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Vasopressor Pregnancy: Use only if potential benefits outweigh possible risks to the fetus; teratogenic in animal studies and crosses the placenta. Parenteral adrenaline should not be used during the second stage of labour.

Adrenaline (Epinephrine)

Brand names: EpiPen, Emerade, Jext

Used in: Anaphylaxis & Allergy Epistaxis (Nosebleed)

Adrenaline (epinephrine) is an endogenous catecholamine and a core emergency drug, used in cardiac arrest, anaphylaxis and as a vasopressor for distributive and cardiogenic 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: 0.5 mg (0.5 mL of adrenaline 1 mg/mL [1:1000])
Route: IM
Frequency: May repeat at 5-minute intervals according to blood pressure, pulse and respiratory function
Anaphylactic reaction. IM route (anterolateral aspect of middle third of the thigh) is recommended by the EU Resuscitation Council as most appropriate. Subcutaneous route not recommended (less effective). Do NOT give 1 mg/mL (1:1000) solution intravenously — IV administration for anaphylaxis requires a 1:10,000 solution. Elderly: no specific dosage regime; use with great caution as more susceptible to cardiovascular side effects. Paediatric: Over 12 years: 0.5 mg IM (0.5 mL 1:1000), or 0.3 mg IM (0.3 mL) if child is small or pre-pubertal. 6–12 years: 0.3 mg IM (0.3 mL 1:1000). 6 months–6 years: 0.15 mg IM (0.15 mL 1:1000). Under 6 months: 0.01 mg/kg IM (0.01 mL/kg 1:1000). May repeat at 5–15 minute intervals according to blood pressure, pulse and respiratory function; use a small volume syringe.

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.

Contraindications

  • Hypersensitivity to the active substance or to any excipient (contraindications are relative — product is for life-threatening emergencies)
  • Use in fingers, toes, ears, nose, genitalia or buttocks (risk of ischaemic tissue necrosis)
  • Do not use if solution is discoloured

Side effects

  • Palpitations, tachycardia; in high dose or sensitive patients: cardiac dysrhythmia (ventricular fibrillation/cardiac arrest), acute angina, risk of acute myocardial infarction
  • Hypertension (with risk of cerebral haemorrhage), pallor, coldness/vasoconstriction of extremities
  • Anxiety, nervousness, fear, hallucinations
  • Headache, tremors, dizziness, syncope
  • Hyperglycaemia, hypokalaemia, metabolic acidosis

Interactions

  • Halothane or other halogenated anaesthetics — avoid or use with extreme caution (risk of ventricular fibrillation)
  • Contains sodium metabisulfite — can cause allergic-type reactions in susceptible individuals

Clinical monograph

How it works

It acts as a non-selective agonist at alpha- and beta-adrenoceptors, causing vasoconstriction, raised heart rate and contractility, and bronchodilation.

Prescribing in practice

  • Selecting the correct concentration and route for the specific indication is critical, because inadvertent use of the cardiac-arrest intravenous strength for intramuscular anaphylaxis or vice versa can cause serious harm.
  • In cardiac arrest it is administered intravenously or intraosseously within the advanced life support cycle; vasopressor infusions ideally run through central access to avoid extravasation necrosis.
  • It can precipitate tachyarrhythmias, myocardial ischaemia and severe hypertension, with effects potentiated by tricyclic antidepressants and complicated by non-selective beta-blockade.

Monitoring

Use continuous ECG and blood pressure monitoring, with invasive haemodynamic monitoring and infusion-site checks for sustained infusions.

Counselling the patient

  • Always verify the indication-matched strength and route before giving.
  • Prefer central administration for prolonged vasopressor infusions.
  • Watch for arrhythmia and ischaemia during and after dosing.

Evidence & guidelines

Adrenaline is a recommended agent across Resuscitation Council UK cardiac arrest and anaphylaxis algorithms.

Reference: UK Resuscitation Council 2021; RCUK Anaphylaxis 2021; NICE; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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Featured in these MRCEM clinical pathways

Adrenaline (Epinephrine) is a core drug in the following exam-focused workups on our sister siteReviseMRCEM.

MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.