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What is epinephrine injection?
Epinephrine is a chemical that narrows blood vessels and opens airways in the lungs. These effects can reverse severe low blood pressure, wheezing, severe skin itching, hives, and other symptoms of an allergic reaction. Epinephrine injection is used to treat severe allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens. Epinephrine is also used to treat exercise-induced anaphylaxis. Epinephrine auto-injectors such as EpiPen and EpiPen Jr. may be kept on hand for self-injection by a person with a history of an severe allergic reaction.
What is the price of this medication and similar alternatives?
Pricing information provided by drugstore.com.
| Epifrin 0.5% SOLN | ALLERGAN | 15/$45.99 or 45/$132.98 |
| Epifrin 1% SOLN | ALLERGAN | 15/$48.99 or 45/$141.98 |
| Epifrin 2% SOLN | ALLERGAN | 15/$53.99 or 45/$153.96 |
| EPINEPHrine HCl 1MG/ML SOLN | HOSPIRA | 3/$8.99 or 9/$20.97 |
| S-2 2.25% NEBU | NEPHRON PHARMACEUTICALS CORP. | 15/$19.99 or 45/$53.99 |
What are the possible side effects of epinephrine ?
Before using epinephrine a second time, tell your doctor if your first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).
Less serious side effects may include:
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fast or uneven heat rate;
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sweating;
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nausea and vomiting;
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pale skin;
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dizziness;
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weakness or muscle tremors;
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headache; or
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feeling nervous or anxious.
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
How should I use epinephrine injection?
Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label. Seek emergency medical attention even after you use this medication to treat a severe allergic reaction. The effects of epinephrine injection may wear off after 10 or 20 minutes. You will need to receive further treatment and observation. The auto-injector device this medicine comes in is a disposable single-use system that contains a spring-loaded needle. Epinephrine injection comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.
What is the most important information I should know about epinephrine injection?
Before using this medication, tell your doctor if you have heart disease or high blood pressure, a heart rhythm disorder, diabetes, or a thyroid disorder. Tell your doctor if you also take digoxin (digitalis, Lanoxin, Lanoxicaps), quinidine (Cardioquin, Quinaglute, Quinidex), an antidepressant such as Elavil, Pamelor, Sinequan, or Tofranil, or an MAO inhibitor such as Marplan, Nardil, Azilect, Eldepryl, Emsam, or Parnate. Do not inject epinephrine into a vein or into the muscles of your buttocks. Inject it only into the fleshy outer portion of the thigh.
What happens if I miss a dose?
Since epinephrine is normally used only as needed in an emergency, you are not likely to be on a dosing schedule. Do not use repeat doses of epinephrine injection without a doctor's advice.
What other drugs will affect epinephrine?
The following drugs can interact with epinephrine injection. Tell your doctor if you are using any of these: digoxin (digitalis, Lanoxin, Lanoxicaps); quinidine (Cardioquin, Quinaglute, Quinidex); a tricyclic antidepressant such as amitriptyline (Elavil, Endep), nortriptyline (Pamelor), doxepin (Sinequan), imipramine (Tofranil), and others; or an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate).
Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?
Epinephrine has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of teratogenicity when epinephrine was given in doses approximately 25 times the usual recommended human dose (on a per kg basis). There are no reports of teratogenicity in humans. There are no controlled data in human pregnancy. Epinephrine is only recommended for use during pregnancy when benefit outweighs risk.
Because epinephrine is an endogenous catecholamine its relationship to adverse pregnancy outcomes is difficult to determine. Moreover, it is usually only used in dire situations that may otherwise portend fetal risk, such as shock, allergic reactions, and severe bronchial asthma. Epinephrine crosses the human placenta and may, in high concentrations, cause both maternal and fetal glycogenolysis and elevated blood glucose concentrations. Animal data indicate that epinephrine may cause decreased placental blood flow, increasing the risk of fetal hypoxemia. There has been an interesting debate in the medical literature as to whether endogenous epinephrine and other vasoactive substances play an etiologic role in placental insufficiency, preeclampsia or toxemia of pregnancy. Data from the Collaborative Perinatal Project (CPP), in which 50,282 mother-child pairs were retrospectively examined, reveal a survival- and race-standardized relative risk for any malformation associated with epinephrine and any sympathomimetic agent of 1.99 and 1.30, respectively. These data are based on an incidence of 22 malformed children from 189 cases (of the 50,282 pairs) where there was first trimester exposures to epinephrine. These data reveal evidence of an association between the use of epinephrine and congenital malformations, although underlying diseases were not accounted for in the analysis. Data from the Michigan Medicaid Birth Defects Study (MMBDS) reveal no evidence of an association between the use of epinephrine and congenital malformations (written communication, Franz Rosa, MD, Food and Drug Administration, 1994). The MMBDS is a retrospective study of 229,101 deliveries between 1985 and 1992. Of the 229,101 deliveries, 35 were exposed to epinephrine during the first trimester. No defects were observed. Epinephrine has been extensively and safely used to prolong the analgesic effect of epidurally administered local anesthetics during human pregnancy. In vitro data have shown that epinephrine increases placental lactate production and increases placental glycogenolysis. While some in vitro data have shown that epinephrine stimulates the spontaneous contractile activity of the nonpregnant uterus, in vivo data have shown that the drug may inhibit uterine contractions and prolong the first stage of labor.
There are no data on the excretion of epinephrine into human milk. The manufacturer states that epinephrine is excreted into human milk. The manufacturer recommends that due to the potential for serious adverse effects in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
Who should NOT use this medication?
- No absolute contraindications to use in life-threatening conditions.
- Relative contraindications include shock (other than anaphylactic shock), organic heart disease, coronary insufficiency, or cardiac dilatation, as well as use in most patients with angle-closure glaucoma, arrhythmias, organic brain damage, or cerebral arteriosclerosis. Contraindicated for use during general anesthesia with chloroform, trichloroethylene, or cyclopropane, and should be used cautiously, if at all, with other halogenated hydrocarbon anesthetics such as halothane.
- Contraindicated in conjunction with local anesthetics for use in fingers, toes, ears, nose, or genitalia.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include fast, pounding, or uneven heart rate, sudden and severe headache, loss of feeling in any part of the body, or sudden problems with vision, speech, or balance.
What should I discuss with my healthcare provider before using epinephrine injection?
Before using this medication, tell your doctor if you have: heart disease or high blood pressure; a heart rhythm disorder; diabetes; or a thyroid disorder. If you have any of these conditions, you may not be able to use epinephrine, or you may need a dose adjustment or special tests to safely use the medication. FDA pregnancy category C. This medication may be harmful to an unborn baby. If possible before ever using this medication, tell your doctor if you are pregnant or plan to become pregnant.
Can I stop taking the medication if I feel better?
As a general rule, you should always take your medications exactly as prescribed and do not change the dosage or stop taking the medication without first discussing it with your healthcare provider.
I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.
Where can I get more information?
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