation) while higher doses increase alpha effects (vasoconstriction). Use caution in patients with coronary artery disease, hypertension, arrhythmias, or hyperthyroidism, as these conditions may be exacerbated by epinephrine administration 1. In situations where intravenous epinephrine is considered essential, monitoring by available means (eg, every-minute blood pressure and pulse measurements and electrocardiographic monitoring, if available) should be conducted 2. For bronchospasm resistant to epinephrine, consider nebulized albuterol, 2.5-5 mg in 3 mL of saline, and repeat as necessary 1, 2.
From the Research
Dosage of Intravenous Epinephrine for Bronchospasm
- The provided studies do not directly address the dosage of intravenous epinephrine for bronchospasm.
- Studies 3, 4, 5, 6, 7 discuss various treatments for bronchospasm, including beta-2 agonists, anticholinergics, and theophylline, but do not mention the use of intravenous epinephrine.
- Therefore, there is no specific dosage of intravenous epinephrine for bronchospasm that can be recommended based on the provided evidence.
Alternative Treatments for Bronchospasm
- Inhaled beta-2 agonists, such as albuterol, are commonly used to treat bronchospasm 3, 5, 6.
- Anticholinergics, such as ipratropium, may also be effective in treating bronchospasm 4, 5.
- Theophylline, a methylxanthine, has been used to treat acute bronchospastic exacerbations of chronic obstructive pulmonary disease, but its use is not recommended due to the risk of toxicity 7.