Adrenaline (epinephrine)

How it works

It is a potent agonist at alpha- and beta-adrenergic receptors, producing vasoconstriction, increased myocardial contractility and heart rate, and bronchodilation.

Prescribing in practice

• Different clinical situations require very different concentrations and routes, so the correct strength must be confirmed against the indication, as confusion between intramuscular anaphylaxis and intravenous cardiac-arrest preparations can be fatal.
• In cardiac arrest it is given intravenously or intraosseously during CPR per the resuscitation algorithm; as a peripheral vasopressor infusion it risks extravasation and tissue necrosis.
• Effects are exaggerated in patients on non-selective beta-blockers or tricyclic antidepressants and it may provoke arrhythmias and severe hypertension.

Monitoring

Continuous ECG, blood pressure and, for infusions, invasive arterial and central access monitoring with frequent checks of the infusion site are required.

Counselling the patient

• Confirm the indication-specific concentration and route before administration.
• Give vasopressor infusions through a central line where feasible to limit extravasation injury.
• Document timing of doses against the resuscitation cycle.

Evidence & guidelines

Adrenaline is recommended in Resuscitation Council UK advanced life support algorithms for cardiac arrest and as a first-line agent in anaphylaxis.