Adrenaline injection instructions for use. Adrenaline - properties and use of injection solution

Adrenaline in injection ampoules is a drug that affects the heart and the entire vascular system. The substance can increase blood pressure. The drug is classified as a special type of hormone, it is also called the emergency hormone. Adrenaline can give a sharp jolt to the body and helps in extreme or critical situations.

In the medical field, an injection of adrenaline is used in cardiac arrest or other situations that may threaten human life. Adrenaline for injection is sold at any pharmacy, but it must be used carefully and only on the recommendation of a doctor.

Types and composition of solution

In the medical field, the solution is also called epinephrine. The main component of the substance is also the same. For injection, epinephrine hydrochloride and epinephrine hydrotartrate are produced. The characteristic feature of the first substance is that it changes upon contact with daylight and air. The liquid for the main component is 0.01% hydrochloric acid.

The second type of drug is characterized by the fact that it is mixed with water, since it does not change upon contact with water or air. Sometimes you have to take a higher dose for an injection, due to the difference in the molecular weight of the two substances.
The package with the medicinal substance contains 1 ml of a solution of 0.1% hydrochloride concentrate or 0.18% hydrogen tartrate.

There is also another form of the product - reddish-orange capsules, which contain 30 ml of ready-to-use solution. This solution is used for intramuscular and intravenous injections. Tablets of the drug are also available for purchase.

How do adrenaline injections work?

Pharmacodynamics. The effect of the injection lies in its effect on alpha and beta adrenaline receptors. What will happen if you inject with such a substance?
The body's reaction to the use of epinephrine is to narrow the blood vessels in the abdominal cavity, on the skin or mucous membranes. The vascular system of the muscles reacts much less to hormone changes. The body can react to injections like this:

• adrenaline receptors of the heart react to the drug, thereby causing an increase in the rate of contraction of the ventricular muscles;
• there is an increase in glucose in the blood system;
• enrichment of the body with glucose is significantly accelerated, which allows you to obtain a large amount of necessary energy in a short time;
• the respiratory tract expands, the body receives more necessary oxygen;
• blood pressure increases significantly in a short time;
• The body stops responding to possible pathogens for a certain period of time.

Adrenaline can also suppress the production of fat deposits, improve muscle activity, and activate the central nervous system. It also stimulates the production of hormones, improves the functioning of the adrenal cortex (which improves the functioning of hormones), enzymes are activated, and the functioning of the blood system is significantly improved.

Application in medicine

Many patients find that their doctor prescribes epinephrine injections for them. But why it should be used is worth examining in more detail.
The instructions that are attached to each package have clear instructions for using the drug:

1. Complex cases of low blood pressure, if other substances have failed (heart surgery, shock from injury, heart or kidney failure);
2. During an overdose of various medications;
3. With severe spasms of the bronchi during surgery;
4. A sudden and severe asthma attack;
5. Severe bleeding from the vessels of the mucous membranes or skin;
6. To suppress various types of bleeding that cannot be stopped with the help of other drugs;
7. To quickly eliminate allergies;
8. With a sharp weakening of contractions of the heart muscle;
9. Low glucose levels;
10. Medicine for ophthalmic surgical operations, for various types of glaucoma.
11. The substance can increase the duration of anesthesia, which is used for prolonged surgical interventions.

Patients should under no circumstances self-prescribe the drug. It is prohibited to use the drug for injection on your own. Violation of such rules can lead to undesirable consequences and serious complications.

Contraindications for use

Since the drug has a serious effect on the body, it also has a number of contraindications. If we talk about older people, the drug is prescribed for them only if there is a real threat to life. But, even in such cases, a low dosage of the drug is used. The drug may be contraindicated in the following circumstances:

• if the patient has symptoms of atherosclerosis;
• high blood pressure;
• when the vessels dilate more than 2 times (aneurysm);
• various stages of diabetes mellitus (due to the fact that glucose levels increase, which can lead to death);
• when thyroid hormones are produced too much;
• with bleeding;
• while carrying a child (the period does not matter);
• in some forms of glaucoma;
• if there is severe intolerance to the components of the product.

In some cases, epinephrine may be used to prolong a patient's anesthesia. But they do this with extreme caution, since adrenaline may enhance the effect of not every anesthetic. During such use of two or more drugs, it is important to maintain compatibility.

Dosage

Parenterally: during a state of shock, hypoglycemia - by dropper, less often - intramuscularly, but slowly;
For adults - 0.5 – 0.75 ml,
Children - 0.2 – 0.5 ml;
High doses are administered using a dropper: single - 1 ml, daily dose - 5 ml.
During an asthmatic attack (adults) - droppers of 0.3–0.7 ml.
Cardiac arrest - intracardial 1 ml.

Possible overdose

There are cases of overdose of a substance, even if it was prescribed by a doctor. This is due to incorrect dosage calculations or other possible health problems.
Symptoms of an overdose can be: a sharp rise in blood pressure much higher than normal, an excessively rapid pulse that quickly turns into bradycardia, pale skin. Then the body suddenly becomes cold, a severe headache appears, and poor orientation in space appears.

Severe manifestations of an overdose: heart attack, cerebral hemorrhage, breathing problems and poor lung condition. There are cases of overdose that cause death.
Overdose rarely occurs if the injections are administered by a doctor in a medical facility. It is for this reason that it is very important to carry out injections in a hospital. After all, if an adverse reaction or overdose occurs, there is access to defibrillators, and doctors will be able to quickly take anti-shock measures.

If the first signs of an overdose appear or adverse reactions occur, you must stop using the drug.
To lower blood pressure, alpha-blockers are used, and to restore normal heart rhythm, beta-blockers are used:

1. Non-selective: nadolol, timolol;
2. Selective: atenolol;
3. Non-selective: labetalol;
4. B1 – selective: nebivolol.

Adverse reactions

The drug not only combines all human powers to protect against possible danger or stress. Since use increases blood pressure, heart rate increases, headaches may occur, and a distorted perception of reality may appear. In such situations, it is difficult for a person to breathe; the feeling of suffocation and lack of oxygen accompanies the person for several more hours. Sometimes hallucinations occur, which can affect future mental and emotional health. The patient may not control his actions and emotions.

If an uncontrolled release of the hormone occurs, the person will clearly feel severe irritability and anxiety. This is influenced by the rapid processing of glucose, increased by adrenaline, with the release of additional energy that is not required at the moment.

The substance does not always act for the benefit of the body. When its amount increases greatly, and it is used for a long period, the hormone complicates the functioning of the cardiac system. This can cause heart problems that need to be treated in a hospital. High levels of epinephrine in the blood affect the occurrence of various signs of psychological disorders, lack of sleep and vigor. Typically, such a reaction negatively affects well-being and subsequently affects the patient’s health.

Adverse reactions include:

1. A sharp increase in blood pressure and deterioration in health;
2. Increased heart rate;
3. If the patient has coronary heart disease, there is a risk of angina pectoris;
4. In the area of ​​the heart there is pressure and severe pain that hinders movement;
5. A person suffers from nausea, which turns into vomiting;
6. The patient feels dizzy and disoriented, spasms in the temples;
7. Mental disorders and panic attacks may occur;
8. A rash may appear on the skin, itching and other allergic reactions may occur;
9. From the genitourinary system, disturbances or difficulties in urination are possible;
10. Increased sweating is possible (extremely rare cases).

If the patient experiences an adverse reaction from using the medication, it is necessary to stop using the substance and consult a doctor about further medication use. Even if injections are given regularly, adverse reactions may also occur.

How to combine

Adrenaline antagonists include α- and β-adrenergic receptor blockers. Non-selective beta-blockers cause a pressor effect of adrenaline.

• Use simultaneously with cardiac glycosides increases the risk of arrhythmia. It is prohibited to use the drugs at the same time. Allowed only in extreme cases;
• with drugs whose action is aimed at eliminating certain symptoms, adverse reactions affecting the state of the cardiac or vascular system may increase;
• with medications for hypertension – their effect noticeably decreases;
• with alkaloids – increases the effect, which negatively affects the patient’s condition (Development of ischemic disease, can cause the development of gangrene);
• Thyroid hormone products – increase the effect of the drug;
• adrenaline reduces the effectiveness of the use of hypoglycemic drugs (this also includes insulin), opioids, and sleeping pills. If we talk about diabetes, the use of adrenaline is prohibited and can only be used in extreme cases;
• combination with drugs that prolong the QT interval results in a sharp duration of action of the drug.

Directions for using the medicine

Adrenaline should be taken with caution for: heart disease, hypertension and arrhythmia. It is very rare now that doctors prescribe the drug after a heart attack; more often they replace it with weaker substances that do not have a strong effect on the cardiac system.
Used in small doses for diseases associated with blood vessels, as there is a risk of complications and side effects.

The substance is rarely used for serious chronic diseases, such as atherosclerosis, glaucoma, diabetes mellitus, prostate hypertrophy.
Weak doses are used for the elderly, children, if anesthesia is used.

Adrenaline is not recommended for use arterially, as a sharp narrowing of blood vessels may occur, which often causes gangrene. If the patient is in cardiac arrest, intracoronary epinephrine may be used. In cases of arrhythmia in a patient, in addition to the drug, the doctor must use beta-blockers.

Pregnancy

Carrying a baby is considered a special period, and the use of Epinephrine (adrenaline) is not recommended. This is due to the fact that it penetrates the placenta and is excreted through breast milk, which can negatively affect the baby’s health.
And although there have been no high-quality studies on the safe use of the substance, doctors usually replace it with safer means.

Pregnant and nursing mothers can only use the drug if the result of treatment outweighs the possible risk to the child.
When therapy is carried out, various tests are first performed to identify a negative reaction.

How to store the substance

The product should be stored in a dark room or in dark packaging. Temperature range from 15 to 25°C. Avoid contact with children.
If the packaging of the drug was damaged during storage or transportation, the substance is not recommended for use.

Read these instructions carefully before you start taking/using this medicine.
Save the instructions, you may need them again.
If you have any questions, consult your doctor.
This medicine is prescribed for you personally and should not be given to others because it may harm them even if they have the same symptoms as you.

INSTRUCTIONS for the use of the medicinal product for medical use ADRENALINE

Registration number: LS-001849-210414
Trade name: Adrenaline
International nonproprietary name: Epinephrine
Chemical name: (R)-1-(3,4-Dihydroxyphenyl)-2methylaminoethanol
Dosage form: solution for injection

Compound:
1 ml of solution contains:
Active substance:
epinephrine (adrenaline) - 1.00 mg
Excipients:
sodium chloride - 8.00 mg,
sodium disulfite (sodium metabisulfite) - 1.00 mg,
chlorobutanol hemihydrate (chlorobutanol hydrate), equivalent to 5.00 mg chlorobutanol,
disodium edetate (disodium salt of ethylenediaminetetraacetic acid) - 0.50 mg,
glycerol (glycerin) - 60.00 mg,
hydrochloric acid - up to pH 2.5-4.0,
water for injection - up to 1 ml.

Description: transparent, colorless or slightly colored liquid with a characteristic odor.

Pharmacotherapeutic group: α- and β-adrenomimetic.

ATX code: C01CA24

Pharmacological properties

Pharmacodynamics
The action is due to the activation of receptor-dependent adenylate cyclase on the inner surface of the cell membrane, an increase in the intracellular concentration of cyclic adenosine monophosphate (cAMP) and calcium ions (Ca2+). In very low doses, at a rate of administration less than 0.01 mcg/kg/min, it can reduce blood pressure due to vasodilation of skeletal muscles. At an injection rate of 0.04-0.1 mcg/kg/min, it increases the frequency and strength of heart contractions, stroke volume and minute blood volume, and reduces total peripheral vascular resistance; above 0.02 mcg/kg/min constricts blood vessels, increases blood pressure (mainly systolic) and total peripheral vascular resistance. The pressor effect can cause a short-term reflex slowing of the heart rate.
Relaxes the smooth muscles of the bronchi. Doses above 0.3 mcg/kg/min reduce renal blood flow, blood supply to internal organs, tone and motility of the gastrointestinal tract.
Dilates the pupils, helps reduce the production of intraocular fluid and intraocular pressure. Causes hyperglycemia (increases glycogenolysis and gluconeogenesis) and increases plasma levels of free fatty acids.
Increases conductivity, excitability and automatism of the myocardium. Increases myocardial oxygen demand.
Inhibits the release of histamine and leukotrienes induced by antigens, eliminates spasm of bronchioles, and prevents the development of edema of their mucous membrane.
Acting on α-adrenergic receptors located in the skin, mucous membranes and internal organs, it causes vasoconstriction, reduces the rate of absorption of local anesthetics, increases the duration and reduces the toxic effect of local anesthesia.
Stimulation of β2-adrenergic receptors is accompanied by increased excretion of potassium ions (K+) from the cell and can lead to hypokalemia.
When administered intracavernosally, it reduces the blood supply to the cavernous bodies.
The therapeutic effect develops almost instantly with intravenous administration (duration of action - 1-2 minutes), 5-10 minutes after subcutaneous administration (maximum effect - after 20 minutes), with intramuscular administration - the onset of the effect is variable.
Pharmacokinetics
- suction
When administered intramuscularly or subcutaneously, it is well absorbed. When administered parenterally, it is quickly destroyed. It is also absorbed after endotracheal and conjunctival administration. The time to reach maximum concentration in the blood with subcutaneous and intramuscular administration is 3-10 minutes. Penetrates through the placenta, into breast milk, does not penetrate the blood-brain barrier.
- metabolism
Metabolized mainly by monoamine oxidase and catechol-O-methyltransferase in the endings of sympathetic nerves and other tissues, as well as in the liver, with the formation of inactive metabolites. The half-life for intravenous administration is 1-2 minutes.
- excretion
It is excreted by the kidneys in the main form of metabolites: vanillylmandelic acid, sulfates, glucuronides, and also in small quantities - unchanged.

Indications for use

Immediate allergic reactions (including urticaria, angioedema, anaphylactic shock) that develop when using drugs, serums, blood transfusions, eating foods, insect bites or the introduction of other allergens; exercise asthma;
Bronchial asthma (relief of status asthmaticus), bronchospasm during anesthesia;
Asystole (including against the background of acutely developed atrioventricular block of the third degree);
Bleeding from superficial vessels of the skin and mucous membranes (including gums);
Arterial hypotension not responding to adequate volumes of replacement fluids (including shock, bacteremia, open heart surgery, renal failure);
The need to prolong the action of local anesthetics;
Episodes of complete atrioventricular block (with the development of syncope (Morgagni-Adams-Stokes syndrome));
Stops bleeding (as a vasoconstrictor).

Contraindications

Hypersensitivity to any of the components of the drug, arterial hypertension, severe atherosclerosis (including cerebral atherosclerosis), hypertrophic obstructive cardiomyopathy, tachyarrhythmia, coronary heart disease, ventricular fibrillation, atrial fibrillation, ventricular arrhythmias, chronic heart failure grade 3-4, myocardial infarction, pheochromocytoma, thyrotoxicosis, diabetes mellitus, acute and chronic arterial insufficiency (including a history of arterial embolism, atherosclerosis, Buerger's disease, diabetic endarteritis, Raynaud's disease), hypovolemia, metabolic acidosis, hypercapnia, hypoxia, pulmonary hypertension, shock of non-allergic origin (including including cardiogenic, traumatic, hemorrhagic), cold injury, Parkinson's disease, organic brain damage, angle-closure glaucoma, convulsive syndrome, prostatic hyperplasia, age under 18 years (except for conditions directly threatening life), pregnancy, lactation, simultaneous use of inhaled agents for general anesthesia (halothane), epinephrine in combination with local anesthetics is not used for local anesthesia of fingers and toes due to the risk of ischemic tissue damage.
In emergency conditions, all contraindications are relative.

With caution

Hyperthyroidism, old age.
To prevent arrhythmias while using the drug, beta-blockers are prescribed.

Use during pregnancy and lactation: see section “Contraindications”.

Directions for use and doses

Subcutaneously, intramuscularly, intravenously.
Immediate allergic reactions (anaphylactic shock): slowly intravenously 0.1-0.25 mg diluted in 10 ml of 0.9% sodium chloride solution, if necessary continue intravenous drip administration at a concentration of 1:10000. In the absence of an immediate threat to life, intramuscular or subcutaneous administration of 0.3-0.5 mg is preferable, if necessary, repeated administration after 10-20 minutes up to 3 times.
Bronchial asthma: subcutaneously 0.3-0.5 mg, if necessary, repeated doses can be administered every 20 minutes up to 3 times, or intravenously 0.1-0.25 mg with a dilution in a concentration of 1:10000.
For asystole: intracardially 0.5 mg (diluted with 10 ml of 0.9% sodium chloride solution or other solution); during resuscitation measures - 0.5-1 mg (diluted) intravenously every 3-5 minutes. If the patient is intubated, endotracheal installation is possible - doses should be 2-2.5 times higher than doses for intravenous administration.
Stop bleeding - locally in the form of tampons moistened with a solution of the drug.
For arterial hypotension: 1 mcg/min intravenously, the rate of administration can be increased to 2-10 mcg/min.
To prolong the effect of local anesthetics: at a concentration of 0.005 mg/ml (the dose depends on the type of anesthetic used), for spinal anesthesia - 0.2-0.4 mg.
Morgagni-Adams-Stokes syndrome (bradyarrhythmic form) at a dose of 1 mg in 250 ml of 5% glucose solution intravenously, gradually increasing the infusion rate until a minimum sufficient number of heartbeats is achieved.
As a vasoconstrictor, 1 mcg/min intravenously, the rate of administration can be increased to 2-10 mcg/min.
Application in pediatric practice:
Newborns (asystole): intravenously, 10-30 mcg/kg every 3-5 minutes, slowly.
Children over 1 month: intravenously, 10 mcg/kg (subsequently, if necessary, 100 mcg/kg is administered every 3-5 minutes (after administration of at least 2 standard doses, higher doses can be used every 5 minutes - 200 mcg /kg). Endotracheal administration can be used.
For children with anaphylactic shock: subcutaneously or intramuscularly, 0.01 mg/kg (maximum - up to 0.3 mg), if necessary, these doses are repeated every 15 minutes (up to 3 times).
For children with bronchospasm: subcutaneously 10 mcg/kg (maximum - up to 0.3 mg), doses, if necessary, repeated every 15 minutes (up to 3-4 times) or every 4 hours.

Side effect

Classification of the frequency of side effects (BOZ):
very often > 1/10
often > 1/100 to< 1/10
uncommon > 1/1000 to< 1/100
rarely from > 1/10000 to< 1/1000
very rarely from< 1/10000, включая отдельные сообщения.
From the cardiovascular system: infrequently - angina, bradycardia or tachycardia, palpitations, increased or decreased blood pressure, at high doses - ventricular arrhythmias (including ventricular fibrillation), rarely - arrhythmia, chest pain, pulmonary edema.
From the nervous system: often - headache, anxiety, tremor, tic, infrequently - dizziness, nervousness, fatigue, nausea, vomiting, personality disorders (psychomotor agitation, disorientation, memory impairment, psychotic disorders: aggressive or panic behavior, schizophrenia-like disorders , paranoia), sleep disturbance, muscle twitching.
From the digestive system: often - nausea, vomiting.
From the urinary system: rarely - difficult and painful urination (with prostatic hyperplasia).
Local reactions: uncommon - pain or burning at the site of intramuscular injection.
Allergic reactions: uncommon - angioedema, bronchospasm, skin rash, erythema multiforme.
Other: infrequently - increased sweating; rarely - hypokalemia.
If the side effects indicated in the instructions get worse, or you notice any other side effects not listed in the instructions, tell your doctor.

Overdose

Symptoms: excessive increase in blood pressure, tachycardia alternating with bradycardia, rhythm disturbances (including atrial and ventricular fibrillation), coldness and pallor of the skin, vomiting, headache, metabolic acidosis, myocardial infarction, cranial hemorrhage (especially in elderly patients), pulmonary edema, death.
Treatment: stop administration, symptomatic therapy - to lower blood pressure - α-blockers (phentolamine), for arrhythmia - β-blockers (propranolol).

Interaction with other drugs

Epinephrine antagonists are α- and β-adrenergic receptor blockers.
The effectiveness of epinephrine is reduced in patients with severe anaphylactic reactions taking beta-blockers. In this case, salbutamol is used intravenously.
Use together with other adrenergic agonists may enhance the effect of epinephrine.
Reduces the effects of narcotic analgesics and sleeping pills.
When used simultaneously with cardiac glycosides, quinidine, tricyclic antidepressants, dopamine, inhalation anesthetics (enflurane, halothane, isoflurane, methoxyflurane), cocaine, the risk of developing arrhythmias increases (they should be used together with extreme caution or not at all); with other adrenergic agonists - increased severity of side effects from the cardiovascular system; with antihypertensive drugs - a decrease in their effectiveness.
With diuretics, it is possible to increase the pressor effect of epinephrine.
Concomitant use with drugs that inhibit monoamine oxidase (procarbazine, selegiline, and furazolidone) can cause a sudden and pronounced increase in blood pressure, hyperpyretic crisis, headache, cardiac arrhythmias, vomiting; with nitrates - weakening of their therapeutic effect; with phenoxybenzamine - increased hypotensive effect and tachycardia; with phenytoin - a sudden decrease in blood pressure and bradycardia (depending on the dose and rate of administration); with thyroid hormone preparations - mutual enhancement of action; with drugs that prolong the QT interval (including astemizole, cisapride, terfenadine) - prolongation of the QT interval; with diatrizoates, iothalamic or ioxaglic acids - increased neurological effects; with ergot alkaloids - increased vasoconstrictor effect (up to severe ischemia and development of gangrene).
Reduces the effect of insulin and other hypoglycemic drugs.

Special instructions

Accidental intravenous administration of epinephrine can cause a sudden increase in blood pressure.
An increase in blood pressure when the drug is administered can cause angina attacks. Epinephrine may cause renal capillary constriction, thereby reducing diuresis.
During infusion, a device with a measuring device should be used to regulate the rate of infusion.
Infusions should be carried out into a large (preferably central) vein.
It is administered intracardially during asystole, if other methods are not available, because there is a risk of cardiac tamponade and pneumothorax.
During the treatment period, it is recommended to determine the concentration of potassium ions (K+) in the blood serum, measure blood pressure, diuresis, minute volume of blood circulation, electrocardiogram, central venous pressure, pressure in the pulmonary artery and wedge pressure in the pulmonary capillaries.
Excessive doses during myocardial infarction may increase ischemia by increasing myocardial oxygen demand.
Increases glycemia, which is why diabetes mellitus requires higher doses of insulin and sulfonylurea derivatives.
When administered endotracheally, absorption and final plasma concentrations of the drug may be unpredictable.
The administration of epinephrine during shock does not replace transfusions of blood, plasma, blood substitute fluids and/or saline solutions.
Epinephrine is not advisable for long-term use (constriction of peripheral blood vessels, leading to the possible development of necrosis or gangrene).
There are no strictly controlled studies of the use of epinephrine in pregnant women. A statistically consistent relationship has been established between the appearance of malformations and inguinal hernia in children whose mothers used epinephrine during the first trimester or throughout pregnancy; in one case, anoxia in the fetus was also reported after intravenous administration of epinephrine to the mother.
Use for correction of low blood pressure during labor is not recommended as it may delay the second stage of labor; when administered in large doses to weaken uterine contractions, it can cause prolonged uterine atony with bleeding.
Can be used in children with cardiac arrest, but caution should be used.
When stopping treatment, doses should be reduced gradually, since sudden discontinuation of therapy can lead to a decrease in blood pressure.
Easily destroyed by alkalizing substances and oxidizing agents, including chlorides, bromides, nitrites, iron salts, peroxides.
If the solution has turned pinkish or brown in color or contains sediment, it should not be administered. The unused portion should be destroyed.
After using the drug, the doctor must individually, in each specific case, decide on the patient’s permission to drive vehicles or engage in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Let's talk about when adrenaline injections in ampoules are prescribed. is a hormone belonging to the group of catecholamine substances. Like other hormones in this group, it is produced by the adrenal glands, or more precisely, by their medulla. The substance plays an important role in the body. This is the emergency hormone.

When a person is in danger, the brain sends a signal to the adrenal glands, and the secretion of adrenaline begins. It helps people quickly concentrate, react and dodge a brick falling from a roof, run away from an angry dog ​​at a speed unusual in normal times, jump over a hole in the way, climb onto the roof of a garage, and so on. At a critical moment, under the influence of the hormone, the immune activity of the body of a healthy person increases, the muscles acquire extraordinary strength.

In medicine, adrenaline is widely used for sudden cardiac arrest in a patient and in other cases. Pharmacies sell adrenaline in ampoules containing a solution of the substance. It is used by injection.

Type and composition of the medicine

In world medicine, a solution of adrenaline as a medicine is known as epinephrine. This is also the name of the active ingredient of the drug. The ampoules produce adrenaline hydrochloride and adrenaline hydrotartrate. The first substance is characterized by the fact that it changes its properties in bright light and upon contact with oxygen. The solution for the main substance is 0.01% hydrochloric acid.

The second type of drug is dissolved in water, since it does not change its properties upon contact with water and air. But its difference is that for injection you have to take a larger dose, due to the difference in the molecular weight of hydrochloride and hydrogen tartrate.

An epinephrine ampoule contains 1 ml of a solution with a concentration of 0.1% hydrochloride or 0.18% hydrogen tartrate.

Another form of release is orange bubbles containing 30 ml of ready-to-use solution. The solution is administered intramuscularly or intravenously using infusions. There is also adrenaline in tablets.

The effect of the drug on the body

The pharmacological effect of the injection solution lies in its effect on alpha and beta adrenergic receptors. What happens if you inject adrenaline? The body's reaction to the administration of epinephrine is a narrowing of blood vessels in the abdominal cavity, in the skin and mucous membranes. Muscular vessels respond less to an increase in the volume of the hormone in the blood.

In addition, the body's reaction to an epinephrine injection is as follows:

• Cardiac adrenoceptors respond to the drug by increasing the rate of ventricular contractions;
• Blood glucose levels increase;
• The rate of glucose processing and energy release increases;
• The airways expand and become available to receive large amounts of oxygen;
• Blood pressure increases;
• The body stops reacting to allergens.

Adrenaline also suppresses the production of fat deposits, increases muscle activity, stimulates the central nervous system, stimulates the production of hormones by the hypothalamus, stimulates the adrenal cortex (promotes its generation of hormones), activates the activity of enzymes, and increases blood clotting.

Indications for use in medicine

Why is epinephrine given? The instructions for use recommend injections of adrenaline in the following situations:

• Complex cases of drop in blood pressure when other drugs do not help (heart surgery, traumatic shock, heart and kidney failure, overdose of medications (drugs));
• Bronchial spasms during surgery and bronchial asthma;
• Bleeding from blood vessels of human mucous membranes and skin;
• To stop various bleedings;
• To relieve an allergic reaction;
• With asystole;
• When blood glucose levels decrease below normal;
• For erections in men not associated with sexual arousal.

The medicine is also used for eye surgeries and open glaucoma. It prolongs the effect of anesthesia, which is used for long operations.

It is prohibited to prescribe injectable adrenaline for yourself and inject it. This can cause harm to health and even death.

Contraindications

For elderly people, the drug is prescribed only in cases that threaten their life, in small doses. The drug is contraindicated in:

• Atherosclerotic symptoms;
• Increased blood pressure;
• Vasodilation more than 2 times (aneurysm);
• Diabetes mellitus;
• With increased production of thyroid hormones (thyrotoxicosis);
• Bleeding of certain types;
• Pregnancy at all stages;
• Closed glaucoma;
• Breastfeeding baby;
• Severe drug intolerance.

To prolong anesthesia, the drug is used with caution. They can enhance the effect of not all anesthetics.

Method of use

Epinephrine is used for intramuscular injections in a dosage of 0.3 to 0.75 ml. Subcutaneous injection of adrenaline is possible. During operations on the heart muscle, an injection is made directly into the ventricle of the heart with a syringe containing adrenaline. Sometimes it is necessary to administer the drug intravenously using a dropper. The doctor decides where to inject. Glaucoma is treated with a 1 - 2% solution of the drug in drops.

Signs of drug overdose

Symptoms of an overdose are an increase in blood pressure much higher than normal, a rapid pulse, gradually turning into bradycardia; paleness of the skin and its coldness, headache and vomiting. More severe cases of overdose reactions are myocardial infarction, craniocerebral hemorrhage, and pulmonary edema. The worst sign of overdose is death. When the drug is administered intravenously, and this is done by a specialist, an overdose occurs extremely rarely. The hospital always has a defibrillator for cases of ventricular fibrillation.

At the first symptoms of an overdose, administration of the solution must be stopped. Alpha-blockers are used to lower blood pressure, and beta-blockers are used to restore normal heart rhythm.

Side effect

Adrenaline not only concentrates all the capabilities of the human body on protecting against unexpected danger. Since it increases blood pressure, the rhythm of breathing and the heart quickens, dizziness occurs, and a distorted perception of reality may appear.

If there is an unreasonable release of the hormone into the blood, the person will feel irritability and anxiety. This is facilitated by increased glucose processing caused by increased adrenaline, releasing additional energy that is not currently needed.

Adrenaline does not always work “for good.” If its content is elevated over a long period, the hormone depresses cardiac activity and causes heart failure. Increased epinephrine levels contribute to insomnia and other signs of mental disorders.

Its side effects include:

• Increased blood pressure;
• Increased heart rate;
• Painful sensations in the heart;
• Nausea leading to vomiting;
• Feeling dizzy;
• Panic attack and other mental disorders;
• Skin rash, itching and other allergic manifestations.

If a person feels signs of a side effect of the medicine, it is necessary to stop the injection and inform the doctor. The medicine can only be injected as prescribed by a specialist.

Adrenaline is a drug that has a pronounced hypertensive (increases blood pressure), vasoconstrictor, cardiac stimulator and bronchodilator (eliminates bronchospasm) effect. When administered intravenously, the therapeutic effect of adrenaline is almost instantaneous; when administered subcutaneously, it develops within 5-10 minutes; when administered intramuscularly, it can vary. Let's consider when adrenaline, an injection solution, is used.

Medicinal properties

When the drug is taken, blood vessels throughout the body begin to constrict. This occurs in the abdominal cavity, on the skin, in the kidneys and blood vessels of the brain. The heart rate also noticeably increases, the tone of the smooth muscles of the intestine decreases (and the opposite effect appears on the skeletal muscles).

Indications for use

The drug is indicated for use in the following cases:

• Spontaneous allergic reactions (including urticaria and anaphylactic shock) from medications, food, insect bites and other factors.
• Bleeding (used as a vasoconstrictor).
• Prolongation of the effect of local anesthetic drugs.
• Bronchial asthma and bronchospasms.
• A strong decrease in blood pressure (more than 1/5 of the norm for a person or in numerical terms below 90 for systolic or 60 for average blood pressure).
• Asystole (cardiac arrest), both instantaneous and developed against the background of a previous arrhythmia.

Directions for use and dosage

The injection can be administered by several different methods: in case of cardiac arrest, an injection is made into the heart, in other cases, depending on the specific situation, everything is administered locally, subcutaneously, intramuscularly or intravenously. Intramuscular administration gives a faster effect than subcutaneous administration.

The dosage varies depending on the age of the patient. For an adult, 0.3 to 0.75 ml is usually administered. The injections can be repeated every 10 minutes, monitoring the reaction of the human body. A single dose cannot exceed 1 ml (approximately 1 mg), and a daily dose cannot exceed 5 ml. If the patient’s condition is quite severe, it is necessary to dissolve adrenaline in a ratio of 1 to 2 in an isotonic sodium chloride solution (for example, 1 mg in a 2 mg solution) and administer it slowly intravenously.

For children, doses are much smaller and depend on how old the child is. If a one-year-old baby has a maximum dose of 0.15 ml, then at the age of up to 4 years it increases to 0.25 ml, at the age of up to 7 years - up to 0.4 ml, at the age of up to 10 years and older - up to 0.5 ml. The drug is administered to the child 1-3 times a day.

Also, if you simply need to stop a person’s bleeding, the drug is applied topically using tampons soaked in it and applied to the problem area.

Application nuances

It is important not to administer the drug from the ampoule intra-arterially, because this will lead to excessive narrowing of peripheral vessels, and this, in turn, to the development of gangrene.

If fluid is used for shock, it does not replace other measures such as plasma, blood or saline transfusions.

Long-term use of the drug is strongly not recommended, because it can lead to the development of necrosis or gangrene. Also, the drug is not recommended for use during lactation. as it may be harmful to the child.

Side effects

In rare cases, the following side effects may occur from adrenaline:

• From the cardiovascular system, sudden painful sensations in the chest and heart rhythm disturbances may be observed.
• Occasionally, a burning sensation or pain may be observed at the site of intramuscular injection of the drug.
• On the part of the digestive system, side effects can manifest themselves in the form of nausea and vomiting; the excretory system sometimes adds to them discomfort and/or difficulty urinating.
• Allergic reactions.
• Increased sweating.
• A severe drop in potassium levels in the blood (manifests itself in the form of fatigue, weakness in the limbs; in severe cases, paralysis, intestinal obstruction and difficulty breathing).
• Nervous state, weakness, fatigue, irritability, anxiety, sleep disturbances.

With the exception of nausea, vomiting and headaches, all other side effects occur no more often (and generally even much less often) than one case per 100 uses of the drug.

The use of adrenaline does not lead to an absolute ban on driving vehicles and machinery; the doctor makes a decision in each specific case individually, based on the patient’s condition and the side effects he has experienced from the drug.

Overdose

In case of an overdose of adrenaline, the following may occur:

• Nausea, vomiting.
• Headache.
• Paleness and low temperature of the patient's skin.
• Heart rhythm disturbances or pathological tachycardia (increased heart rate over 90 beats per minute).
• In case of severe overdose or in poor health, pulmonary edema, heart attack, stroke and even death.

Let's sum it up

Adrenaline in the form of an injection solution can not only have a therapeutic effect, but, in some situations, even save a person’s life. But so that it does not harm a person, it is necessary to observe the correct dosage and adhere to precautions. However, an experienced doctor, when contacting a medical institution, will take them into account and use the injection solution (1 ml or a smaller dose) as effectively as possible.

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The beneficial properties of the hormone adrenaline are that it prepares a person for danger. Pharmacology produces the drug Epinephrine (Adrenaline), which contains as a main substance. What are its functions, are there any contraindications and side factors? Let's try to answer these questions.

Release form and composition

Adrenaline is produced in the form of solutions - Epinephrine hydrochloride and Epinephrine hydrotartrate. The first substance is a powder that has a pinkish tint. It is dissolved in hydrochloric acid. Ampoules with solution are included in the package contents.

The second substance is a grayish powdery substance. Hydrotartrate is dissolved in distilled water. Before placing in an ampoule, the powder is sterilized at a temperature of 100 degrees. Sterilization is carried out for a quarter of an hour.

Both solutions do not tolerate light and oxygen well. Therefore, the medicine is kept in a dark place. Before administering the solution to the patient, draw it completely (from the ampoule) into a syringe. It is prohibited to use solutions that have been opened and mixed with powder after they have been exposed to air for several hours. The injection dose is prescribed by the attending physician.

Pharmacological effects of Epinephrine

There are no differences between the two types of the drug - hydrochloride and hydrogen tartrate. But there is a difference in molecular weights. Since the second has a smaller mass of molecules, a larger dose of medicine is placed in the ampoule.

The drug belongs to the pharmacological group of adrenergic and sympathomimetics. It is prescribed in the following situations:

• If rapid allergic reactions occur. This could be urticaria, Quincke's edema, allergic shock. In this case, the cause of allergies can be different - from the bites of wasps and other insects to allergies to medications and food taken.
• For bronchial asthma. A medication for asthma relieves an attack of suffocation. This also includes difficulty breathing during surgery and cardiac arrest under the same conditions.
• Epinephrine helps stop bleeding from the mucous membranes and blood vessels of the skin.
• Lowering blood pressure (hypotension), in cases where less effective drugs do not have the desired effect. This can happen with injury or shock, circulation of bacteria in the blood (bacteremia), with insufficient kidney function, chronic heart failure, during heart surgery, or with drug overdose.
• To treat low blood glucose levels below normal. This happens in a situation of insulin overdose.
• To stop bleeding.
• In ophthalmological practice. Ophthalmologists prescribe the drug for glaucoma, eye surgery, conjunctivitis, eye swelling, intraocular high pressure. Epinephrine is also used to stop bleeding from the mucous membranes of the eyes.
• With an erection unrelated to sexual arousal.

In addition to these indications, the drug is used during operations to prolong the duration of anesthesia.

Contraindications for the use of Epinephrine

Adrenaline is not a safe drug. In some situations, its use is prohibited or carried out with caution under the supervision of a specialist. Contraindications for Adrenaline are quite serious. Diseases for which you should not take Epinephrine:

1. atherosclerosis (formation of cholesterol plaques in blood vessels);
2. high blood pressure;
3. in the presence of internal and external bleeding;
4. during pregnancy;
5. while breastfeeding;
6. if the reaction to the drug is too strong.

Medicines are not used for anesthesia using certain drugs. Anesthesiologists know this.

When prescribing a medicine, you need to remember the effect it has on a person:

• increases blood pressure;
• increases the amount of glucose in the blood;
• relieves bronchial spasms;
• Helps avoid allergies and cures them;
• constricts blood vessels;
• inhibits the formation of glycogen in the liver and skeletal muscles;
• increases the degree of glucose absorption by body tissues, activating glycolytic enzymes;
• increases the activity of skeletal muscles;
• promotes fat burning and prevents its generation;
• helps the body stay awake, simultaneously increasing mental mobilization and brain activity;
• directionally activates the activity of the hypothalamus;
• promotes the production of adrenocorticotropin;
• increases blood clotting.

Adrenaline normalizes metabolic processes and regeneration of the myocardium and muscle tissue. It is an anti-inflammatory agent. It promotes the breakdown of proteins to release energy.

Side effects of Epinephrine on the body

Since the drug increases the breathing rate and activates the brain, the patient often feels dizzy after the injection. He may perceive the world around him inadequately.

If there was no reason to increase the natural hormone adrenaline, when its content increases, a person may feel anxiety and inexplicable irritability. The medicine leads to the same consequences.

In primitive times, the main problem of man was obtaining food. This problem was solved by hunting, pursuit, and fast running. At the same time, adrenaline decreased. Nowadays, human tasks have expanded significantly in composition. But their solution is found without the use of physical force. Therefore, the amount of adrenaline does not decrease. To reduce it, people play sports.

Treatment with the drug is prescribed for a certain period of time, which should not be exceeded. With long-term use of the medicine, the functioning of the heart is inhibited, which leads to heart failure.

Adrenaline also has a bad effect on mentally excitable people. Their nervousness increases, and problems with sleep appear. In some cases, a person is diagnosed with a chronic stress condition.

A side effect of the drug is an increase in blood pressure, which is harmful for hypertensive patients. The drug also disrupts the rhythm of the heartbeat. But when treated with Epinephrine injections, you cannot take medications to restore normal heartbeat, such as Obzidan and Anaprilin.

Method of administration of the medicine and dosage

Instructions for use of Epinephrine indicate that Adrenaline injections are given subcutaneously. Sometimes the doctor prescribes intramuscular or intravenous injections.

The dosage is calculated by a specialist individually, taking into account the characteristics of the disease and the patient’s well-being. The following table gives an idea of ​​the average dose of the medicine:

If the heartbeat stops during surgery, the dose of Adrenaline reaches 1 ml. If the medicine is intended to stop an asthma attack, up to 0.7 ml is administered. Typically, for therapeutic purposes, the doctor will recommend a dosage of up to 0.75 ml for an adult and up to 0.5 ml for a child.

For allergic shock, the dose of Adrenaline is minimal and ranges from 0.1 ml to 0.25 ml of powder, which is diluted in 10 ml of solution. In this case, an intravenous drip method is often used to administer the solution in a ratio of 1:10,000. If there is no danger to life, use the intramuscular or subcutaneous route of administration.

If a specialist has prescribed a medicine to treat low blood pressure, the solution is administered intravenously using a dropper. The dose is 0.001 ml per minute.

If it is necessary to increase the operating time of the anesthetic, the dose is calculated based on the consideration that 1 ml of anesthetic contains 0.005 ml of Epinephrine.

Signs of a hormone overdose

Symptoms of overdose are:

• strong increase in blood pressure numbers;
• dilation of the eye pupils;
• Increased heart rate, turning into a weak pulse;
• Supraventricular arrhythmia of the heart, accompanied by electrical activity of the atria with a frequency of over 350 per minute;
• Cooling of the skin and its pallor;
• Anxiety and fear for no reason;

• Nausea and vomiting;
• Hand trembling;
• Headache;
• Acid-base imbalance, accompanied by low blood pH and bicarbonate deficiency;
• Kidney failure.

An overdose can lead to more serious consequences. These include myocardial infarction, cerebral hemorrhage, and pulmonary edema. A dose of 10 ml of the drug is considered lethal.

Overdose is treated with drugs from the group of alpha- and beta-blockers. If an overdose causes several symptoms at once, complex therapy is carried out.

Combination with other medications

In medicine, the issue of combining drugs is being actively studied. Thus, it is known that treatment with Epinephrine is unacceptable while taking narcotic and sleeping pills and related medications and analgesics. The drug will reduce the effect of analgin and other similar drugs. The drug is not prescribed together with antidepressants. It does not combine with cardiac glycosides and quinidine. The use of these drugs together with Epinephrine increases the risk of cardiac arrhythmia. Some drugs for Adrenaline reduce the effect on the patient’s body, others cause significant harm.

With caution

The hormone is prescribed under the strict supervision of a doctor in the following cases:

• Low blood pH and low bicarbonate concentration;
• With reduced oxygen content in the body organs;
• With a tendency to increase blood pressure;
• For dizziness, shortness of breath, chest pain, which are symptoms of pulmonary hypertension;
• For arrhythmia of the ventricles of the heart;
• After myocardial infarction;
• For shock not associated with allergies;
• For atherosclerosis and vascular obstruction;
• When blood flow in an artery is blocked.

All cases in which it is dangerous to take the drug are outlined in the description of the drug. Before prescribing a medicine, you must thoroughly study the instructions. You cannot inject it at home unless your doctor gives permission. In the hospital, specialists are always nearby to help with side effects from the injection.

The shelf life of Adrenaline is 24 months. It must be stored in a place protected from sunlight and artificial lighting. The drug likes to be cool, so you can put it on a shelf on the refrigerator door.