Epinephrine
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| ID | DRUG-EPINEPHRINE |
|---|---|
| Тип | Препарат |
| Синоніми | AdrenalinAuvi-QEpiPenadrenalineАдреналін (епінефрин) |
| Статус | переглянуто 2026-04-27 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Дані про препарат
| Клас | Endogenous catecholamine; non-selective α and β adrenergic agonist (sympathomimetic) |
|---|---|
| Механізм дії | Endogenous catecholamine that stimulates all adrenergic receptor subtypes: α1 (vasoconstriction → reverses anaphylactic vasodilation and hypotension, reduces mucosal edema), β1 (positive inotropy and chronotropy → reverses cardiogenic component of anaphylactic shock and supports tissue perfusion), and β2 (bronchodilation → reverses anaphylactic bronchospasm; mast cell membrane stabilization → decreases further mediator release; vasodilation in skeletal muscle). The combined α + β1 + β2 actions make epinephrine uniquely first-line for anaphylaxis — no other single agent reverses all three life-threatening components (hypotension, bronchospasm, upper airway edema). Also used for cardiac arrest (asystole, PEA, refractory VF/VT) and infusion-reaction-related hypotension. Approved as a generic medicine since the early 20th century; modern auto-injectors approved 1980s. |
| Типове дозування | ANAPHYLAXIS (adult): 0.3-0.5 mg (0.3-0.5 mL of 1 mg/mL solution) IM into anterolateral thigh (vastus lateralis); REPEAT every 5-15 min as needed; if 2 doses required, escalate to IV infusion. Pediatric: 0.01 mg/kg IM (max 0.3 mg child <30 kg, 0.5 mg ≥30 kg). IV infusion for refractory anaphylactic shock: 0.05-1 µg/kg/min titrate to MAP ≥65 mmHg. CARDIAC ARREST: 1 mg IV/IO push every 3-5 min during CPR (pediatric 0.01 mg/kg). SEVERE INFUSION REACTION (e.g., chemotherapy hypersensitivity): 0.3-0.5 mg IM thigh as for anaphylaxis. CRITICAL ROUTE NOTES: IM thigh is standard for anaphylaxis — IM deltoid is suboptimal (slower absorption); SC route is OBSOLETE (slow, unreliable absorption); IV bolu... |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | True |
| Остання перевірка для України | 2026-04-27 |
Нотатки
ABSOLUTE FIRST-LINE for anaphylaxis — no equivalent alternative. H1/H2 antihistamines (diphenhydramine, famotidine), corticosteroids (hydrocortisone, methylprednisolone), and bronchodilators are all ADJUNCTS, NOT replacements. Delay or omission of epinephrine in anaphylaxis is the leading modifiable cause of fatal outcome — give EARLY (within 5 min of recognition), give IM thigh (NOT SC, NOT deltoid), and REPEAT every 5-15 min if symptoms persist. Common pitfall in chemotherapy infusion reactions: treating with diphenhydramine + steroid alone while withholding epinephrine for "mild" symptoms — escalate immediately if hypotension, bronchospasm, or upper airway involvement. Patients on β-blockers who develop refractory anaphylaxis: add glucagon 1-5 mg IV bolus then 5-15 µg/min infusion (bypasses β-receptor block via intracellular cAMP elevation). Auto-injectors not widely available in Ukraine — emergency department / oncology day-unit protocols should pre-position 1 mg/mL ampules + syringes and drill the IM-thigh administration. Ukraine: registered, NSZU- covered, ubiquitous.
Де використовується
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