Vasopressor Pregnancy: C — use in all life-threatening emergencies

Adrenaline (Epinephrine)

Brand names: EpiPen, Emerade, Jext

Adult dose

Dose: 1mg (10ml of 1:10,000)

Route: IV / IO

Frequency: Every 3–5 min in cardiac arrest

Cardiac arrest: 1mg IV/IO every 3–5 min. Anaphylaxis: 0.5mg IM (0.5ml of 1:1,000) anterolateral thigh — repeat at 5 min if no improvement.

Paediatric dose

Dose: 0.01 mg/kg

Route: IV / IO

Frequency: Every 3–5 min (cardiac arrest)

Max: 1mg

Concentration: 0.1 mg/ml

Dose adjustments

Renal

No adjustment required in emergencies.

Paediatric weight-based calculator

Patient weight (kg)

Clinical pearls

Cardiac arrest: give 1mg after the 2nd shock for VF/pVT. For non-shockable rhythms (PEA/asystole), give ASAP.
Anaphylaxis: IM route preferred over SC — faster absorption. Use anterolateral mid-thigh.
1:1,000 = 1mg/mL (for IM anaphylaxis). 1:10,000 = 0.1mg/mL (for IV cardiac arrest). Do not confuse strengths.
Paed anaphylaxis: 0.01mg/kg IM (1:1,000), max 0.5mg. EpiPen Jr (150mcg) >15kg; EpiPen (300mcg) >30kg.
Infusion for cardiogenic shock/post-arrest: 0.01–0.5 mcg/kg/min via central line.

Contraindications

No absolute contraindications in cardiac arrest or severe anaphylaxis
Relative: hypertrophic obstructive cardiomyopathy (dynamic LVOT obstruction) in anaphylaxis

Side effects

Tachycardia, hypertension
Anxiety, tremor, headache
Pallor, cool peripheries
Arrhythmias at high doses

Interactions

MAO inhibitors: risk of severe hypertension
Beta-blockers: reduced efficacy for anaphylaxis — consider glucagon 1mg IV
Tricyclic antidepressants: potentiation of adrenergic effects

Monitoring

Continuous ECG
BP every 5 min
SpO₂
urine output

Reference: BNFc; UK Resuscitation Council 2021; RCUK Anaphylaxis 2021; NICE BNF 84. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Westley Croup Score · Respiratory

Drugs

Pathways