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Epinephrine (adrenaline) (nasal): Drug information

Epinephrine (adrenaline) (nasal): Drug information
(For additional information see "Epinephrine (adrenaline) (nasal): Patient drug information" and see "Epinephrine (adrenaline) (nasal): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Adrenalin
Brand Names: Canada
  • Adrenalin
Pharmacologic Category
  • Alpha-/Beta- Agonist
Dosing: Adult
Nasal decongestant

Nasal decongestant: Intranasal: Apply 1 mg/mL solution locally as drops or spray or with sterile swab as needed.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Epinephrine (adrenaline) (nasal): Pediatric drug information")

Nasal congestion

Nasal congestion: Children ≥6 years and Adolescents: Intranasal: 1 mg/mL topical solution: Apply locally as drops or spray or with sterile swab; may also further dilute prior to application; consult product specific labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.

Cardiovascular: Angina pectoris, cardiac arrhythmia, chest pain, flushing, hypertension, palpitations, tachycardia (parenteral administration), vasoconstriction, ventricular ectopy

Central nervous system: Anxiety (transient), apprehension, cerebral hemorrhage, dizziness, headache, insomnia, nervousness, restlessness

Dermatologic: Diaphoresis, pallor

Gastrointestinal: Anorexia, nausea, vomiting, xerostomia

Genitourinary: Acute urinary retention (patients with bladder outflow obstruction)

Hypersensitivity: Hypersensitivity reaction (eyelid)

Neuromuscular & skeletal: Tremor, weakness

Ophthalmic: Angle-closure glaucoma (precipitation or exacerbation), burning sensation of eyes, eye irritation, eye pain, stinging of eyes (transient)

Respiratory: Dry throat, dyspnea, pulmonary edema

Warnings/Precautions

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with cardiovascular diseases (eg, coronary artery disease, hypertension).

• Cerebrovascular disease: Use with caution in patients with cerebrovascular disease.

• Diabetes: Use with caution in patients with diabetes mellitus; may transiently increase blood glucose levels.

• Parkinson's disease: Use with caution in patients with Parkinson's disease; may cause temporary worsening of symptoms.

• Thyroid disease: Use with caution in patients with thyroid disease.

Special populations:

• Older adult: Use with caution in the elderly.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Nasal, as hydrochloride:

Adrenalin: 0.1% (30 mL)

Generic: 0.1% (10 mL, 30 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Adrenalin Nasal)

0.1% (per mL): $10.02

Solution (EPINEPHrine HCl (Nasal) Nasal)

0.1% (per mL): $10.00

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Nasal, as hydrochloride:

Adrenalin: 0.1% (30 mL) [contains chlorobutanol (chlorobutol), sodium metabisulfite]

Administration: Adult

Intranasal: May be diluted with isotonic saline for a less concentrated solution (refer to manufacturer's labeling).

Administration: Pediatric

Intranasal: Apply as drops or with sterile swab.

Use: Labeled Indications

Nasal decongestant: Treatment of nasal congestion.

Medication Safety Issues
Sound-alike/look-alike issues:

EPINEPHrine may be confused with ePHEDrine

Metabolism/Transport Effects

Substrate of COMT

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy

Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Beta-Blockers (Beta1 Selective): May diminish the therapeutic effect of EPINEPHrine (Nasal). Risk C: Monitor therapy

Beta-Blockers (Nonselective): May enhance the hypertensive effect of EPINEPHrine (Nasal). Risk C: Monitor therapy

Beta-Blockers (with Alpha-Blocking Properties): May diminish the therapeutic effect of EPINEPHrine (Nasal). Risk C: Monitor therapy

Bromocriptine: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Management: Consider alternatives to this combination when possible. If combined, monitor for hypertension and tachycardia, and do not coadminister these agents for more than 10 days. Risk D: Consider therapy modification

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Chloroprocaine (Systemic): May enhance the hypertensive effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification

COMT Inhibitors: May increase the serum concentration of COMT Substrates. Risk C: Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy

Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): May enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Risk X: Avoid combination

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Inhalational Anesthetics: May enhance the arrhythmogenic effect of EPINEPHrine (Nasal). Risk C: Monitor therapy

Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination

Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification

Lisuride: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Risk X: Avoid combination

Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of EPINEPHrine (Nasal). Risk C: Monitor therapy

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Pergolide: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Risk D: Consider therapy modification

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy

Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Risk D: Consider therapy modification

Pregnancy Considerations

Refer to the EPINEPHrine (Systemic) monograph.

Breastfeeding Considerations

Refer to the EPINEPHrine (Systemic) monograph.

Mechanism of Action

Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in local vasoconstriction and relief of nasal congestion

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Local vasoconstriction (topical): 5 minutes

Duration of action: Local vasoconstriction (topical): <1 hour

Metabolism: Taken up into the adrenergic neuron and metabolized by monoamine oxidase and catechol-o-methyltransferase; circulating drug hepatically metabolized

Excretion: Urine (as inactive metabolites, metanephrine, and sulfate and hydroxy derivatives of mandelic acid, small amounts as unchanged drug)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AU) Australia: Adrenaline;
  • (BR) Brazil: Adrenalina;
  • (CO) Colombia: Adrenalina clorhidrato;
  • (CZ) Czech Republic: Isopto ephinal;
  • (DE) Germany: Infectokrupp | Suprarenin;
  • (ES) Spain: Adrenalina level;
  • (FI) Finland: Eppy | Isopto epinal;
  • (FR) France: Eppy;
  • (GB) United Kingdom: Adrenaline | Epifrin | Eppy | Mf adrenalin | Simplene;
  • (HU) Hungary: Epinal | Eppy | Oftan adrenalin;
  • (ID) Indonesia: Adrenal;
  • (IE) Ireland: Eppy;
  • (IN) India: Epitrate;
  • (IT) Italy: Adrenalina;
  • (JP) Japan: Glaucon | Sanepi;
  • (LT) Lithuania: Isopto ephinal;
  • (LV) Latvia: Isopto ephinal;
  • (NO) Norway: Adrenalin | Adrenalin apotek ab;
  • (PL) Poland: Adrenalin hcl | Glaucon | Isopto ephinal;
  • (PR) Puerto Rico: Epifrin | Epinephrine | Glaucon;
  • (SE) Sweden: Eppy | Glaufrin;
  • (SK) Slovakia: Glaucon;
  • (TW) Taiwan: Glaucon;
  • (VE) Venezuela, Bolivarian Republic of: Epifrin
  1. Adrenalin chloride solution (epinephrine) [prescribing information]. Rochester, MI: JHP Pharmaceuticals; received March 2017.
Topic 9115 Version 167.0

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