{"id":"epinephrine","rwe":[{"pmid":"41906180","year":"2026","title":"The shift towards lower-risk oral food challenges since the implementation of oral immunotherapy: a retrospective cohort study.","finding":"","journal":"Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology","studyType":"Clinical Study"},{"pmid":"41905653","year":"2026","title":"A Health-Economic Analysis of Alpha-Gal Screening in the Asymptomatic Patient to Prevent Fatal Anaphylaxis.","finding":"","journal":"The journal of allergy and clinical immunology. In practice","studyType":"Clinical Study"},{"pmid":"41905390","year":"2025","title":"Anaphylaxis After a Third Exposure to Sugammadex.","finding":"","journal":"Anesthesia progress","studyType":"Clinical Study"},{"pmid":"41904615","year":"2026","title":"Safety of Topical Epinephrine Compared with Oxymetazoline in Pediatric Functional Endoscopic Sinus Surgery: A Retrospective Cohort Study.","finding":"","journal":"The Annals of otology, rhinology, and laryngology","studyType":"Clinical Study"},{"pmid":"41902369","year":"2026","title":"Retrospective Evaluation of Outcomes in Canine Anaphylaxis Patients Receiving Late Epinephrine or No Epinephrine: 49 Cases (2019-2023).","finding":"","journal":"Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)","studyType":"Clinical Study"}],"_fda":{"id":"3b2a5ecf-ba3d-d11c-e063-6394a90a81b7","set_id":"0172280c-f7d6-4613-9dbd-f94d3ae5825a","openfda":{"nui":["N0000000209","N0000000245","N0000175552","N0000175555","N0000175570","M0003647"],"unii":["YKH834O4BH"],"route":["INTRAVENOUS"],"rxcui":["727373"],"spl_id":["3b2a5ecf-ba3d-d11c-e063-6394a90a81b7"],"brand_name":["Epinephrine"],"spl_set_id":["0172280c-f7d6-4613-9dbd-f94d3ae5825a"],"package_ndc":["70518-3816-0"],"product_ndc":["70518-3816"],"generic_name":["EPINEPHRINE"],"product_type":["HUMAN PRESCRIPTION DRUG"],"pharm_class_cs":["Catecholamines [CS]"],"substance_name":["EPINEPHRINE"],"pharm_class_epc":["alpha-Adrenergic Agonist [EPC]","beta-Adrenergic Agonist [EPC]","Catecholamine [EPC]"],"pharm_class_moa":["Adrenergic alpha-Agonists [MoA]","Adrenergic beta-Agonists [MoA]"],"manufacturer_name":["REMEDYREPACK INC."],"application_number":["NDA211363"],"original_packager_product_ndc":["76329-3318"]},"version":"4","pregnancy":["8.1 Pregnancy Risk Summary Limited published data on epinephrine use in pregnant women are not sufficient to determine a drug-associated risk for major birth defects or miscarriage. However, there are risks to the mother and fetus associated with epinephrine use during labor or delivery, and risks due to untreated hypotension associated with septic shock (see Clinical Considerations) . In animal reproduction studies, epinephrine demostrated adverse developmental effects when administed to pregnant rabbits (gastroschisis), mice (teratogenie effects, embryonic lethality, and delayed skeletal ossification), and hamsters (embryonic lethality and delayed skeletal ossification) during organogenesis at doses approximately 15 times, 3 times and 2 times, respectively, the maximum recommended daily intramuscular or subcutaneous dose (see Data). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the United States general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Clinical Considerations Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated. Delaying treatment in pregnant women with hypotension associated with septic shock may increase the risk of maternal and fetal morbidity and mortality. Do not withhold life-sustaining therapy for a pregnant woman. Labor or Delivery Epinephrine usually inhibits spontaneous or oxytocin-induced contractions of the pregnant human uterus and may delay the second stage of labor. Avoid epinephrine during the second stage of labor. In dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage. Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg. Although epinephrine may improve maternal hypotension associated with septic shock and anaphylaxis, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia. Data Animal Data In an embryofetal development study with pregnant rabbits dosed during the period of organogenesis (on days 3 to 5, 6 to 7, or 7 to 9 of gestation), epinephrine caused teratogenic effects (including gastroschisis) at doses approximately 15 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at a maternal subcutaneous dose of 1.2 mg/kg/day for 2 to 3 days).Animals treated on days 6 to 7 had decreased number of implantations. In an embryofetal development study, pregnant mice were administered epinephrine (0.1 to 10 mg/kg/day) on Gestation Days 6 to 15. Teratogenic effects, embryonic lethality, and delays in skeletal ossification were observed at approximately 3 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at maternal subcutaneous dose of 1 mg/kg/day for 10 days). These effects were not seen in mice at approximately 2 times the maximum recommended daily intramuscular or subcutaneous dose (on a mg/m 2 basis at a subcutaneous maternal dose of 0.5 mg/kg/day for 10 days). In an embryofetal development study with pregnant hamsters dosed during the period of organogenesis from gestation days 7 to 10, epinephrine produced reductions in litter size and delayed skeletal ossification at doses approximately 2 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at a maternal subcutaneous dose of 0.5 mg/kg/day)."],"overdosage":["10 OVERDOSAGE Overdosage of epinephrine may produce extremely elevated arterial pressure, which may result in cerebrovascular hemorrhage, particularly in elderly patients. Overdosage may also result in pulmonary edema because of peripheral vascular constriction together with cardiac stimulation. Epinephrine overdosage may also cause transient bradycardia followed by tachycardia and these may be accompanied by potentially fatal cardiac arrhythmias. Premature ventricular contractions may appear within one minute after injection and may be followed by multifocal ventricular tachycardia (prefibrillation rhythm). Subsidence of the ventricular effects may be followed by atrial tachycardia and occasionally by atrioventricular block. Myocardial ischemia and infarction, cardiomyopathy, extreme pallor and coldness of the skin, metabolic acidosis due to elevated blood lactic acid levels, and renal insufficiency and failure have also been reported. Epinephrine is rapidly inactivated in the body and treatment following overdose is primarily supportive. Treatment of pulmonary edema consists of a rapidly acting alpha-adrenergic blocking drug (such as phentolamine mesylate) and respiratory support. Treatment of arrhythmias consists of administration of a beta-adrenergic blocking drug (such as propranolol). If necessary, pressor effects may be counteracted by rapidly acting vasodilators (such as nitrites) or alpha-adrenergic blocking drugs. If prolonged hypotension follows such measures, it may be necessary to administer another pressor drug."],"description":["11 DESCRIPTION Epinephrine, USP is a non-selective alpha and beta-adrenergic agonist designated chemically as (R) -4-(1-Hydroxy-2-(methylamino)ethyl)benzene-1,2-diol, a white, microcrystalline powder. It has the following structural formula: The molecular weight of epinephrine is 183.2. Epinephrine solution deteriorates rapidly on exposure to air or light, turning pink from oxidation to adrenochrome and brown from the formation of melanin. Epinephrine Injection USP, 1 mg/10 mL (0.1 mg/mL) is supplied as a sterile aqueous solution that is clear, colorless and nonpyrogenic. Each mL of the solution contains epinephrine (0.1 mg) as the active ingredient and the following inactive ingredients: citric acid monohydrate (3.3 mg), edetate disodium dihydrate (0.004 mg), sodium chloride (8.2 mg), sodium citrate dihydrate (1.5 mg), sodium metabisulfite, and Water for Injection. Hydrochloric acid solution is added to dissolve the active ingredient. Sodium hydroxide solution is added to adjust the pH. Nitrogen is used for blanketing protection. Solution must be diluted prior to intravenous use. structure"],"how_supplied":["16 HOW SUPPLIED/STORAGE AND HANDLING Epinephrine Injection USP, 1 mg/10 mL (0.1 mg/mL) is a clear colorless solution available in a single-dose Luer-Jet™ Luer-Lock prefilled syringe packaged in a carton. It is supplied in the following presentation. NDC: 70518-3816-00 PACKAGING: 10 in 1 PACKAGE, 1 in 1 CARTON, 10 mL in 1 SYRINGE TYPE 2 Epinephrine is light sensitive. Protect from light until ready to use. Do not refrigerate. Protect from freezing. Store at room temperature, between 20° to 25°C (68° to 77°F). (See USP Controlled Room Temperature.) Protect from alkalis and oxidizing agents. Rx Only Repackaged and Distributed By: Remedy Repack, Inc. 625 Kolter Dr. Suite #4 Indiana, PA 1-724-465-8762"],"geriatric_use":["8.5 Geriatric Use Clinical studies of epinephrine for the treatment of hypotension associated with septic shock did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy."],"pediatric_use":["8.4 Pediatric Use Safety and effectiveness of epinephrine in pediatric patients with septic shock have not been established."],"effective_time":"20250730","clinical_studies":["14 CLINICAL STUDIES 14.1 Hypotension associated with Septic Shock Fourteen clinical studies from the literature documented that epinephrine increases the mean arterial pressure (MAP) in patients with hypotension associated with septic shock."],"pharmacodynamics":["12.2 Pharmacodynamics Intravenous use for hypotension associated with septic shock Following intravenous administration of epinephrine, increases in systolic blood pressure and heart rate are observed. Decreases in systemic vascular resistance and diastolic blood pressure are observed at low doses of epinephrine because of β 2 -mediated vasodilation, but are overtaken by α 1 -mediated peripheral vasoconstriction at higher doses leading to increase in diastolic blood pressure. The onset of blood pressure increase following an intravenous dose of epinephrine is < 5 minutes and the time to offset blood pressure response occurs within 20 min. Most vascular beds are constricted including renal, splanchnic, mucosal and skin."],"pharmacokinetics":["12.3 Pharmacokinetics Following intravenous injection, epinephrine is rapidly cleared from the plasma with an effective half-life of < 5 min. A pharmacokinetic steady state following continuous intravenous infusion is achieved within 10-15 min. In patients with septic shock, epinephrine displays dose-proportional pharmacokinetics in the infusion dose range of 0.03 to 1.7 mcg/kg/min. Epinephrine is extensively metabolized with only a small amount excreted unchanged. Epinephrine is rapidly degraded to vanillylmandelic acid, an inactive metabolite, by monoamine oxidase and catechol-O-methyltransferase that are abundantly expressed in the liver, kidneys and other extraneuronal tissues. The tissues with the highest contribution to removal of circulating exogenous epinephrine are the liver (32%), kidneys (25%), skeletal muscle (20%), and mesenteric organs (12%). Specific Populations Elderly In a pharmacokinetic study of 45-minute epinephrine infusions given to healthy men aged 20 to 25 years and healthy men aged 60 to 65 years, the mean plasma metabolic clearance rate of epinephrine at steady state was greater among the older men (144.8 versus 78 mL/kg/min for a 14.3 ng/kg/min infusion). Body Weight Body weight has been found to influence epinephrine pharmacokinetics. Higher body weight was associated with a higher plasma epinephrine clearance and a lower concentration plateau."],"adverse_reactions":["6 ADVERSE REACTIONS The following adverse reactions are discussed elsewhere in labeling: • Hypertension [see Warnings and Precautions (5.1)] • Pulmonary Edema [see Warnings and Precautions (5.2)] • Cardiac Arrhythmias and Ischemia [see Warnings and Precautions (5.3)] • Extravassation and Tissue Necrosis with Intravenous Infusion [see Warnings and Precautions (5.4)] • Renal Impairment [see Warnings and Precautions (5.5)] • Allergic Reactions associated with Sulfite [see Warnings and Precautions (5.6)] The following adverse reactions associated with the infusion of epinephrine were identified in the literature. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency reliably or to establish a causal relationship to drug exposure. Cardiovascular disorders: tachycardia, supraventricular tachycardia, ventricular arrhythmias, myocardial ischemia, myocardial infarction, limb ischemia, pulmonary edema Gastrointestinal disorders : Nausea, vomiting General disorders and administrative site conditions : Chest pain, extravasation Metabolic : hypoglycemia, hyperglycemia, insulin resistance, hypokalemia, lactic acidosis Nervous system disorders : Headache, nervousness, paresthesia, tremor, stroke, central nervous system bleeding Psychiatric disorders : Excitability Renal disorders : Renal insufficiency Respiratory : Pulmonary edema, rales Skin and subcutaneous tissue disorders : Diaphoresis, pallor, piloerection, skin blanching, skin necrosis with extravasation Most common adverse reactions to systemically administered epinephrine are headache; anxiety; apprehensiveness; restlessness; tremor; weakness; dizziness; sweating; palpitations; pallor; peripheral coldness; nausea/vomiting; and/or respiratory difficulties. Arrhythmias, including fatal ventricular fibrillation, rapid rises in blood pressure producing cerebral hemorrhage, and angina have occurred. (6.1) To report SUSPECTED ADVERSE REACTIONS, contact Amphastar Pharmaceuticals, Inc. at 1-800-423-4136 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch."],"contraindications":["4 CONTRAINDICATIONS None. None."],"drug_interactions":["7 DRUG INTERACTIONS Drugs that counter the pressor effects of epinephrine include alpha blockers, vasodilators such as nitrates, diuretics, antihypertensives, and ergot alkaloids. ( 7 .1) Drugs that potentiate the effects of epinephrine include sympathomimetics, beta blockers, tricyclic antidepressants, MAO inhibitors, COMT inhibitors, clonidine, doxapram, oxytocin, levothyroxine sodium, and certain antihistamines. ( 7 .2) Drugs that increase the arrhythmogenic potential of epinephrine include beta blockers, cyclopropane and halogenated hydrocarbon anesthetics, quinidine, antihistamines, exogenous thyroid hormones, diuretics, and cardiac glycosides. Observe for development of cardiac arrhythmias. ( 7 .3) Potassium-depleting drugs, including corticosteroids, diuretics, and theophylline, potentiate the hypokalemic effects of epinephrine. ( 7 .4) 7.1 Drugs Antagonizing Pressor Effects of Epinephrine • α-blockers, such as phentolamine • Vasodilators, such as nitrates • Diuretics • Antihypertensives • Ergot alkaloids • Phenothiazine antipsychotics 7.2 Drugs Potentiating Pressor Effects of Epinephrine • Sympathomimetics • β-blockers, such as propranolol • Tricyclic anti-depressants • Monoamine oxidase (MAO) inhibitors • Catechol-O-methyl transferase (COMT) inhibitors, such as entacapon • Clonidine • Doxapram • Oxytocin 7.3 Drugs Potentiating Arrhythmogenic Effects of Epinephrine Patients who are concomitantly receiving any of the following drugs should be observed carefully for the development of cardiac arrhythmias [see Warnings and Precautions (5.6) and Adverse Reactions (6)]. • β-blockers, such as propranolol • Cyclopropane or halogenated hydrocarbon anesthetics, such as halothane • Antihistamines • Thyroid hormones • Diuretics • Cardiac glycosides, such as digitalis glycosides • Quinidine 7.4 Drugs Potentiating Hypokalemic Effects of Epinephrine • Potassium depleting diuretics • Corticosteroids • Theophylline"],"mechanism_of_action":["12.1 Mechanism of Action Epinephrine acts on both alpha (α)- and beta (β)-adrenergic receptors. The mechanism of the rise in blood pressure is 3-fold: a direct myocardial stimulation that increases the strength of ventricular contraction (positive inotropic action), an increased heart rate (positive chronotropic action), and peripheral vasoconstriction."],"clinical_pharmacology":["12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Epinephrine acts on both alpha (α)- and beta (β)-adrenergic receptors. The mechanism of the rise in blood pressure is 3-fold: a direct myocardial stimulation that increases the strength of ventricular contraction (positive inotropic action), an increased heart rate (positive chronotropic action), and peripheral vasoconstriction. 12.2 Pharmacodynamics Intravenous use for hypotension associated with septic shock Following intravenous administration of epinephrine, increases in systolic blood pressure and heart rate are observed. Decreases in systemic vascular resistance and diastolic blood pressure are observed at low doses of epinephrine because of β 2 -mediated vasodilation, but are overtaken by α 1 -mediated peripheral vasoconstriction at higher doses leading to increase in diastolic blood pressure. The onset of blood pressure increase following an intravenous dose of epinephrine is < 5 minutes and the time to offset blood pressure response occurs within 20 min. Most vascular beds are constricted including renal, splanchnic, mucosal and skin. 12.3 Pharmacokinetics Following intravenous injection, epinephrine is rapidly cleared from the plasma with an effective half-life of < 5 min. A pharmacokinetic steady state following continuous intravenous infusion is achieved within 10-15 min. In patients with septic shock, epinephrine displays dose-proportional pharmacokinetics in the infusion dose range of 0.03 to 1.7 mcg/kg/min. Epinephrine is extensively metabolized with only a small amount excreted unchanged. Epinephrine is rapidly degraded to vanillylmandelic acid, an inactive metabolite, by monoamine oxidase and catechol-O-methyltransferase that are abundantly expressed in the liver, kidneys and other extraneuronal tissues. The tissues with the highest contribution to removal of circulating exogenous epinephrine are the liver (32%), kidneys (25%), skeletal muscle (20%), and mesenteric organs (12%). Specific Populations Elderly In a pharmacokinetic study of 45-minute epinephrine infusions given to healthy men aged 20 to 25 years and healthy men aged 60 to 65 years, the mean plasma metabolic clearance rate of epinephrine at steady state was greater among the older men (144.8 versus 78 mL/kg/min for a 14.3 ng/kg/min infusion). Body Weight Body weight has been found to influence epinephrine pharmacokinetics. Higher body weight was associated with a higher plasma epinephrine clearance and a lower concentration plateau."],"indications_and_usage":["1 INDICATIONS AND USAGE Epinephrine is a non-selective alpha and beta adrenergic agonist indicated to increase mean arterial blood pressure in adult patients with hypotension associated with septic shock. ( 1.1 ) 1.1 Hypotension associated with Septic Shock Epinephrine Injection USP, 1 mg/10 mL (0.1 mg/mL) is indicated to increase mean arterial blood pressure in adult patients with hypotension associated with septic shock."],"warnings_and_cautions":["5 WARNINGS AND PRECAUTIONS • Monitor blood pressure frequently. (5.1) • Increases cardiac output and causes peripheral vasoconstriction. (5.2) • May induce cardiac arrhythmias and myocardial ischemia. (5.3) • Avoid extravasation into tissues, which can cause local necrosis. (5.4) • Constricts renal blood vessels which may result in oliguria or renal impairment. (5.5) • Sulfite Warning. (5.6) 5.1 Hypertension Because individual response to epinephrine may vary significantly, monitor blood pressure frequently and titrate to avoid excessive increases in blood pressure. Patients receiving monoamine oxidase inhibitors (MAOI) or antidepressants of triptyline or imipramine types may experience severe, prolonged hypertension when given epinephrine. 5.2 Pulmonary Edema Epinephrine increases cardiac output and causes peripheral vasoconstriction, which may result in pulmonary edema. 5.3 Cardiac Arrhythmias and Ischemia Epinephrine may induce cardiac arrhythmias and myocardial ischemia in patients, especially patients suffering from coronary artery disease or cardiomyopathy [see Adverse Reactions (6) and Drug Interactions (7.3)] . 5.4 Extravasation and Tissue Necrosis with Intravenous Infusion Avoid extravasation of epinephrine into the tissues, to prevent local necrosis. When Epinephrine Injection is administered intravenously, check the infusion site frequently for free flow. Blanching along the course of the infused vein, sometimes without obvious extravasation, may be attributed to vasa vasorum constriction with increased permeability of the vein wall, permitting some leakage. This also may progress on rare occasions to superficial slough. Hence, if blanching occurs, consider changing the infusion site at intervals to allow the effects of local vasoconstriction to subside. There is a potential for gangrene in a lower extremity when infusions of catecholamine are given in an ankle vein. Antidote for Extravasation Ischemia: To prevent sloughing and necrosis in areas in which extravasation has taken place, infiltrate the area with 10 mL to 15 mL of saline solution containing from 5 mg to 10 mg of phentolamine, an adrenergic blocking agent. Use a syringe with a fine hypodermic needle, with the solution being infiltrated liberally throughout the area, which is easily identified by its cold, hard, and pallid appearance. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated with 12 hours. 5.5 Renal Impairment Epinephrine constricts renal blood vessels, which may result in oliguria or renal impairment. 5.6 Allergic Reactions Associated with Sulfite Contains sodium bisulfite, which may cause mild to severe allergic reactions including anaphylaxis orasthmatic episodes, particularly in patients with a history of allergies. The presence of sodium bisulfite in this product should not preclude its use for the treatment of hypotension associated with septic shock, even if the patient is sulfite-sensitive, as the alternatives to using epinephrine in a life-threatening situation may not be satisfactory. In susceptible patients, consider using a formulation of epinephrine or another vasoconstrictor that does not contain sodium bisulfite."],"nonclinical_toxicology":["13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term studies to evaluate the carcinogenic potential of epinephrine have not been conducted. Epinephrine and other catecholamines have been shown to have mutagenic potential in vitro. Epinephrine was positive in the Salmonella bacterial reverse mutation assay, positive in the mouse lymphoma assay, and negative in the in vivo micronucleus assay. Epinephrine is an oxidative mutagen based on the E. coli WP2 Mutoxitest bacterial reverse mutation assay. This should not prevent the use of epinephrine under the conditions noted under the Indications and Usage. The potential for epinephrine to impair reproductive performance has not been evaluated, but epinephrine has been shown to decrease implantation in female rabbits dosed subcutaneously with 1.2 mg/kg/day (15-fold the highest human intramuscular or subcutaneous daily dose) during gestation days 3 to 9. 13.2 Animal Toxicology and/or Pharmacology Epinephrine was associated with metabolic effects, decreased mesentery, coronary and renal conductance in a sheep model of septic shock. Data from hemolysis study have shown that epinephrine at 1:1000 dilution is non-hemolytic. Epinephrine infusion significantly increased the MAP (69 vs. 86 mmHg) and cardiac output (6.4 vs. 7.1 L/min) and decreased renal blood flow (330 vs. 247 mL/min)."],"spl_unclassified_section":["Repackaged and Distributed By: Remedy Repack, Inc. 625 Kolter Dr. Suite #4 Indiana, PA 1-724-465-8762"],"dosage_and_administration":["2 DOSAGE AND ADMINISTRATION • Hypotension associated with septic shock ( 2.2 ) : o Dilute epinephrine in dextrose solution prior to infusion. o Infuse epinephrine into a large vein. o Titrate 0.05 mcg/kg/min to 2 mcg/kg/min to achieve desired blood pressure. o Wean gradually. 2.1 General Considerations Inspect visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use if the solution is colored or cloudy, or if it contains particulate matter. Discard any unused portion. 2.2 Hypotension associated with Septic Shock Dilute epinephrine in 5% Dextrose Injection, USP or 5% Dextrose and Sodium Chloride solution. These dextrose containing fluids provide protection against significant loss of potency by oxidation. Administration in saline solution alone is not recommended. If indicated, administer whole blood or plasma separately. Add the entire contents of epinephrine prefilled syringe to 1000 mL of a 5% Dextrose containing solution. Each mL of this dilution contains 1 mcg of epinephrine. Whenever possible, give infusions of epinephrine into a large vein. Avoid using a catheter tie-in technique, because the obstruction to blood flow around the tubing may cause stasis and increased local concentration of the drug. Avoid the veins of the leg in elderly patients or in those suffering from occlusive vascular diseases. To provide hemodynamic support in septic shock associated hypotension in adult patients, the suggested dosing infusion rate of intravenously administered epinephrine is 0.05 mcg/kg/min to 2 mcg/kg/min, and is titrated to achieve a desired mean arterial pressure (MAP). The dosage may be adjusted periodically, such as every 10 to 15 minutes, in increments of 0.05 mcg/kg/min to 0.2 mcg/kg/min, to achieve the desired blood pressure goal. After hemodynamic stabilization, wean incrementally over time, such as by decreasing doses of epinephrine every 30 minutes over a 12- to 24-hour period."],"spl_product_data_elements":["Epinephrine Epinephrine CITRIC ACID MONOHYDRATE EDETATE DISODIUM SODIUM CHLORIDE SODIUM CITRATE SODIUM METABISULFITE WATER HYDROCHLORIC ACID NITROGEN EPINEPHRINE EPINEPHRINE"],"dosage_forms_and_strengths":["3 DOSAGE FORMS AND STRENGTHS Injection: 10 mL single-dose prefilled syringe containing 1 mg/10 mL (0.1 mg/mL) epinephrine as the hydrochloride in a sterile, clear and colorless solution. Injection: 1 mg/10 mL (0.1 mg/mL) single-dose prefilled syringe."],"use_in_specific_populations":["8 USE IN SPECIFIC POPULATIONS • Pregnancy: May lead to fetal harm (8.1) • Elderly patients and pregnant women may be at greater risk of developing adverse reactions when epinephrine is administered parenterally. (8.1, 8.5) 8.1 Pregnancy Risk Summary Limited published data on epinephrine use in pregnant women are not sufficient to determine a drug-associated risk for major birth defects or miscarriage. However, there are risks to the mother and fetus associated with epinephrine use during labor or delivery, and risks due to untreated hypotension associated with septic shock (see Clinical Considerations) . In animal reproduction studies, epinephrine demostrated adverse developmental effects when administed to pregnant rabbits (gastroschisis), mice (teratogenie effects, embryonic lethality, and delayed skeletal ossification), and hamsters (embryonic lethality and delayed skeletal ossification) during organogenesis at doses approximately 15 times, 3 times and 2 times, respectively, the maximum recommended daily intramuscular or subcutaneous dose (see Data). The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the United States general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively. Clinical Considerations Hypotension associated with septic shock is a medical emergency in pregnancy which can be fatal if left untreated. Delaying treatment in pregnant women with hypotension associated with septic shock may increase the risk of maternal and fetal morbidity and mortality. Do not withhold life-sustaining therapy for a pregnant woman. Labor or Delivery Epinephrine usually inhibits spontaneous or oxytocin-induced contractions of the pregnant human uterus and may delay the second stage of labor. Avoid epinephrine during the second stage of labor. In dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with hemorrhage. Avoid epinephrine in obstetrics when maternal blood pressure exceeds 130/80 mmHg. Although epinephrine may improve maternal hypotension associated with septic shock and anaphylaxis, it may result in uterine vasoconstriction, decreased uterine blood flow, and fetal anoxia. Data Animal Data In an embryofetal development study with pregnant rabbits dosed during the period of organogenesis (on days 3 to 5, 6 to 7, or 7 to 9 of gestation), epinephrine caused teratogenic effects (including gastroschisis) at doses approximately 15 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at a maternal subcutaneous dose of 1.2 mg/kg/day for 2 to 3 days).Animals treated on days 6 to 7 had decreased number of implantations. In an embryofetal development study, pregnant mice were administered epinephrine (0.1 to 10 mg/kg/day) on Gestation Days 6 to 15. Teratogenic effects, embryonic lethality, and delays in skeletal ossification were observed at approximately 3 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at maternal subcutaneous dose of 1 mg/kg/day for 10 days). These effects were not seen in mice at approximately 2 times the maximum recommended daily intramuscular or subcutaneous dose (on a mg/m 2 basis at a subcutaneous maternal dose of 0.5 mg/kg/day for 10 days). In an embryofetal development study with pregnant hamsters dosed during the period of organogenesis from gestation days 7 to 10, epinephrine produced reductions in litter size and delayed skeletal ossification at doses approximately 2 times the maximum recommended intramuscular, subcutaneous, or intravenous dose (on a mg/m 2 basis at a maternal subcutaneous dose of 0.5 mg/kg/day). 8.2 Lactation Risk Summary There is no information regarding the presence of epinephrine in human milk or the effects of epinephrine on the breastfed infant or on milk production. However, due to its poor oral bioavailability and short half-life, epinephrine exposure is expected to be very low in the breastfed infant. The lack of clinical data during lactation precludes a clear determination of the risk of epinephrine to a breastfed infant. 8.4 Pediatric Use Safety and effectiveness of epinephrine in pediatric patients with septic shock have not been established. 8.5 Geriatric Use Clinical studies of epinephrine for the treatment of hypotension associated with septic shock did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy."],"animal_pharmacology_and_or_toxicology":["13.2 Animal Toxicology and/or Pharmacology Epinephrine was associated with metabolic effects, decreased mesentery, coronary and renal conductance in a sheep model of septic shock. Data from hemolysis study have shown that epinephrine at 1:1000 dilution is non-hemolytic. Epinephrine infusion significantly increased the MAP (69 vs. 86 mmHg) and cardiac output (6.4 vs. 7.1 L/min) and decreased renal blood flow (330 vs. 247 mL/min)."],"package_label_principal_display_panel":["DRUG: Epinephrine GENERIC: Epinephrine DOSAGE: INJECTION ADMINSTRATION: INTRAVENOUS NDC: 70518-3816-0 PACKAGING: 10 mL in 1 SYRINGE, TYPE 2 OUTER PACKAGING: 1 in 1 CARTON OUTER PACKAGING: 10 in 1 PACKAGE ACTIVE INGREDIENT(S): EPINEPHRINE 0.1mg in 1mL INACTIVE INGREDIENT(S): CITRIC ACID MONOHYDRATE EDETATE DISODIUM SODIUM CHLORIDE SODIUM CITRATE SODIUM METABISULFITE WATER HYDROCHLORIC ACID NITROGEN MM1"]},"tags":[{"label":"Catecholamine","category":"class"},{"label":"Small Molecule","category":"modality"},{"label":"Alpha-1D adrenergic receptor","category":"target"},{"label":"ADRA1D","category":"gene"},{"label":"ADRA2A","category":"gene"},{"label":"ADRA1B","category":"gene"},{"label":"A01AD01","category":"atc"},{"label":"Respiratory (Inhalation)","category":"route"},{"label":"Intracardiac","category":"route"},{"label":"Topical","category":"route"},{"label":"Aerosol","category":"form"},{"label":"Capsule","category":"form"},{"label":"Gel","category":"form"},{"label":"Injection","category":"form"},{"label":"Off-Patent","category":"patent"},{"label":"Generic Available","category":"availability"},{"label":"Established","category":"status"},{"label":"Acute exacerbation of asthma","category":"indication"},{"label":"Administration of Local Anesthetic Nerve Block","category":"indication"},{"label":"Allergic Reactions","category":"indication"},{"label":"Anaphylaxis","category":"indication"},{"label":"Asthma management","category":"indication"},{"label":"Bronchiectasis","category":"indication"},{"label":"Approved 1940s","category":"decade"},{"label":"Adrenergic Agents","category":"pharmacology"},{"label":"Adrenergic Agonists","category":"pharmacology"},{"label":"Adrenergic alpha-Agonists","category":"pharmacology"},{"label":"Adrenergic beta-Agonists","category":"pharmacology"},{"label":"Anti-Asthmatic Agents","category":"pharmacology"},{"label":"Bronchodilator Agents","category":"pharmacology"},{"label":"Cardiovascular Agents","category":"pharmacology"},{"label":"Mydriatics","category":"pharmacology"},{"label":"Neurotransmitter Agents","category":"pharmacology"},{"label":"Peripheral Nervous System Agents","category":"pharmacology"},{"label":"Respiratory System Agents","category":"pharmacology"},{"label":"Sympathomimetics","category":"pharmacology"},{"label":"Vasoconstrictor Agents","category":"pharmacology"}],"phase":"marketed","safety":{"boxedWarnings":[],"safetySignals":[{"date":"","signal":"DRUG INEFFECTIVE","source":"FDA FAERS","actionTaken":"10451 reports"},{"date":"","signal":"FATIGUE","source":"FDA FAERS","actionTaken":"5779 reports"},{"date":"","signal":"PAIN","source":"FDA FAERS","actionTaken":"5742 reports"},{"date":"","signal":"HEADACHE","source":"FDA FAERS","actionTaken":"5739 reports"},{"date":"","signal":"NAUSEA","source":"FDA FAERS","actionTaken":"5484 reports"},{"date":"","signal":"OFF LABEL USE","source":"FDA FAERS","actionTaken":"5157 reports"},{"date":"","signal":"DYSPNOEA","source":"FDA FAERS","actionTaken":"4971 reports"},{"date":"","signal":"SINUSITIS","source":"FDA FAERS","actionTaken":"4205 reports"},{"date":"","signal":"PNEUMONIA","source":"FDA FAERS","actionTaken":"3612 reports"},{"date":"","signal":"PRODUCT DOSE OMISSION ISSUE","source":"FDA FAERS","actionTaken":"3457 reports"}],"drugInteractions":[{"url":"/drug/inhalational-anesthetics","drug":"Inhalational Anesthetics","action":"Use caution","effect":"Inhalational Anesthetics may enhance the arrhythmogenic effect of Alpha/Beta Agonists","source":"DrugCentral","drugSlug":"inhalational-anesthetics"},{"url":"/drug/isocarboxazid","drug":"isocarboxazid","action":"Avoid combination","effect":"May interact with Isocarboxazid","source":"DrugCentral","drugSlug":"isocarboxazid"},{"url":"/drug/labetalol","drug":"labetalol","action":"Monitor closely","effect":"May interact with Labetalol","source":"DrugCentral","drugSlug":"labetalol"},{"url":"/drug/linezolid","drug":"linezolid","action":"Avoid combination","effect":"May interact with Linezolid","source":"DrugCentral","drugSlug":"linezolid"},{"url":"/drug/methylthioninium-chloride","drug":"methylthioninium chloride","action":"Avoid combination","effect":"May interact with Methylene Blue","source":"DrugCentral","drugSlug":"methylthioninium-chloride"},{"url":"/drug/metoprolol","drug":"metoprolol","action":"Monitor closely","effect":"May interact with Metoprolol","source":"DrugCentral","drugSlug":"metoprolol"},{"url":"/drug/nadolol","drug":"nadolol","action":"Monitor closely","effect":"May interact with Nadolol","source":"DrugCentral","drugSlug":"nadolol"},{"url":"/drug/penbutolol","drug":"penbutolol","action":"Monitor closely","effect":"May interact with Penbutolol","source":"DrugCentral","drugSlug":"penbutolol"},{"url":"/drug/phenelzine","drug":"phenelzine","action":"Avoid combination","effect":"May interact with Phenelzine","source":"DrugCentral","drugSlug":"phenelzine"},{"url":"/drug/pindolol","drug":"pindolol","action":"Monitor closely","effect":"May interact with Pindolol","source":"DrugCentral","drugSlug":"pindolol"},{"url":"/drug/procarbazine","drug":"procarbazine","action":"Avoid combination","effect":"May interact with Procarbazine","source":"DrugCentral","drugSlug":"procarbazine"},{"url":"/drug/propranolol","drug":"propranolol","action":"Monitor closely","effect":"May interact with Propranolol","source":"DrugCentral","drugSlug":"propranolol"},{"url":"/drug/sotalol","drug":"sotalol","action":"Monitor closely","effect":"May interact with Sotalol","source":"DrugCentral","drugSlug":"sotalol"},{"url":"/drug/timolol","drug":"timolol","action":"Monitor closely","effect":"May interact with Timolol","source":"DrugCentral","drugSlug":"timolol"},{"url":"/drug/tranylcypromine","drug":"tranylcypromine","action":"Avoid combination","effect":"May interact with Tranylcypromine","source":"DrugCentral","drugSlug":"tranylcypromine"}],"commonSideEffects":[{"effect":"cardiac arrhythmias","drugRate":"reported","severity":"unknown"},{"effect":"excessive rise in blood pressure","drugRate":"reported","severity":"unknown"},{"effect":"cerebral hemorrhage","drugRate":"reported","severity":"unknown"},{"effect":"hemiplegia","drugRate":"reported","severity":"unknown"},{"effect":"subarachnoid hemorrhage","drugRate":"reported","severity":"unknown"},{"effect":"anginal pain","drugRate":"reported","severity":"unknown"},{"effect":"anxiety","drugRate":"reported","severity":"unknown"},{"effect":"restlessness","drugRate":"reported","severity":"unknown"},{"effect":"throbbing headache","drugRate":"reported","severity":"unknown"},{"effect":"tremor","drugRate":"reported","severity":"unknown"},{"effect":"weakness","drugRate":"reported","severity":"unknown"},{"effect":"dizziness","drugRate":"reported","severity":"unknown"},{"effect":"pallor","drugRate":"reported","severity":"unknown"},{"effect":"respiratory difficulty","drugRate":"reported","severity":"unknown"},{"effect":"palpitations","drugRate":"reported","severity":"unknown"},{"effect":"fear","drugRate":"reported","severity":"unknown"}],"contraindications":["Acute nephropathy","Angina pectoris","Angle-closure glaucoma","Anterior uveitis","Aphakia","Atrial fibrillation","Bacterial septicemia","Benign prostatic hyperplasia","Bleeding","Bradycardia","Cardiogenic shock","Cerebral arteriosclerosis","Chronic heart failure","Chronic myocardial ischemia","Complete atrioventricular block","Conduction disorder of the heart","Decreased respiratory function","Deficiency of cholinesterase","Denuded skin","Diabetes mellitus","Disease of liver","Disorder of cardiovascular system","Disorder of coronary artery","Heart block","Hepatic failure"],"specialPopulations":{"Pregnancy":"Epinephrine may lead to fetal anoxia, spontaneous abortion or both. There are no adequate and well controlled studies in pregnant women. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.","Geriatric use":"Clinical studies of epinephrine for the treatment of hypotension associated with septic shock did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy with potential for interaction with epinephrine.","Paediatric use":"Safety and effectiveness of epinephrine in pediatric patients with septic shock have not been established. Clinical use data support weight-based dosing for treatment of anaphylaxis in pediatric patients, and other reported clinical experience with the use of epinephrine suggests that the adverse reactions seen in children are similar in nature and extent to those both expected and reported in adults."}},"trials":[],"aliases":["adrenaline"],"patents":[{"type":"Method of Use","number":"9295657","applicant":"PH HEALTH LTD","territory":"US","tradeName":"ADRENALIN","expiryDate":"2035-03-13"},{"type":"Method of Use","number":"11918655","applicant":"ARS PHARMACEUTICALS OPERATIONS INC","territory":"US","tradeName":"NEFFY","expiryDate":"2039-02-06"},{"type":"Method of Use","number":"11744895","applicant":"ARS PHARMACEUTICALS OPERATIONS INC","territory":"US","tradeName":"NEFFY","expiryDate":"2039-02-06"},{"type":"Method of Use","number":"11717571","applicant":"ARS PHARMACEUTICALS OPERATIONS INC","territory":"US","tradeName":"NEFFY","expiryDate":"2039-02-06"},{"type":"Formulation","number":"11191838","applicant":"ARS PHARMACEUTICALS OPERATIONS INC","territory":"US","tradeName":"NEFFY","expiryDate":"2039-02-06"},{"type":"Method of Use","number":"11173209","applicant":"ARS PHARMACEUTICALS OPERATIONS INC","territory":"US","tradeName":"NEFFY","expiryDate":"2038-02-06"},{"type":"Method of Use","number":"10682414","applicant":"ARS PHARMACEUTICALS OPERATIONS INC","territory":"US","tradeName":"NEFFY","expiryDate":"2039-02-06"},{"type":"Method of Use","number":"11083698","applicant":"PH HEALTH LTD","territory":"US","tradeName":"ADRENALIN","expiryDate":"2039-03-21"},{"type":"Formulation","number":"11141540","applicant":"ADAMIS PHARMACEUTICALS CORP","territory":"US","tradeName":"SYMJEPI","expiryDate":"2036-10-20"},{"type":"Formulation","number":"10688244","applicant":"KALEO INC","territory":"US","tradeName":"AUVI-Q","expiryDate":"2037-12-21"},{"type":"Formulation","number":"10842938","applicant":"KALEO INC","territory":"US","tradeName":"AUVI-Q","expiryDate":"2037-12-21"},{"type":"Formulation","number":"11771830","applicant":"KALEO INC","territory":"US","tradeName":"AUVI-Q","expiryDate":"2037-12-21"},{"type":"Formulation","number":"10653646","applicant":"PH HEALTH LTD","territory":"US","tradeName":"ADRENALIN","expiryDate":"2039-03-21"},{"type":"Formulation","number":"11207280","applicant":"PH HEALTH LTD","territory":"US","tradeName":"ADRENALIN","expiryDate":"2039-03-21"},{"type":"Formulation","number":"9119876","applicant":"PH HEALTH LTD","territory":"US","tradeName":"ADRENALIN","expiryDate":"2035-03-13"},{"type":"Formulation","number":"10130592","applicant":"PH HEALTH LTD","territory":"US","tradeName":"ADRENALIN","expiryDate":"2035-03-13"},{"type":"Formulation","number":"12133837","applicant":"PH HEALTH 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LTD","territory":"US","tradeName":"ADRENALIN","expiryDate":"2035-03-13"},{"type":"Formulation","number":"12539283","applicant":"FRESENIUS KABI USA LLC","territory":"US","tradeName":"EPINEPHRINE","expiryDate":"2045-01-17"},{"type":"Formulation","number":"8206360","applicant":"KALEO INC","territory":"US","tradeName":"AUVI-Q","expiryDate":"2027-02-27"},{"type":"Formulation","number":"7947017","applicant":"KALEO INC","territory":"US","tradeName":"AUVI-Q","expiryDate":"2028-03-12"},{"type":"Formulation","number":"10576156","applicant":"ARS PHARMACEUTICALS OPERATIONS INC","territory":"US","tradeName":"NEFFY","expiryDate":"2038-02-06"}],"pricing":[{"market":"United States","source":"CMS National Average Drug Acquisition Cost (NADAC)","asOfDate":"2024-01-03","unitCost":"$117.1693/EA","priceType":"NADAC","sourceUrl":"https://data.medicaid.gov/dataset/4j6z-xnwq","annualCost":"$42,767","description":"EPINEPHRINE 0.15 MG AUTO-INJCT","retrievedDate":"2026-04-07"}],"_sources":{"trials":{"url":"https://clinicaltrials.gov/search?intr=epinephrine","method":"api_direct","source":"ClinicalTrials.gov","rawText":"","confidence":1,"sourceType":"ctgov","retrievedAt":"2026-04-19T23:50:33.741278+00:00"},"patents":{"url":"","method":"deterministic","source":"FDA Orange Book","rawText":"","confidence":1,"sourceType":"fda_orange_book","retrievedAt":"2026-04-19T23:50:33.741202+00:00"},"timeline":{"url":"https://en.wikipedia.org/wiki/Epinephrine","method":"deterministic","source":"Wikipedia","rawText":"","confidence":0.8,"sourceType":"wikipedia","retrievedAt":"2026-04-19T23:50:41.082830+00:00"},"regulatory.ca":{"url":"","method":"api_direct","source":"Health Canada DPD","rawText":"","confidence":1,"sourceType":"health_canada_dpd","retrievedAt":"2026-04-19T23:50:39.805976+00:00"},"regulatory.us":{"url":"","method":"api_direct","source":"FDA Drugs@FDA","rawText":"","confidence":1,"sourceType":"fda_drugsfda","retrievedAt":"2026-04-19T23:50:32.870125+00:00"},"publicationCount":{"url":"https://pubmed.ncbi.nlm.nih.gov/?term=epinephrine","method":"api_direct","source":"PubMed/NCBI","rawText":"","confidence":1,"sourceType":"pubmed","retrievedAt":"2026-04-19T23:50:40.025918+00:00"},"mechanism.drugClass":{"url":"https://api.fda.gov/drug/label.json","method":"deterministic","source":"FDA Label (EPC)","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:50:30.534394+00:00"},"administration.route":{"url":"","method":"deterministic","source":"FDA Label","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:50:30.534416+00:00"},"safety.boxedWarnings":{"url":"","method":"deterministic","source":"FDA Label (no boxed warning)","rawText":"","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:50:30.534421+00:00"},"safety.safetySignals":{"url":"https://api.fda.gov/drug/event.json","method":"api_direct","source":"FDA FAERS","rawText":"","confidence":1,"sourceType":"fda_faers","retrievedAt":"2026-04-19T23:50:41.593211+00:00"},"mechanism.target_chembl":{"url":"","method":"api_direct","source":"ChEMBL mechanism: Adrenergic receptor agonist","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-19T23:50:41.082774+00:00"},"crossReferences.chemblId":{"url":"https://www.ebi.ac.uk/chembl/compound_report_card/CHEMBL1256958/","method":"api_direct","source":"ChEMBL (EMBL-EBI)","rawText":"","confidence":1,"sourceType":"chembl","retrievedAt":"2026-04-19T23:50:40.739704+00:00"},"regulatory.fda_application":{"url":"","method":"deterministic","source":"FDA Label","rawText":"NDA211363","confidence":1,"sourceType":"fda_label","retrievedAt":"2026-04-19T23:50:30.534424+00:00"}},"allNames":"epipen","offLabel":[],"synonyms":["epinephrine","vasoconstrictine","nephridine","renoform","suprarenin","epinephrine bitartrate","(-)-adrenaline","epinephrine hydrochloride"],"timeline":[{"date":"1948-11-19","type":"positive","source":"DrugCentral","milestone":"FDA approval"},{"date":"1995-08-03","type":"positive","source":"FDA Orange Book","milestone":"Epi E Z Pen Jr approved — 0.15MG/DELIVERY"},{"date":"2004-05-28","type":"positive","source":"FDA Orange Book","milestone":"Twinject approved — EQ 0.15MG/DELIVERY"},{"date":"2012-08-10","type":"positive","source":"FDA Orange Book","milestone":"Auvi-Q approved — EQ 0.15MG/DELIVERY"},{"date":"2012-12-07","type":"positive","source":"FDA Orange Book","milestone":"Adrenalin approved — EQ 1MG BASE/ML (EQ 1MG BASE/ML)"},{"date":"2013-12-18","type":"positive","source":"FDA Orange Book","milestone":"Adrenalin approved — EQ 30MG BASE/30ML (EQ 1MG BASE/ML)"},{"date":"2017-06-15","type":"positive","source":"FDA Orange Book","milestone":"Symjepi approved — 0.3MG/0.3ML (0.3MG/0.3ML)"},{"date":"2018-11-07","type":"positive","source":"FDA Orange Book","milestone":"Primatene Mist approved — 0.125MG/INH"},{"date":"2019-11-05","type":"positive","source":"FDA Orange Book","milestone":"New formulation approved (Hospira)"},{"date":"2020-04-24","type":"neutral","source":"FDA Orange Book","milestone":"Generic entry — 4 manufacturers approved"},{"date":"2022-08-15","type":"positive","source":"FDA Orange Book","milestone":"New formulation approved (Intl Medication Sys)"},{"date":"2023-04-21","type":"positive","source":"FDA Orange Book","milestone":"Adrenalin approved — 2MG/250ML (8MCG/ML)"},{"date":"2024-02-14","type":"positive","source":"FDA Orange Book","milestone":"New formulation approved (Bpi Labs)"},{"date":"2024-08-09","type":"positive","source":"FDA Orange Book","milestone":"Neffy approved — 2MG/SPRAY"},{"date":"2025-03-13","type":"positive","source":"FDA Orange Book","milestone":"New formulation approved (Fresenius Kabi Usa)"}],"aiSummary":"Epipen (epinephrine) is a small molecule catecholamine that targets the alpha-1D adrenergic receptor. Originally developed, it is now owned by Ph Health and has been FDA-approved since 1948 for various indications including anaphylaxis, asthma management, and allergic reactions. Epipen is off-patent with 7 generic manufacturers available. Key safety considerations include potential cardiovascular and neurological effects. As a medication, Epipen is used to rapidly alleviate severe allergic reactions.","approvals":[{"date":"1948-11-19","orphan":false,"company":"","regulator":"FDA"}],"brandName":"Epipen","ecosystem":[{"indication":"Acute exacerbation of asthma","otherDrugs":[{"name":"bitolterol","slug":"bitolterol","company":"Sanofi Aventis Us"},{"name":"levosalbutamol","slug":"levosalbutamol","company":"Oak Pharms Inc"},{"name":"norepinephrine","slug":"norepinephrine","company":"Hospira"},{"name":"orciprenaline","slug":"orciprenaline","company":""}],"globalPrevalence":262000000},{"indication":"Administration of Local Anesthetic Nerve Block","otherDrugs":[{"name":"articaine","slug":"articaine","company":""},{"name":"mepivacaine","slug":"mepivacaine","company":"Eastman Kodak"}],"globalPrevalence":null},{"indication":"Allergic Reactions","otherDrugs":[],"globalPrevalence":200000000},{"indication":"Anaphylaxis","otherDrugs":[],"globalPrevalence":null},{"indication":"Asthma management","otherDrugs":[{"name":"beclometasone dipropionate","slug":"beclometasone-dipropionate","company":""},{"name":"bitolterol","slug":"bitolterol","company":"Sanofi Aventis Us"},{"name":"budesonide","slug":"budesonide","company":""},{"name":"ciclesonide","slug":"ciclesonide","company":"Takeda Gmbh"}],"globalPrevalence":262000000},{"indication":"Bronchiectasis","otherDrugs":[{"name":"acetylcysteine","slug":"acetylcysteine","company":"Apothecon"},{"name":"bitolterol","slug":"bitolterol","company":"Sanofi Aventis Us"},{"name":"cysteine","slug":"cysteine","company":"Hospira"},{"name":"norepinephrine","slug":"norepinephrine","company":"Hospira"}],"globalPrevalence":null},{"indication":"Bronchitis","otherDrugs":[{"name":"acetylcysteine","slug":"acetylcysteine","company":"Apothecon"},{"name":"amphotericin B","slug":"amphotericin-b","company":"Apothecon"},{"name":"bitolterol","slug":"bitolterol","company":"Sanofi Aventis Us"},{"name":"cefixime","slug":"cefixime","company":""}],"globalPrevalence":null},{"indication":"Dyspnea","otherDrugs":[],"globalPrevalence":null}],"mechanism":{"target":"Alpha-1D adrenergic receptor","novelty":"First-in-class","targets":[{"gene":"ADRA1D","source":"DrugCentral","target":"Alpha-1D adrenergic receptor","protein":"Alpha-1D adrenergic receptor"},{"gene":"ADRA2A","source":"DrugCentral","target":"Alpha-2A adrenergic receptor","protein":"Alpha-2A adrenergic receptor"},{"gene":"ADRA1B","source":"DrugCentral","target":"Alpha-1B adrenergic receptor","protein":"Alpha-1B adrenergic receptor"},{"gene":"ADRA2C","source":"DrugCentral","target":"Alpha-2C adrenergic receptor","protein":"Alpha-2C adrenergic receptor"},{"gene":"ADRA2B","source":"DrugCentral","target":"Alpha-2B adrenergic receptor","protein":"Alpha-2B adrenergic receptor"},{"gene":"ADRB2","source":"DrugCentral","target":"Beta-2 adrenergic receptor","protein":"Beta-2 adrenergic receptor"},{"gene":"DRD2","source":"DrugCentral","target":"D(2) dopamine receptor","protein":"D(2) dopamine receptor"},{"gene":"ADRA1A","source":"DrugCentral","target":"Alpha-1A adrenergic receptor","protein":"Alpha-1A adrenergic receptor"},{"gene":"SLC6A2","source":"DrugCentral","target":"Sodium-dependent noradrenaline transporter","protein":"Sodium-dependent noradrenaline transporter"},{"gene":"ADRB1","source":"DrugCentral","target":"Beta-1 adrenergic receptor","protein":"Beta-1 adrenergic receptor"}],"moaClass":"Adrenergic alpha-Agonists","modality":"Small Molecule","drugClass":"alpha-Adrenergic Agonist [EPC]","explanation":"Epinephrine acts on both alpha ()- and beta ()-adrenergic receptors. The mechanism of the rise in blood pressure is 3-fold: direct myocardial stimulation that increases the strength of ventricular contraction (positive inotropic action), an increased heart rate (positive chronotropic action), and peripheral vasoconstriction.","oneSentence":"Epipen works by stimulating the alpha-1D adrenergic receptor to rapidly increase heart rate, blood pressure, and bronchodilation.","technicalDetail":"Epipen exerts its effects by binding to the alpha-1D adrenergic receptor, a subtype of adrenergic receptors that are G protein-coupled receptors. This binding causes an increase in intracellular cyclic AMP, leading to the activation of protein kinase A and subsequent phosphorylation of downstream targets, ultimately resulting in the observed physiological effects."},"_wikipedia":{"url":"https://en.wikipedia.org/wiki/Adrenaline","title":"Adrenaline","extract":"Adrenaline, also known as epinephrine and alternatively spelled adrenalin, is a hormone and medication which is involved in regulating visceral functions. It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and by a small number of neurons in the medulla oblongata. It plays an essential role in the fight-or-flight response by increasing blood flow to muscles, heart output by acting on the SA node, pupil dilation response, and blood sugar level. It does this by binding to alpha and beta receptors. It is found in many animals, including humans, and some single-celled organisms. It has also been isolated from the plant Scoparia dulcis found in Northern Vietnam.","wiki_history":"== History ==\n\nExtracts of the adrenal gland were first obtained by Polish physiologist Napoleon Cybulski in 1895. These extracts, which he called nadnerczyna (\"adrenalin\"), contained adrenaline and other catecholamines. American ophthalmologist William H. Bates discovered adrenaline's usage for eye surgeries prior to 20 April 1896. In 1897, John Jacob Abel (1857–1938), the father of modern pharmacology, found a natural substance produced by the adrenal glands that he named epinephrine. The first hormone to be identified, it remains a crucial, first-line treatment for cardiac arrests, severe allergic reactions, and other conditions. In 1901, Jokichi Takamine successfully isolated and purified the hormone from the adrenal glands of sheep and oxen. Adrenaline was first synthesized in the laboratory by Friedrich Stolz and Henry Drysdale Dakin, independently, in 1904.\n\nAlthough secretin is mentioned as the first hormone, adrenaline is the first hormone since the discovery of the activity of adrenal extract on blood pressure was observed in 1895 before that of secretin in 1902. In 1897, John Jacob Abel (1857–1938) of Johns Hopkins University, the first chairman of the first US department of pharmacology, found a compound called epinephrine with the molecular formula of C<sub>17</sub>H<sub>15</sub>NO<sub>4</sub>.","wiki_society_and_culture":"==Society and culture==\n===Adrenaline junkie===\n\nAn adrenaline junkie is someone who \"has a compulsive desire for extreme excitement\". Such activities include extreme and risky sports, substance abuse, unsafe sex, and crime. The term relates to the increase in circulating levels of adrenaline during physiological stress. Such an increase in the circulating concentration of adrenaline is secondary to the activation of the sympathetic nerves innervating the adrenal medulla, as it is rapid and not present in animals where the adrenal gland has been removed. Although such stress triggers adrenaline release, it also activates many other responses within the central nervous system reward system, which drives behavioral responses; while the circulating adrenaline concentration is present, it may not drive behavior. Nevertheless, adrenaline infusion alone does increase alertness and has roles in the brain, including the augmentation of memory consolidation."},"commercial":{"launchDate":"1948","_launchSource":"DrugCentral (FDA 1948-11-19, )"},"references":[{"id":1,"url":"https://drugcentral.org/drugcard/1028","fields":["approvals","synonyms","ATC","PK","indications","contraindications","DDIs","targets","patents","FAERS"],"source":"DrugCentral"},{"id":2,"url":"https://clinicaltrials.gov/search?intr=epinephrine","fields":["trials"],"source":"ClinicalTrials.gov"},{"id":3,"url":"https://pubmed.ncbi.nlm.nih.gov/?term=epinephrine","fields":["publications"],"source":"PubMed/NCBI"},{"id":4,"url":"https://en.wikipedia.org/wiki/Adrenaline","fields":["history","overview"],"source":"Wikipedia"},{"id":5,"url":"https://www.fda.gov/drugs/drug-approvals-and-databases/orange-book-data-files","fields":["patents","exclusivity","genericManufacturers"],"source":"FDA Orange 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