Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Adrenaline (epinephrine)

Generic name
Adrenaline (epinephrine)
Brand name
ATC Code
C01CA24

Pharmacokinetics in children

No information

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dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

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Available formulations

No information is present at this moment.

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Dosages

Resuscitation
  • Intravenous
    • Preterm and Term neonate
      [4] [10] [22] [26]
      • 1:10,000 solution (0.1 mg/ml): 0.01 - 0.03 mg/kg/dose, bolus.

      • Repeat administration if necessary within 3-5 minutes

    • 1 month up to 18 years
      [3]
      • 1:10,000 solution (0.1 mg/ml): 0.01 mg/kg/dose, bolus.
        • Equivalent to 0.1 ml/kg of 1:10,000 solution
        • The following doses may possibly be used in asystole: 0.1 mg/kg (equivalent to 0.1 ml/kg of 1:1000 solution).
        • Repeat if necessary every 3-5 minutes.
  • Endotracheopulmonary
    • Preterm and Term neonate
      [4] [10] [22] [26] [27]
      • 1:10,000 solution (0.1 mg/ml): 0.05 - 0.1 mg/kg/dose, once only.

      • Endotracheal administration is not preferred. Use only when IV access is not available.

    • 1 month up to 18 years
      • 1:1000 solution: 0.1 mg/kg/dose, bolus.
        • Equivalent to 0.1 ml/kg of 1:1000 solution.
        • Endotracheal administration is not preferred.
Circulatory insufficiency
  • Intravenous
    • Premature and Term neonate
      [23] [24] [25] [28]
      • 0.02 - 0.5 microg./kg/minute, continuous infusion. Increase dose based on effect.
Laryngitis subglottica (pseudo-croup)
  • Inhalation
    • 1 month up to 18 years
      [5]
      • 5 mg/dose, once only.
Anaphylaxis, including anaphylactic shock
  • Intramuscular
    • 1 month up to 18 years
      [2] [6] [7] [9] [20] [29]
      • Administration in hospital setting: 0.01 mg/kg/dose Repeat 2 times at 15-minute intervals if necessary, then every 4 hours if necessary. Max: 0.5 mg/dose.

      • Self administration or administration by parents/caregivers: 

        7,5- 30 kg: 0.15 mg/dose (auto injector pen)
        30-60 kg: 0.3 mg/dose (auto injector pen)
        ≥ 60 kg:  0.3-0.5 mg/dose (auto injector pen)

        A second injection may be needed if the symptoms do not abate or are exacerbated after the first dose. The second injection can be administered after approximately 5-15 minutes.

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Renal impaiment in children > 3 months

No information available on dose adjustment in renal impairment.

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The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects

No information is present at this moment.

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The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Watch out for extravasation: central venous catheter. Watch out for renal and mesenteric vasoconstriction.

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Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

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Adrenergic and dopaminergic agents
C01CA04

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References

  1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
  2. Mylan Healthcare B.V, SmPC Epipen Junior (RVG 32726) 10-11-2021, www.geneesmiddelinformatiebank.nl
  3. Centrafarm, SmPC Adrenaline (RVG 50812) 14-06-2021, www.geneesmiddeleninformatiebank.nl
  4. NVK, Richtlijn Reanimatie van het kind bij de geboorte, www.nvk.nl, 2014, http://www.nvk.nl/Kwaliteit/Richtlijnenoverzicht/Details/tabid/1558/articleType/ArticleView/articleId/765/Reanimatie-van-pasgeborenen.aspx#tab15
  5. Brand, PLP et al, Werkboek Kinderlongziekten, VU Uitgeverij, 2001
  6. Muraro A, et al, The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immun, Allergy , 2007, 62, 857-71
  7. Cardona V., et al, World Allergy Organisation anaphylaxis guidelines: Summary, J ALLERGY CLIN IMMUNOL, 2020, 13, 100472
  8. NVK, Richtlijn Astma bij Kinderen, 2013
  9. Turner, NM, Leroy, P, Advanced Paediatric Life Support, de Nederlandse editie, Bohn, Stafleu van Loghum, 2015, 4e druk
  10. Wyllie J. et al, European Resuscitation Council Guidelines for Resuscitation 2015 Section 7. Resuscitation and support of transition of babies at birth., Resuscitation, 2015, 95, 249-263
  11. Sanofi, SmPC Suprarenin Injektionslösung (6196724.00.00/6091497.00.00), 08/2017
  12. DR. Mann Pharma, SmPC Emerade 150/300/500 µg Injektionslösung in einem Fertigpen (86870.00.00), 12/2016
  13. Infectopharm, SmPC Adrenalin 1:1000 Infektopharm Injektionslösung (3000341.00.00), 01/2015
  14. Sanofi, SmPC Suprarenin® Ampullen, Durchstechflasche (6196724.00.00/6091497.00.00), 08/2017
  15. Infectopharm, SmPC Infectokrupp Inhal 4mg/ml Lösung für einen Vernebler (52642.00.00), 01/2015
  16. INFECTOPHARM, SmPC INFECTOKRUPP® Inhal (52642.00.00), 01/2015
  17. Laboratoire Aguettant, SmPC Adrenalin 1:10.000 Aguettant, Injektionslösung in einer Fertigspritze (93835.00.00), 08/2016
  18. MEDA Pharma , SmPC FASTJEKT® Junior (65312.00.00), 02/2017
  19. MEDA Pharma, SmPC FASTJEKT® (13579.00.00), 02/2017
  20. Dr. Gerhard Mann, SmPC Emerade 150/300/500 Mikrogramm Injektionslösung in einem Fertigpen (86870.00.00/86871.00.00/86872.00.00), 12/2016
  21. EurimPharm, SmPC Epipen Junior Autoinjektor (88904.00.00), 02/2017
  22. Barber CA, Wyckoff MH., Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room., Pediatrics, 2006, 118(3), 1028-34
  23. Baske K, et al., Epinephrine versus dopamine in neonatal septic shock: a double-blind randomized controlled trial, Eur J Pediatr, 2018, 177(9), 1335-42
  24. Pellicer A, et al., Cardiovascular support for low birth weight infants and cerebral hemodynamics: a randomized, blinded, clinical trial., Pediatrics. , 2005, 115(6), 1501-12
  25. Valverde E, et al., Dopamine versus epinephrine for cardiovascular support in low birth weight infants: analysis of systemic effects and neonatal clinical outcomes., Pediatrics., 2006, 117(6), e1213-22
  26. Aziz K, et al., Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Circulation, 2020, 142(16_suppl_2), S524-s50
  27. Halling C, et al., Efficacy of Intravenous and Endotracheal Epinephrine during Neonatal Cardiopulmonary Resuscitation in the Delivery Room., J Pediatr., 2017, 185, 232-6
  28. Lee G, et al. , Efficacy of Low-Dose Epinephrine Continuous Infusion in Neonatal Intensive Care Unit Patients., J Pediatr Pharmacol Ther., 2021, 26(1), 51-5
  29. Muraro A, et al., Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology, Allergy, 2014, 69(8), 1026-45

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Changes

Changes