Manufacturer
PHARMANIAGA LIFESCIENCE SDN. BHD.
Contents
ADRENALINE ACID TARTRATE
Indication
Adrenaline (Epinephrine) 1 mg/ml (1:1000) Solution for Injection may be used in the emergency treatment of anaphylaxis and acute allergic reactions
Instruction
The intramuscular (IM) route as the most appropriate for most individuals who have to give adrenaline to treat an anaphylactic reaction. The patient should be monitored as soon as possible (pulse, blood pressure, ECG, pulse oximetry). This will help monitor the response to adrenaline.
The best site for IM injection is the anterolateral aspect of the middle third of the thigh.
The needle used for injection needs to be sufficiently long to ensure that the adrenaline is injected into muscle.
Drug interaction
Sympathomimetic agents/Oxytocin: Adrenaline should not be administered concomitantly with oxytocin or other sympathomimetic agents because of the possibility of additive effects and increased toxicity.
Alpha-adrenergic blocking agents:Alpha-blockers such as phentolamine antagonise the vasoconstriction and hypertension effects of adrenaline. Beta-adrenergic blocking agents:Severe hypertension and reflex bradycardia may occur with non-selective beta-blocking drugs such as propranolol, due to alpha-mediated vasoconstriction.Beta-blockers, especially non-cardioselective agents, also antagonise the cardiac and bronchodilator effects of adrenaline. Patients with severe anaphylaxis who are taking non-cardioselective beta-blockers may not respond to adrenaline treatment. General anaesthetics Administration of adrenaline in patients receiving halogenated hydrocarbon general anaesthetics that increase cardiac irritability and seem to sensitise the myocardium to adrenaline may result in arrhythmias including ventricular premature contractions, tachycardia, or fibrillation (See section 4.4). Antidepressant agents: Tricyclic antidepressants such as imipramine may potentiate the effects of adrenaline, especially on heart rhythm and rate. Non-selective MAO inhibitors: increased pressor action of adrenaline, usually moderate. Selective MAO-A inhibitors: Linezolid (by extrapolation from non-selective MAO inhibitors): Risk of aggravation of pressor action. Antihypertensive agents: Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine, with the risk of severe hypertension. Adrenaline increases blood pressure and may antagonise the effects of antihypertensive drugs. Phenothiazines: Adrenaline should not be used to counteract circulatory collapse or hypotension caused by phenothiazines: a reversal of adrenaline's pressor effects resulting in further lowering of blood pressure may occur. Other medicinal products: Adrenaline should not be used in patients receiving high dosage of other drugs (e.g. cardiac glycosides) that can sensitise the heart to arrhythmias. Some antihistamines (e.g. diphenhydramine) and thyroid hormones may potentiate the effects of Adrenaline, especially on heart rhythm and rate. Hypokalaemia: The hypokalaemic effect of adrenaline may be potentiated by other drugs that cause potassium loss, including corticosteroids, potassium-depleting diuretics, aminophylline and theophylline. Hyperglycaemia: Adrenaline-induced hyperglycaemia may lead to loss of blood-sugar control in diabetic patients treated with insulin or oral hypoglycaemic agents.
Malaysia
