Medications › Vasopressor / Bronchodilator / Sympathomimetic › Adrenaline Auto-Injector (EpiPen, EpiPen Jr)

Vasopressor / Bronchodilator / Sympathomimetic IM

Adrenaline Auto-Injector (EpiPen, EpiPen Jr)

Adrenaline (Epinephrine)

CPG Reference

Anaphylaxis — Clinical Practice Guideline

Precautions

⚠ ALWAYS give adrenaline auto-injector FIRST, then asthma reliever puffer, if patient has known asthma AND allergy to food, insects or medication with sudden breathing difficulty (wheeze, persistent cough or hoarse voice) — even if there are no skin symptoms
⚠ Do not allow patient to walk or stand pre or post adrenaline administration — minimum 1 hour observation after 1 dose, 4 hours if more than 1 dose administered
⚠ Patient's own auto-injector may be used
⚠ Advise transport to a medical facility due to risk of bi-phasic reactions
⚠ Catastrophic hypotension could render IM adrenaline ineffective
⚠ Upright positioning coupled with significant hypotension can precipitate death
⚠ Patients should not walk post auto-injector administration due to risk of collapse
⚠ If non-drowsy antihistamines were administered prior to arrival and patient has decreased alertness, suspect anaphylaxis
⚠ Hypotension in adults: systolic BP < 90 mmHg or > 30% decrease from baseline; in children < (70 mmHg + [2 × age]) from 1–10 years

Adult

Amount EpiPen® 300 MICROg (0.3 mg)

Route IM — anterolateral thigh (may be administered through a single layer of clothing)

Repeat Repeat at 5-minute intervals as clinically required

Position patient supine or left lateral/recovery position if unconscious or pregnant. Each device is single-use only.

Paediatric — weight > 20 kg (or adults/children > 50 kg)

Amount EpiPen® 300 MICROg (0.3 mg)

Route IM — anterolateral thigh (may be administered through a single layer of clothing)

Repeat Repeat at 5-minute intervals as clinically required

Position patient supine or left lateral/recovery position if unconscious. Each device is single-use only.

Paediatric — weight 7.5–20 kg (approximately 1–5 years)

Amount EpiPen® Jr 150 MICROg (0.15 mg)

Route IM — anterolateral thigh (may be administered through a single layer of clothing)

Repeat Repeat at 5-minute intervals as clinically required

Position patient supine or held/laid horizontally. Infants should be held or laid horizontally, not sitting upright. Each device is single-use only.

Onset: Approximately 60 seconds Duration: Short duration of effect; half-life approximately 5 minutes

Side Effects

Drug Interactions

Clinical Notes

→ Administer adrenaline auto-injector BEFORE salbutamol puffer in patients with known asthma and allergy presenting with breathing difficulty
→ Position patient supine with legs outstretched; left lateral position for pregnant patients; do NOT sit patient upright or allow standing
→ Patient must NOT be mobilised until minimum 1 hour after 1 dose of adrenaline, or 4 hours if more than 1 dose — assess circulatory stability before any mobilisation
→ Patient must be monitored at a medical facility for 4 hours after the last dose of adrenaline (risk of bi-phasic reaction)
→ Remove trigger or injection mechanism if possible
→ Consider oxygen therapy if indicated
→ Antihistamines have no role in the treatment or prevention of respiratory or cardiovascular symptoms in acute anaphylaxis
→ Prepare auto-injector as per Adrenaline Autoinjector 'EpiPen' clinical skill: form fist around device with orange tip pointing down, pull blue safety cap, push orange tip firmly against outer mid-thigh until click heard, hold 3 seconds, remove and safely discard
→ IV adrenaline, nebulised adrenaline, further doses beyond initial auto-injector, and adrenaline infusion are outside EHS scope — requires Advanced Care or higher
→ Consider CSPSOC contact for further advice or authorisation