Ep·i·Pen ( p  -pn ) A trademark for a self-injection kit containing epinephrine, used intramuscularly for anaphylactic shock. |
EpiPen,
epinephrine hydrochloride
Anapen (UK), EpiPen, EpiPen Jr.
Pharmacologic class: Sympathomimetic (direct acting)
Therapeutic class: Bronchodilator, mydriatic
Pregnancy risk category C
Action
Stimulates alpha- and beta-adrenergic receptors, causing relaxation of cardiac and bronchial smooth muscle and dilation of skeletal muscles. Also decreases aqueous humor production, increases aqueous outflow, and dilates pupils by contracting dilator muscle.
Availability
Aerosol inhaler: 160 mcg, 200 mcg, 220 mcg, 250 mcg
Auto-injector for I.M. injection: 1:2,000 (0.5 mg/ml)
Injection: 0.01 mg/ml, 0.1 mg/ml, 0.5 mg/ml, 1 mg/ml, 5 mg/ml parenteral suspension
Nebulizer inhaler: 1%, 1.25%, 2.25%
Ophthalmic drops: 0.5%, 1%, 2%
Solution: 1:200,000
⊘Indications and dosages
➣ Bronchodilation; anaphylaxis; hypersensitivity reaction
Adults: 0.1 to 0.5 ml of 1:1,000 solution subcutaneously or I.M., repeated q 10 to 15 minutes p.r.n. Or 0.1 to 0.25 ml of 1:10,000 solution I.V. slowly over 5 to 10 minutes; may repeat q 5 to 15 minutes p.r.n. or follow with a continuous infusion of 1 mcg/minute, increased to 4 mcg/minute p.r.n. For emergency treatment, EpiPen delivers 0.3 mg I.M. of 1:1,000 epinephrine.
Children: For emergency treatment, EpiPen Jr. delivers 0.15 mg I.M. of 1:2,000 epinephrine.
➣ Acute asthma attack
Adults and children ages 4 and older: 160 to 250 mcg metered aerosol (equivalent to one inhalation); repeat once after 1 minute, if needed. Don't give subsequent doses for at least 3 hours. Or one to three deep inhalations of 1% solution with hand-held nebulizer, repeated q 3 hours p.r.n.
➣ To restore cardiac rhythm in cardiac arrest
Adults: 0.5 to 1 mg I.V., repeated q 3 to 5 minutes, if needed. If no response, may give 3 to 5 mg I.V. q 3 to 5 minutes.
➣ Chronic simple glaucoma
Adults: One drop in affected eye once or twice daily. Adjust dosage to meet patient's needs.
➣ To prolong local anesthetic effects
Adults and children: 1:200,000 concentration with local anesthetic
Contraindications
• Hypersensitivity to drug, its components, or sulfites
• Angle-closure glaucoma
• Cardiac disease
• Cerebral arteriosclerosis
• MAO inhibitor use within past 14 days
• Labor
• Breastfeeding
Precautions
Use cautiously in:
• hypertension, hyperthyroidism, diabetes, prostatic hypertrophy
• elderly patients
• pregnant patients
• children.
Administration
• In anaphylaxis, use I.M. route, not subcutaneous route, if possible.
☞ Inject EpiPen and EpiPen Jr. only into anterolateral aspect of thigh. Don't inject into buttocks or give I.V.
☞ Be aware that not all epinephrine solutions can be given I.V. Check manufacturer's label.
• For I.V. injection, give each 1-mg dose over at least 1 minute. For continuous infusion, use rate of 1 to 10 mcg/minute, adjusting to desired response.
• Use Epi-Pen Jr. for patients weighing less than 30 kg (66 lb).
☞ Don't give within 14 days of MAO inhibitors.
| Route | Onset | Peak | Duration |
| I.V. | Immediate | 5 min | Short |
| I.M. | Variable | Unknown | 1-4 hr |
| Subcut. | 5-15 min | 0.5 hr | 1-4 hr |
| Inhalation | 1-5 min | Unknown | 1-3 hr |
Adverse reactions
CNS: nervousness, anxiety, tremor, vertigo, headache, disorientation, agitation, drowsiness, fear, dizziness, asthenia, cerebral hemorrhage, cerebrovascular accident (CVA)
CV: palpitations, widened pulse pressure, hypertension, tachycardia, angina, ECG changes, ventricular fibrillation, shock
GI: nausea, vomiting
GU: decreased urinary output, urinary retention, dysuria
Respiratory: dyspnea, pulmonary edema
Skin: urticaria, pallor, diaphoresis, necrosis
Other: hemorrhage at injection site
Interactions
Drug-drug. Alpha-adrenergic blockers: hypotension from unopposed beta-adrenergic effects
Antihistamines, thyroid hormone, tricyclic antidepressants: severe sympathomimetic effects
Beta-adrenergic blockers (such as propranolol): vasodilation and reflex tachycardia
Cardiac glycosides, general anesthetics: increased risk of ventricular arrhythmias
Diuretics: decreased vascular response
Doxapram, mazindol, methylphenidate: enhanced CNS stimulation or pressor effects
Ergot alkaloids: decreased vasoconstriction
Guanadrel, guanethidine: enhanced pressor effects of epinephrine
Levodopa: increased risk of arrhythmias
Levothyroxine: potentiation of epinephrine effects
MAO inhibitors: increased risk of hypertensive crisis
Drug-diagnostic tests. Glucose: transient elevation
Lactic acid: elevated level (with prolonged use)
Patient monitoring
☞ Monitor vital signs, ECG, and cardiovascular and respiratory status. Watch for ventricular fibrillation, tachycardia, arrhythmias, and signs and symptoms of shock. Ask patient about anginal pain.
• Assess drug's effect on underlying problem (such as anaphylaxis or asthma attack), and repeat dose as needed.
☞ Monitor neurologic status, particularly for decreased level of consciousness and other signs and symptoms of cerebral hemorrhage or CVA.
• Monitor fluid intake and output, watching for urinary retention or decreased urinary output.
• Inspect injection site for hemorrhage or skin necrosis.
Patient teaching
• Teach patient who uses auto-injector how to use syringe correctly, when to inject drug, and when to repeat doses.
• Teach patient who uses hand-held nebulizer correct use of equipment and drug. Explain indications for both initial dose and repeat doses.
☞ Inform patient that drug may cause serious adverse effects. Tell him which symptoms to report.
• If patient will self-administer drug outside of health care setting, explain need for prompt evaluation by a health care provider to ensure that underlying disorder has been corrected.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
EpiPen®
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