Epinephrine

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.

• 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.

• None. None.contraindicated

• 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.

• 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.

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 epine…

• 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.

Metabolism

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.

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.

• Nov 19, 1948NDANDA006488Fresenius Kabi Usa
• Oct 3, 1972NDANDA016964Hospira
• Dec 30, 1981NDANDA018304Fresenius Kabi Usa
• Dec 22, 1987NDANDA019430Viatris
• Apr 3, 2000NDANDA020971Deproco
• May 30, 2003NDANDA020800Impax
• Feb 26, 2010NDANDA022466Pierrel
• Aug 10, 2012NDANDA201739Kaleo Inc

Reference statistics from the openFDA drug-shortage dataset. For a live view, consult the FDA database directly. Not clinical guidance.

• Epinephrine, Injection, .1 mg/1 mL (NDC 0409-4933-01)To be discontinued
  Sponsor: Hospira, Inc., a Pfizer Company
  Updated Nov 7, 2025
• Epinephrine, Injection, .1 mg/1 mL (NDC 0409-4933-10)To be discontinued
  Sponsor: Hospira, Inc., a Pfizer Company
  Updated Nov 7, 2025
• Lidocaine Hydrochloride And Epinephrine, Injection, 1 g/50 mL (2%; 1:100,000) (NDC 0409-3182-03)Active
  Sponsor: Hospira, Inc., a Pfizer Company
  Updated Jun 9, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 2.5 g/50 mL (0.5%; 1:200,000) (NDC 0409-3177-01)Active
  Sponsor: Hospira, Inc., a Pfizer Company · Reason: Other
  Updated May 22, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 200 mg/20 mL (1%; 1:100,000) (NDC 0409-3178-01)Active
  Sponsor: Hospira, Inc., a Pfizer Company
  Updated Jun 9, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 300 mg/30 mL (1%; 1:100,000) (NDC 0409-3178-02)Active
  Sponsor: Hospira, Inc., a Pfizer Company · Reason: Other
  Updated May 22, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 400 mg/20 mL (2%; 1:100,000) (NDC 0409-3182-01)Active
  Sponsor: Hospira, Inc., a Pfizer Company · Reason: Other
  Updated May 22, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 400 mg/20 mL (2%; 1:200,000) (NDC 0409-3183-01)Active
  Sponsor: Hospira, Inc., a Pfizer Company · Reason: Other
  Updated May 22, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 450 mg/30 mL (1.5%; 1:200,000) (NDC 0409-3181-01)Active
  Sponsor: Hospira, Inc., a Pfizer Company · Reason: Other
  Updated May 22, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 500 mg/50 mL (1%; 1:100,000) (NDC 0409-3178-03)Active
  Sponsor: Hospira, Inc., a Pfizer Company · Reason: Other
  Updated May 22, 2026
• Lidocaine Hydrochloride and Epinephrine, Injection, 600 mg/30 mL (2%; 1:100,000) (NDC 0409-3182-02)Active
  Sponsor: Hospira, Inc., a Pfizer Company
  Updated Jun 9, 2026
• Lidocaine Hydrochloride And Epinephrine, Injection, 75 mg/5 mL (1.5%; 1:200,000) (NDC 0409-1209-01)Active
  Sponsor: Hospira, Inc., a Pfizer Company · Reason: Other
  Updated May 22, 2026

1. 1Drug Ineffective10,6999.8%
2. 2Fatigue5,9555.4%
3. 3Headache5,8965.4%
4. 4Pain5,8685.4%
5. 5Nausea5,6455.2%
6. 6Off Label Use5,3284.9%
7. 7Dyspnoea5,1274.7%
8. 8Sinusitis4,2773.9%
9. 9Pneumonia3,7273.4%
10. 10Product Dose Omission Issue3,6453.3%
11. 11Diarrhoea3,5583.3%
12. 12Vomiting3,5193.2%
13. 13Dizziness3,3793.1%
14. 14Pyrexia3,3513.1%
15. 15Rash3,2082.9%

Recent PubMed references pinned to Epinephrine as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.

• Novelties in the pragmatic management of anaphylaxis in pediatric age.
  European journal of pediatrics · 2026 · Marseglia GL, Tosca MA, Miraglia Del Giudice M, et al.
  PMID 42262574DOI 10.1007/s00431-026-07147-3
• Anaphylaxis and Epinephrine Use in Pregnancy.
  The journal of allergy and clinical immunology. In practice · 2026 · Tanno LK, Ellis AK, Hossenbaccus L, et al.
  PMID 42250901DOI 10.1016/j.jaip.2026.04.016
• Bimetallic Co/Mn-doped metal-organic framework for UV-visible spectrophotometric and chemiluminescent dual-mode detection of adrenaline.
  Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy · 2026 · Liu X, Mei Y, Wu T, et al.
  PMID 42134171DOI 10.1016/j.saa.2026.128026
• Rhythm-specific association of epinephrine with outcomes in non-shockable cardiac arrest: a nationwide propensity-matched study.
  Resuscitation · 2026 · Emoto R, Nishikimi M, Kikutani K, et al.
  PMID 42069043DOI 10.1016/j.resuscitation.2026.111116
• The Role of Ultrasound-Guided Lipoma Plane Block with or without Adrenaline in Enhancing Anesthetic Precision, Patient Comfort, and Surgical Efficiency: A Prospective Randomized Controlled Trial.
  La Clinica terapeutica · 2026 · Alfeky AA, Elsawy AGS, Ali MAE, et al.
  PMID 42047122DOI 10.7417/CT.2026.2020
• Profiles of stress hormones in relation to DENV serotypes among dengue-positive patients.
  PloS one · 2026 · Anwar M, Waheed A, Fatima T, et al.
  PMID 42030262DOI 10.1371/journal.pone.0344532
• Determinants of false-positive plasma free metanephrines and methoxytyramine: the role of medications and chronic disease.
  Endocrine-related cancer · 2026 · Knigge LM, Potthoff K, Constantinescu G, et al.
  PMID 42007997DOI 10.1530/ERC-25-0549
• Intra-aortic adrenaline titration during cardiac arrest.
  Scandinavian journal of trauma, resuscitation and emergency medicine · 2026 · Manning JE, Barnard EBG, Barratt J, et al.
  PMID 41987287DOI 10.1186/s13049-026-01609-1

The 10 most recently updated of 3,501 ClinicalTrials.gov registrations naming Epinephrine as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

• A Study to Compare Blinatumomab Alone to Blinatumomab With Nivolumab in Patients Diagnosed With First Relapse B-Cell Acute Lymphoblastic Leukemia (B-ALL)
  Recruiting · Phase 2 · Interventional · 461 enrolled · National Cancer Institute (NCI)
  NCT04546399updated 2026-06-12
• PENG Block + LIA For Endoprosthesis Surgery
  Recruiting · Interventional · 100 enrolled · ASST Gaetano Pini-CTO
  NCT07239817updated 2026-06-12
• Hématologie Adulte Prevalence of Adrenal Insufficiency Post-chemotherapy Adrenocorticotropia in Adult Hematology
  Withdrawn · Interventional · 0 enrolled · Rennes University Hospital
  NCT03688789updated 2026-06-12
• Integrated Therapies for Alcohol Use in Alcohol-associated Liver Disease (ITAALD) Trial
  Recruiting · Phase 2 · Interventional · 216 enrolled · Samer Gawrieh
  NCT07060638updated 2026-06-12
• PRESERVE: LUPKYNIS in Combination With Belimumab, Obinutuzumab or Anifrolumab in Patients With Lupus Nephritis
  Recruiting · Phase 4 · Interventional · 150 enrolled · Aurinia Pharmaceuticals Inc.
  NCT07611214updated 2026-06-12
• Angiotensin 2 for AKI After OLT
  Active not recruiting · Phase 4 · Interventional · 30 enrolled · University of California, Los Angeles
  NCT04592744updated 2026-06-12
• Treating Exacerbations of Asthma With Oral Montelukast in Children
  Completed · Phase 2 · Interventional · 90 enrolled · Vanderbilt University Medical Center
  NCT05819541updated 2026-06-12
• Vasopressin and Epinephrine Versus Epinephrine Alone in Cardiac Arrest
  Completed · Phase 4 · Interventional · 2,416 enrolled · Hospices Civils de Lyon
  NCT00127907updated 2026-06-11
• Pelvic Pain in Women With Endometriosis
  Completed · Observational · 78 enrolled · National Institute of Neurological Disorders and Stroke (NINDS)
  NCT00073801updated 2026-06-11
• Chest Tube-Delivered Bupivacaine to Decrease Postoperative Pain After Cardiac Surgery
  Not yet recruiting · Early phase 1 · Interventional · 60 enrolled · University of Calgary
  NCT07643506updated 2026-06-11

Frequently asked questions

How does Epinephrine work?

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.

What is Epinephrine used for?

According to FDA labeling, Epinephrine carries indications including: 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.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.

What class of drug is Epinephrine?

Epinephrine is classified as Adrenergic and dopaminergic agents, Alpha- and beta-adrenoreceptor agonists, Local hemostatics, Other agents for local oral treatment, Sympathomimetics in glaucoma therapy, Sympathomimetics, plain, alpha-Adrenergic Agonist, beta-Adrenergic Agonist, Catecholamine, Adrenergic alpha-Agonists, Adrenergic beta-Agonists, Adrenergic beta1-Agonists, Adrenergic beta2-Agonists, Arterial Vasoconstriction, Bronchodilation, Decreased Intraocular Aqueous Secretion, Decreased Uterine Smooth Muscle Contraction or Tone, Hemostasis Alteration, Increased Blood Pressure, Positive Chronotropy, Positive Inotropy, Pupillary Dilation.

What are the brand names for Epinephrine?

Epinephrine is marketed under brand names including Adrenalin, Articadent, Auvi-Q, Citanest Forte, Epipen, Flavalta, Lignospan, Marcaine with Epinephrine.

What are the contraindications for Epinephrine?

Epinephrine labeling lists contraindications including: None. None.. Always consult the full prescribing information and a clinician.