1 May 2026Injectable drugsSource update: June 2025
Epinephrine = EPN = Adrenaline injectable
Epinephrine injectable guidance for severe anaphylaxis and shock-related hypotension, with IM first-line and IV use only in equipped hospitals.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Therapeutic action
Sympathomimetic.
Indications
- Severe anaphylactic reaction.
- Acute hypotension despite fluid therapy in shock.
Forms and strengths, route of administration
Check the route of administration indicated on the ampoule. IV route should only be used by well trained personnel in well-equipped hospitals.
- 1 mg in 1 ml ampoule for IM injection only.
- 1 mg in 1 ml ampoule for IV injection or infusion only.
Dose
| EPN dose (microgram/kg/min) | 0.1 | 0.15 | 0.2 | 0.25 | 0.3 | 0.35 | 0.4 | 0.45 | 0.5 |
|---|---|---|---|---|---|---|---|---|---|
| Infusion rate (ml/hour) | 2.4 | 3.6 | 4.8 | 6 | 7.2 | 8.4 | 9.6 | 10.8 | 12 |
Severe anaphylactic reaction
- Administer undiluted solution by IM route into the anterolateral thigh.
- Child under 6 months: 0.1 to 0.15 ml.
- Child 6 months to 5 years: 0.15 ml.
- Child 6 to 12 years: 0.3 ml.
- Child over 12 years and adult: 0.5 ml, or 0.3 ml if small or prepubertal child.
- Repeat after 5 minutes if no or poor clinical improvement, up to a total of 3 IM injections.
Acute hypotension despite fluid therapy or anaphylactic reaction unresponsive to epinephrine IM
Use diluted solution in 0.9% sodium chloride, 5% glucose, or Ringer lactate and administer by continuous IV infusion using an infusion or syringe pump.
- Child and adult: 0.1 microgram/kg/minute, increasing if necessary by 0.05 microgram/kg/minute every 10 minutes for the first hour, then every hour, maximum 1 microgram/kg/minute.
Contra-indications, adverse effects, precautions
- Administer with caution to patients with hypertension, angina, ischaemic heart disease, hyperthyroidism, and older patients.
- May cause arrhythmia, hypertension, agitation, headache, and tissue necrosis following extravasation.
- Pregnancy and breast-feeding: no contra-indication.
- In anaphylaxis, use IV treatment only if there is no or poor improvement after 3 IM injections or if there is circulatory collapse.
- Epinephrine is colourless: discard any ampoules with a pink or brownish colour.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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