EMERADE®300 MICROGRAMS
Acute anaphylaxis (for self-administration)
▶BY INTRAMUSCULAR INJECTION
▶Child (body-weight 30 kg and above): 300 micrograms,
then 300 micrograms after 5 – 15 minutes as required
EMERADE®500 MICROGRAMS
Acute anaphylaxis (for self-administration for patients at
risk of severe anaphylaxis)
▶BY INTRAMUSCULAR INJECTION
▶Child 12–17 years: 500 micrograms, then 500 micrograms
after 5 – 15 minutes as required
EPIPEN®AUTO-INJECTOR 0.3MG
Acute anaphylaxis (for self-administration)
▶BY INTRAMUSCULAR INJECTION
▶Child (body-weight 30 kg and above): 300 micrograms,
then 300 micrograms after 5 – 15 minutes as required
EPIPEN®JR AUTO-INJECTOR 0.15MG
Acute anaphylaxis (for self-administration)
▶BY INTRAMUSCULAR INJECTION
▶Child (body-weight up to 15 kg): 150 micrograms, then
150 micrograms after 5 – 15 minutes as required
▶Child (body-weight 15–30 kg): 150 micrograms, then
150 micrograms after 5 – 15 minutes as required, on the
basis of a dose of 10 micrograms/kg, 300 micrograms
may be more appropriate for some children
JEXT®150 MICROGRAMS
Acute anaphylaxis (for self-administration)
▶BY INTRAMUSCULAR INJECTION
▶Child (body-weight up to 15 kg): 150 micrograms, then
150 micrograms after 5 – 15 minutes as required
▶Child (body-weight 15–30 kg): 150 micrograms, then
150 micrograms after 5 – 15 minutes as required, on the
basis of a dose of 10 micrograms/kg, 300 micrograms
may be more appropriate for some children
JEXT®300 MICROGRAMS
Acute anaphylaxis (for self-administration)
▶BY INTRAMUSCULAR INJECTION
▶Child (body-weight 30 kg and above): 300 micrograms,
then 300 micrograms after 5 – 15 minutes as requiredlUNLICENSED USE
▶With intramuscular use for acute anaphylaxisAuto-injectors
delivering 150 -microgram dose of adrenaline may not be
licensed for use in children with body-weight under 15 kg.
▶With intravenous use for acute hypotensionAdrenaline 1 in
1000 ( 1 mg/mL) solution is not licensed for intravenous
administration.
IMPORTANT SAFETY INFORMATION
SAFE PRACTICE
Intravenous route should be used withextreme careby
specialists only.
MHRA/CHM ADVICE: ADRENALINE AUTO-INJECTORS: UPDATED
ADVICE AFTER EUROPEAN REVIEW (AUGUST 2017)
Following a European review of all adrenaline auto-
injectors approved in the EU, the MHRA recommend that
2 adrenaline auto-injectors are prescribed, which
patients should carry at all times. This is particularly
important for patients with allergic asthma, who are at
increased risk of a severe anaphylactic reaction. Patients
with allergies and their carers should be trained to use
the particular auto-injector they have been prescribed
and encouraged to practise using a trainer device.
Patients are advised to check the expiry date of the
adrenaline auto-injectors and obtain replacements
before they expire.lCAUTIONSArrhythmias.cerebrovascular disease.cor
pulmonale.diabetes mellitus.hypercalcaemia.
hyperreflexia.hypertension.hyperthyroidism.
hypokalaemia.ischaemic heart disease.obstructive
cardiomyopathy.occlusive vascular disease.organic brain
damage.phaeochromocytoma.prostate disorders.
psychoneurosis.severe angina.susceptibility to angle-
closure glaucoma
CAUTIONS, FURTHER INFORMATIONCautions listed are only
for non-life-threatening situations.
lINTERACTIONS→Appendix 1 : sympathomimetics,
vasoconstrictor
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
Angina pectoris.angle closure glaucoma.anxiety.
appetite decreased.arrhythmias.asthenia.
cardiomyopathy.CNS haemorrhage.confusion.dizziness
.dry mouth.dyspnoea.headache.hepatic necrosis.
hyperglycaemia.hyperhidrosis.hypersalivation.
hypertension (increased risk of cerebral haemorrhage).
hypokalaemia.insomnia.intestinal necrosis.metabolic
acidosis.mydriasis.myocardial infarction.nausea.pallor
.palpitations.peripheral coldness.psychosis.pulmonary
oedema (on excessive dosage or extreme sensitivity).renal
necrosis.soft tissue necrosis.tremor.urinary disorders.
vomiting
SPECIFIC SIDE-EFFECTS
▶Frequency not known
▶With intramuscular useMuscle necrosis.necrotising fasciitis
.peripheral ischaemia
▶With intravenous useHemiplegia.muscle rigidity
lPREGNANCYMay reduce placental perfusion and cause
tachycardia, cardiac irregularities, and extrasystoles in
fetus. Can delay second stage of labour. Manufacturers
advise use only if benefit outweighs risk.
lBREAST FEEDINGPresent in milk but unlikely to be
harmful as poor oral bioavailability.
lRENAL IMPAIRMENTManufacturers advise use with
caution in severe impairment.
lMONITORING REQUIREMENTSMonitor blood pressure and
ECG.
lDIRECTIONS FOR ADMINISTRATION
Acute hypotension
▶With intravenous useForcontinuous intravenous infusion,
dilute with Glucose 5 % or Sodium Chloride 0. 9 % and give
through a central venous catheter. Incompatible with
bicarbonate and alkaline solutions.Neonatal intensive care,
dilute 3 mg/kg body-weight to afinal volume of 50 mL with
infusionfluid; an intravenous infusion rate of 0. 1 mL/hour
provides a dose of 100 nanograms/kg/minute; infuse
through a central venous catheter. Incompatible with
bicarbonate and alkaline solutions. These infusions are
usually made up with adrenaline 1 in 1000 ( 1 mg/mL)
solution.
▶When used by inhalationFor nebulisation in croup,
adrenaline 1 in 1000 solution may be diluted with sterile
sodium chloride^0.^9 % solution.
lPRESCRIBING AND DISPENSING INFORMATIONIt is
important, in acute anaphylaxis where intramuscular
injection might still succeed, time should not be wasted
seeking intravenous access. Great vigilance is needed to
ensure that thecorrect strengthof adrenaline injection is
used; anaphylactic shock kits need to make avery clear
distinctionbetween the 1 in10 000strength and the 1 in
1000 strength. Patients with severe allergy should be
instructed in the self-administration of adrenaline by
intramuscular injection. Packs for self-administration
need to beclearly labelled with instructionson how to
administer adrenaline (intramuscularly, preferably at the
midpoint of the outer thigh, through light clothing if
necessary) so that in the case of rapid collapse someoneBNFC 2018 – 2019 Cardiac arrest 137
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