Catecholamine Vasopressor/Inotrope
Pregnancy: Use in life-threatening emergency — benefits outweigh risks
Adrenaline (ICU — Vasopressor/Inotrope)
Brand names: Epinephrine
Adult dose
Dose: Infusion: 0.01–1 mcg/kg/min IV; Anaphylaxis: 0.5 mg IM (1:1000); Cardiac arrest: 1 mg IV (1:10,000) every 3–5 min
Route: IV infusion / IM / IV bolus
Frequency: Continuous infusion (ICU); as per protocol (cardiac arrest)
Max: No fixed maximum — titrate to haemodynamic response
ICU use: add to distributive or cardiogenic shock unresponsive to noradrenaline ± dobutamine. At low doses: beta-predominant (inotropy, chronotropy); at high doses: alpha-predominant (vasoconstriction). Must be given via central line at ICU doses.
Paediatric dose
Dose: 0.01–1 mcg/min/kg
Route: IV infusion
Frequency: Continuous
Max: 1 mcg/kg/min
Neonatal/paediatric septic shock: start 0.05–0.1 mcg/kg/min, titrate. Anaphylaxis: 0.01 mg/kg IM (1:1000), max 0.5 mg.
Dose adjustments
Renal
No dose adjustment — titrate to MAP and clinical response.
Hepatic
No dose adjustment required.
Paediatric weight-based calculator
Neonatal/paediatric septic shock: start 0.05–0.1 mcg/kg/min, titrate. Anaphylaxis: 0.01 mg/kg IM (1:1000), max 0.5 mg.
Clinical pearls
- Second-line vasopressor in septic shock after noradrenaline per Surviving Sepsis Campaign 2021
- High-dose adrenaline in cardiac arrest: associated with ROSC but poorer neurological outcomes in post-arrest studies — dose per ALS algorithm only
- Peripheral extravasation causes severe tissue necrosis — use only via central line at ICU infusion doses; antidote for extravasation: phentolamine 5–10 mg SC/intradermal
Contraindications
- No absolute contraindications in life-threatening situations
- Avoid in cocaine toxicity (augments sympathomimetic crisis)
Side effects
- Tachyarrhythmias
- Hypertension (overdose)
- Peripheral ischaemia/necrosis (prolonged high-dose)
- Hypokalaemia
- Hyperglycaemia
- Lactic acidosis (high-dose — mesenteric ischaemia)
Interactions
- Beta-blockers (blunt chronotropic effect; alpha effects unopposed — severe hypertension)
- MAOIs (hypertensive crisis)
- Halothane (myocardial sensitisation — arrhythmias)
- Oxytocin (additive vasoconstriction)
Monitoring
- Continuous arterial line for BP
- ECG (arrhythmia surveillance)
- Lactate (mesenteric ischaemia marker)
- Peripheral perfusion (capillary refill, mottling)
Reference: BNFc; BNF 90; Surviving Sepsis Campaign Guidelines 2021; Resuscitation Council UK ALS 2021; BNFc. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.