Pharmacology. Epinephrine is an endogenous catecholamine with alpha- and beta-adrenergic agonist properties that is used primarily in emergency situations to treat anaphylaxis or cardiac arrest. Beneficial effects include inhibition of histamine release from mast cells and basophils, bronchodilation, positive inotropic effects, and peripheral vasoconstriction. Epinephrine is not active after oral administration. Subcutaneous injection produces effects within 5–10 minutes, with peak effects at 20 minutes. Intravenous or inhalational administration produces much more rapid onset. Epinephrine is inactivated rapidly in the body, with an elimination half-life of 2 minutes.

Indications

1. 
   

   Anaphylaxis and anaphylactoid reactions.

   
   
2. 
   

   Epinephrine occasionally is used for hypotension resulting from overdose with beta blockers, calcium antagonists, and other cardiac-depressant drugs.

Contraindications

1. 
   

   Tachyarrhythmias or ventricular fibrillation and uncorrected hypovolemia.

   
   
2. 
   

   Epinephrine is relatively contraindicated in patients with organic heart disease, peripheral arterial occlusive vascular disease with thrombosis, or ergot poisoning (See Ergot Derivatives).

   
   
3. 
   

   Narrow-angle glaucoma.

Adverse effects

1. 
   

   Anxiety, restlessness, tremor, and headache.

   
   
2. 
   

   Severe hypertension, which may result in intracranial hemorrhage, pulmonary edema, or myocardial necrosis or infarction.

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