Epinephrine intravenous (IV) slow bolus for treatment of anaphylaxis refractory to intramuscular (IM) epinephrine – Adult or adolescent patient

• Use a prefilled 0.1 mg/mL epinephrine 10 mL syringe (also called "cardiac" or "ACLS" epinephrine).
• Take 1 mL of this solution and dilute it with 9 mL of normal saline to make a total volume of 10 mL (final concentration 0.01 mg/mL).

• Slowly administer 5 to 10 mL of the diluted (0.01 mg/mL) solution in 1 to 2 mL aliquots over 1 to 2 minutes while monitoring the patient's heart rate and blood pressure.
• Wait at least 3 minutes after administration to assess response.
• If the patient is still severely hypotensive or shows little improvement, a second dose can be administered.

Slow IV bolus epinephrine may be used (infrequently) as a temporizing measure in an emergency while a titratable epinephrine infusion solution is being prepared.

As soon as the epinephrine infusion solution is available, bolus administration is discontinued and replaced by titration of the infusion; refer to UpToDate topic on emergency management of anaphylaxis and separately available epinephrine infusion tables.