Pharmacological properties

Pharmacodynamics. adrenaline (epinephrine) is a catecholamine which excites sympathetic nervous system (α- and β-receptors) and thus raises chss, warm emission and strengthens coronary circulation.

Impact of β-receptors of adrenaline on unstriated muscles of bronchial tubes causes their relaxation that, in turn, softens rattles and reduces an asthma.

Adrenaline is quickly inactivated by

, the most part of a dose of adrenaline is allocated in the form of metabolites with urine.

Pharmacokinetics. Adrenaline is natural substance which is produced by marrow of adrenal glands in response to loading or a stress. It is metabolized by two enzymes: (KOMT) and MAO catechol-au-methyltransferase. It is very important that a significant amount of these enzymes is in a liver though it is not essential to fabrics in the course of disintegration. The most part of a dose of adrenaline is allocated in the form of metabolites with urine.

T _½ adrenaline of blood plasma is made by 2.5 min. At p / to or use in oil local vasoconstriction delays absorption therefore the therapeutic effect proceeds without obvious symptoms and time of action can increase. It is recommended to mass the injection site of an injection.

Indication

Allergic reactions of immediate type (acute anaphylaxis), for example: allergic reactions to stings of insects, to food, medicines, at contact with allergens, in an idiopathic disease, at use of the means causing an anaphylaxis. for immediate use to patients at emergence of risk of an acute anaphylaxis and also to persons who in the anamnesis had cases of emergence of anaphylactic reactions.

Use

Dosing

Adult. The recommended dose makes 0.3 mg, enter in oil.

Children. Children with the body weight of 30 kg: the recommended dose makes 0.3 mg, enter in oil.

Drug is used at the first symptoms of an acute anaphylaxis.

in the absence of clinical manifestations of improvement or at aggravation of symptoms after the first injection the use of the second injection is possible

. The repeated injection is entered approximately in 5–15 min.

After medicament use the patient needs to consult with the doctor for acceptance of the appropriate measures, further inspection and/or further treatment.

Doctor has to be convinced by

that the patient understood indications and rules of use of medicament Epipen.

Doctor has to inform the patient of the instruction for use of drug, the correct use and possible symptoms of an acute anaphylaxis in detail.

Route of administration. The medicament is administered by hips, in oil in a front surface. The medicament is not administered in a buttock. The medicament can be administered through clothes or p / to. See also section SPECIAL INSTRUCTIONS.

Children. Epipen apply at children with body weight 30 kg.

At children with the body weight of 15-30 kg is applied Epipen Unior whose dose contains 0.15 mg of adrenaline.

At children with the body weight of 15 kg of a dose of 0.15 mg is not recommended to be applied because of complexity of calculation of a dose.

do not have

Contraindication

known absolute contraindications to medicament use epipen in emergency aid at allergic reactions.

Side effects

Are connected by

with influence of adrenaline on α- and β-adrenoceptors and include such symptoms as tachycardia and ag and also side reactions from central nervous system.

Frequency is defined by

as follows: very often (≥1/10); often (from ≥1/100 to 1/10); infrequently (from ≥1/1000 to 1/100); seldom (from ≥1/10 000 to 1/1000); very seldom (1/10,000) and frequency is unknown (it is impossible to establish, based on the available data).

from mentality: frequency is unknown — a disturbing state.

from nervous system: frequency is unknown — a headache, dizziness, a tremor.

from a cardiovascular system: seldom — a stressful cardiomyopathy; frequency is unknown — tachycardia, arrhythmia, AG, peripheral ischemia which can result from accidental administration of medicament in muscles of hands or legs.

from a GIT: frequency is unknown — nausea, vomiting.

from skin and hypodermic fabrics: frequency is unknown — the increased sweating.

General disturbances and complications in the injection site of drug: frequency is unknown — increased fatigue, reactions in the injection site, such as pain, hemorrhage, formation of hematomas, puffiness.

Special instructions

Patients have to be informed by

that in case of an acute anaphylaxis it is necessary to call the ambulance. after introduction of the first dose of medicament it is necessary to ask immediately for the help the doctor for passing of careful medical examination and purpose of further treatment, if necessary.

Medicine are applied by hips, in oil in a front surface. Patients have to be informed that the medicament is not administered in a buttock.

Adrenaline is applied with care on doctor's orders to patients with cardiovascular diseases and also sick diabetes, to persons with a hyperthyroidism, AG and to patients of advanced age if the potential advantage exceeds risk. At use of adrenaline, side reactions at patients with the increased intraocular pressure, OPN, prostate adenoma are possible that results in stagnation of urine, a hypercalcemia and hypopotassemia. With Parkinson's disease the use of adrenaline can cause in patients temporary symptoms of Parkinson's disease, such as rigidity and trembling.

to

It was reported about accidental injections of medicament in muscles of hands or legs that led to peripheral ischemia. In case of wrong administration of medicament the patient needs to see a doctor for purpose of treatment.

At persons with a dense hypodermic and fat layer adrenaline can not reach muscle tissue and not render optimum effect.

Epipen contains sodium metabisulphite which can seldom cause serious reactions of hypersensitivity, including symptoms of an acute anaphylaxis and a bronchospasm, especially in persons with OH. Patients with these diseases need to study the instruction for use of the medicament Epipen attentively.

One medicament dose contains 1 mmol of sodium (23 mg), that is it is actually beznatriyevy.

Use and utilization. Solution needs to be checked through a window of previously filled handle: solution has to be transparent and colourless. Not to use previously filled handle if solution is painted or contains a deposit, not to use after expiry date. The expiration date is specified on the label, not to use previously filled handle after the termination of an expiration date.

Drug is intended to

for single use. At once to utilize previously filled handle after use.

Each previously filled handle contains 2 ml of an injection of adrenaline of 1 mg/ml that makes a single dose (0.3 ml) of 0.3 mg of adrenaline. After use in previously filled handle there are 1.7 ml of substance.

to Observe the instructions below, only when you are ready to use previously filled handle.

Previously filled handle to hold

only in the middle, not to hold it for the end. For the correct carrying out an injection to follow the following rules:

• not to close an orange tip fingers or a hand. Not to press on an orange tip fingers or a hand;
• needle leaves an orange tip;
• not to delete a blue protective cover, are not ready to use of previously filled handle yet.

1. To hold previously filled handle with the dominating hand (hand to which you write) so that the blue protective cap was directed towards a thumb (an orange tip down).

2. To remove a blue protective cap other hand.

3. To hold previously filled handle at an external part of a hip at distance about 10 cm. The orange tip has to be directed towards a leg.

4. It is sure to enter previously filled handle into an external part of a hip at right angle (90 °) (the click has to sound).

5. To keep previously filled handle in the injection site during 10 pages. After introduction of an injection the window of previously filled handle will be closed. To take previously filled handle (there will be an orange tip, will close a needle) and to utilize.

6. To mass area of administration of medicament during 10 pages. To call the ambulance and to report about the happened anaphylaxis.

by

allows presence of a small amount of vials of air in previously filled handle, it does not affect efficiency of use of drug.

After use of medicament will remain the most part of liquid (≈90%) which cannot be reused.

However if the window is closed by

and the orange tip is put forward, you received a necessary dose of drug. After use to place previously filled handle in a tuba, it needs to be had at itself during the visit to the doctor, in clinic or drugstore.

As Epipen is used for rendering emergency medical service, to immediately call the ambulance after its use, having specified the diagnosis "anaphylaxis".

to Report

to the doctor about use of an injection of adrenaline or to show packing and/or the instruction for medical use of medicine.

in case of overdose or wrong administration of adrenaline should ask for medical care immediately.

Use during pregnancy and feeding by a breast

Pregnancy. Controlled researches on use of adrenaline for pregnant women were not conducted.

Adrenaline is applied during pregnancy, only if the potential advantage exceeds potential risk for a fruit.

Feeding by a breast. There is no biologically available form of adrenaline for oral administration, any dose of adrenaline in breast milk does not influence children of chest age.

Reproductive function. As adrenaline is substance which is naturally produced in an organism, the medicament Epipen does not affect reproductibility.

Ability to influence speed of response at control of vehicles or other mechanisms. During treatment it is not recommended to run vehicles or other mechanisms as at patients symptoms of an acute anaphylaxis are possible.

With care to apply

Interaction

to the patients applying medicines which can cause arrhythmia, including cardiac glycosides and quinidine. effect of adrenaline can be strengthened at use of tricyclic antidepressants, Mao's inhibitors and inhibitors catechol-au-methyltransferase (komt), hormones of a thyroid gland, theophylline, oxytocin, parasympatholytics, some antihistaminic (difengidramin, chlorpheniramine), a levodopa and alcohol.

Adrenalin slows down insulin secretion, thereby increases glucose level in blood. Patients with the diabetes accepting adrenaline need to raise a dose of insulin or oral gipoglikemiziruyushchy drugs.

Attention! Beta promoting effect can be reduced at simultaneous use with blockers of β-adrenoceptors.

At simultaneous use of adrenaline with cardiac glycosides, quinidine, tricyclic antidepressants, a dopamine, means for an inhalation anesthesia (enfluran, a halothane, izofluran, metoksifluran), cocaine risk of developing arrhythmia increases.

At simultaneous use of adrenaline with other sympathomimetic means strengthening of severity of side effects from a cardiovascular system is possible

.

At simultaneous use of adrenaline with antihypertensive medicaments (including with diuretics) decrease in their efficiency is possible

.

At simultaneous use of adrenaline with MAO inhibitors (including furasolidone, Procarbazinum, selegilin) perhaps sudden and significant increase in the ABP, hyperpyrexial crisis, a headache, arrhythmia, vomiting.

At simultaneous use of adrenaline with medicaments of hormones of a thyroid gland perhaps mutual strengthening of action.

At the combined use of adrenaline with astemizoly, tsizapridy, terfenadiny lengthening of an interval of Q-T on the ECG is possible

.

At simultaneous use of adrenaline with alkaloids of an ergot strengthening of vasopressor effect up to the profound ischemia and a gangrenosis is possible

.

At simultaneous use of adrenaline with gipoglikemiziruyushchy medicaments (including insulin) decrease in gipoglikemiziruyushchy effect is possible

.

Overdose

Overdose or accidental intravascular administration of adrenaline can lead to craniocereberal hemorrhage owing to sharp growth hell. cases with a lethal outcome can be caused by a fluid lungs because of peripheral vascular narrowing along with warm stimulation.

Fluid lungs can be eliminated with

by means of blockers of α-adrenoceptors, such as phentolamine. In arrhythmia appoint blockers of β-adrenoceptors.

Storage conditions

At a temperature not above 25 °C in original packing for protection against light. not to freeze.