Epinephrine

What is epinephrine?

Epinephrine (Epiclor®) is an injectable drug used most often in emergency situations for animals (e.g., anaphylaxis, cardiopulmonary resuscitation [CPR]). It may also be added to local anesthesia drugs because it causes the veins to constrict, thus delaying the body’s absorption of the drugs and prolonging the duration of the local anesthetic.

Human formulations of epinephrine are often used off-label (extra label) in pets. Many drugs are commonly prescribed for off-label use in veterinary medicine. 

"Off label" means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How is epinephrine given?

• Epinephrine comes as a liquid solution that is injected into the muscle (IM) or under the skin (SQ).
• Follow your veterinarian’s directions and give this medication exactly as prescribed.
• Epinephrine may be prescribed as pre-filled, single-dose syringes or auto-injectors (Epi-pen®).
• If you accidentally inject yourself, contact your physician immediately.

This medication should take effect immediately and improvement in clinical signs should follow.

What if I miss giving my pet the medication?

Epinephrine is reserved for use in emergency situations. If you do not have epinephrine available and your pet starts having an allergic reaction, contact your veterinarian or emergency animal services immediately.

Is any monitoring needed with this medication?

Follow up with your veterinarian after giving epinephrine and follow their instructions for monitoring.

Are there any potential side effects?

Epinephrine may cause the following side effects:

• Increased heart rate
• Nervousness
• Restlessness
• Excitement
• Nausea and vomiting
• Increased blood pressure
• Tissue damage when injected repeatedly in the same area of tissue

Are there any risk factors for this medication?

There are no absolute contraindications in life-threatening situations. USE WITH CAUTION in:

• Pets with diabetes
• Pets with high blood pressure
• Pets with an abnormal heart rhythm
• Pets with a low circulating blood volume
• Pets that are pregnant, nursing, or giving birth

Are there any drug interactions I should be aware of?

Several medications should be USED WITH CAUTION when given with epinephrine, including: 

• Alpha-2-adrenergic agonists (e.g., detomidine, dexmedetomidine, medetomidine, xylazine) 
• Alpha-adrenergic antagonists (e.g., phenoxybenzamine, phentolamine, prazosin) 
• Antihistamines 
• Beta-adrenergic antagonists (e.g., atenolol, propranolol, sotalol) 
• Bronchodilators (e.g., albuterol, terbutaline) 
• Levothyroxine 
• Monoamine oxidase inhibitors (e.g., amitraz, selegiline) 
• Nitrates (e.g., nitroglycerin) 
• Oxytocin 
• Phenothaizines (e.g., acepromazine) 
• Phenylpropanolamine 
• Tricyclic antidepressants (e.g., amitriptyline, clomipramine) 

Be sure to tell your veterinarian about any medications (including vitamins, supplements, and herbal therapies) that your pet is taking before starting any treatment.

How do I store epinephrine?

• Store at controlled room temperature, between 59°F and 86°F (15°C and 30°C).
• Protect from light.
• Keep away from children and other animals.
• Do not use if the liquid is discolored or has evidence of material floating in it.
• Ask your veterinarian for specific disposal instructions. Do not flush medicines down the sink or toilet unless instructed to do so. 

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet's weight and symptoms.