Reviewed by NICU and Pharmacy
Dose and Administration
- 0.1-0.3 ml/kg 1:10,000 concentration by
IV push, or intracardiac.
- 0.3ml/kg 1:10,000 concentration. Repeat
dose every 3-5 minutes as necessary.
- 100-300 nanograms/kg/minute
(0.1-0.3micrograms/kg/minute). Start at 100 nanograms/kg/minute
(0.1micrograms/kg/minute) and titrate to desired response to a maximum
of 1000 nanograms/kg/minute (1microgram/kg/minute).
- Use 1:10,000 concentration (0.1mg/ml) to
prepare continuous infusion.
- Usual dilution 0.3 mg/kg in 50ml D5W, D10W,
- Use as a continuous infusion should be
discussed with specialist on call.
- Give through a Central Venous Line (UVC,
Longline, or Surgical CVL)
Slow IV push/intracardiac
- 0.1-0.3ml/kg/minute, 1:10,000
Acute cardiovascular collapse
Can be used as a second or third line inotrope.
Short-term use for cardiac failure resistant to
other drug management.
Contraindications and Precautions
- Hypersensitivity to sympathomimetics.
- Caution in infants with cardiovascular disease,
Adrenaline, a catecholamine, stimulates alpha
and beta receptors. It increases heart rate, increases myocardial contractility,
automaticity and conduction velocity. Adrenaline also increases systemic
vascular resistance (via constriction of arterioles), and increases blood flow
to skeletal muscle, brain, liver and myocardium. It decreases renal blood flow
by 40%. Pulmonary resistance may increase, although the major effect of
adrenaline is to redistribute blood from the systemic to pulmonary circulation
and thereby increase pulmonary pressure.
Adrenaline must be given parenterally to reach
pharmacologically effective concentrations because it is rapidly metabolised in
the gastrointestinal tract and liver. Its vasoconstrictive properties account
for the slow rate of absorption from subcutaneous or intramuscular
administration sites. The major portion of adrenaline is rapidly metabolised by
the same enzyme systems that metabolise endogenous catecholamines.
Possible Adverse Effects
Venous irritation, soft tissue injury at the
site of IV infusion.
Cardiac arrhythmias (PVCs and ventricular
Renal vascular ischaemia with decreased urine
Severe hypertension with
Hyperglycaemia related to the inhibition of
insulin secretion and conversion of glycogen reserves.
- Always use as a 1:10,000
concentration (0.1 mg/ml) for individual doses.
- If possible, correct acidosis before
administration of adrenaline to enhance the effectiveness of the drug.