Beneficial effects and adverse effects of epinephrine in the treatment of anaphylaxis

* Risk of adverse effects may be increased in the following conditions:

• Use of tricyclic antidepressants, monoamine oxidase inhibitors, or cocaine.
• Some preexisting cardiovascular, central nervous system, or thyroid diseases. Examples include intracranial surgery, acute aneurysm, or untreated hyperthyroidism.

¶ Serious adverse effects such as those listed in the table potentially occur when epinephrine is given in overdose by any route, most commonly after an intravenous bolus injection, an overly rapid intravenous infusion, or an erroneous intravenous injection of a 1 mg/mL (1:1000) epinephrine solution instead of an appropriately diluted 0.1 mg/mL (1:10,000) or a 0.01 mg/mL epinephrine solution.

Δ Anaphylaxis can present as an acute coronary syndrome, arrhythmias, myocardial infarction, or angina, before or in the absence of epinephrine injection. This potentially occurs in patients with known coronary artery disease, patients in whom subclinical coronary artery disease is unmasked, and patients (including children) with transient coronary artery vasospasm in whom no cardiovascular abnormalities can be detected by electrocardiogram or echocardiography after recovery from anaphylaxis.