Catecholamine Vasopressor/Inotrope Pregnancy: Limited data insufficient to determine drug-associated risk; hypotension from septic shock is a medical emergency in pregnancy. Adverse developmental effects seen in animal studies.

Adrenaline (ICU — Vasopressor/Inotrope)

Brand names: Epinephrine

Used in: Anaphylaxis & Allergy Epistaxis (Nosebleed)

Adrenaline (epinephrine) is the first-line treatment of anaphylaxis (intramuscular), is used in cardiac arrest, and as an intravenous vasopressor/inotrope in shock.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.05 mcg/kg/min to 2 mcg/kg/min (titrated)

Route: IV infusion

Frequency: Continuous infusion, titrated to achieve desired mean arterial pressure (MAP)

Hypotension associated with septic shock (US labelling). Dilute in 5% Dextrose Injection (or 5% Dextrose and Sodium Chloride) — saline alone not recommended; adding the prefilled syringe contents to 1000 mL gives 1 mcg/mL. Infuse into a large vein; avoid leg veins in elderly or occlusive vascular disease. Adjust every 10–15 min in increments of 0.05–0.2 mcg/kg/min. After stabilisation, wean incrementally (e.g. every 30 min over 12–24 hours). Note: UK SPC (eMC) for the 1:1000 ampoule does not give an IV infusion posology and states the 1:1000 solution is not suitable for IV use (must be diluted to 1:10,000 before IV use, reserved for specialists) — clinician must verify the ICU IV regimen against UK SPC/local ICU protocol.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

• Hypotension associated with septic shock ( 2.2 ) : o Dilute epinephrine in dextrose solution prior to infusion. o Infuse epinephrine into a large vein. o Titrate 0.05 mcg/kg/min to 2 mcg/kg/min to achieve desired blood pressure. o Wean gradually. 2.1 General Considerations Inspect visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use if the solution is colored or cloudy, or if it contains particulate matter. Discard any unused portion. 2.2 Hypotension associated with Septic Shock Dilute epinephrine in 5% Dextrose Injection, USP or 5% Dextrose and Sodium Chloride solution. These dextrose containing fluids provide …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-06-08. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

US labelling states None. UK SPC (1:1000 ampoule) lists: hypersensitivity to active substance/excipients (relative — emergency use); avoid use in fingers, toes, ears, nose, genitalia or buttocks (ischaemic necrosis); do not use if discoloured

Side effects

Tachycardia, supraventricular tachycardia, ventricular arrhythmias, myocardial ischaemia, myocardial infarction
Limb ischaemia, pulmonary oedema, extravasation (with tissue necrosis)
Headache, nervousness, paraesthesia, tremor, stroke, CNS bleeding
Hyperglycaemia/hypoglycaemia, insulin resistance, hypokalaemia, lactic acidosis
Renal insufficiency; nausea, vomiting, chest pain

Interactions

Drugs antagonising pressor effects: alpha-blockers, vasodilators (nitrates), diuretics, antihypertensives, ergot alkaloids, phenothiazine antipsychotics
Drugs potentiating pressor effects: sympathomimetics, beta-blockers, tricyclic antidepressants, MAO inhibitors, COMT inhibitors, clonidine, doxapram, oxytocin
Drugs increasing arrhythmogenic potential: beta-blockers, cyclopropane/halogenated hydrocarbon anaesthetics, quinidine, antihistamines, thyroid hormones, diuretics, cardiac glycosides
Potassium-depleting drugs (corticosteroids, diuretics, theophylline) potentiate hypokalaemic effects

Clinical monograph

How it works

It stimulates alpha- and beta-adrenoceptors, producing vasoconstriction, increased cardiac rate and force, and bronchodilation.

Prescribing in practice

For anaphylaxis the intramuscular route (anterolateral thigh) is first-line and repeated as needed; the intramuscular and intravenous concentrations differ and must never be confused.
Intravenous use is for cardiac arrest or a titrated infusion in critical care with monitoring.
It can cause tachyarrhythmia, hypertension and tissue ischaemia; infusion extravasation causes local injury.

Monitoring

In anaphylaxis monitor airway, breathing, circulation and response; for infusions monitor ECG, blood pressure and the infusion site.

Counselling the patient

After using an auto-injector for a severe allergic reaction, always call emergency services — a second reaction can occur.
Carry two auto-injectors if prescribed and know how and when to use them.

Evidence & guidelines

First-line for anaphylaxis (Resuscitation Council UK) and used in cardiac arrest and shock.

Reference: Surviving Sepsis Campaign Guidelines 2021; Resuscitation Council UK ALS 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Westley Croup Score · Respiratory

Pathways