Adrin1 mg/ml

Established / Emergency Indications

• Anaphylaxis: Adrin is the first-line emergency treatment for severe allergic reactions (anaphylaxis) of any cause, including insect stings, foods, drugs, latex, or idiopathic anaphylaxis.
• Cardiac arrest (ACLS): Adrin is used as part of Advanced Cardiovascular Life Support (ACLS) protocols for cardiac arrest, including asystole, pulseless electrical activity, and shock-refractory ventricular fibrillation/pulseless ventricular tachycardia.
• Severe acute asthma/bronchospasm: Adrin may be used for severe, life-threatening bronchospasm or acute asthma exacerbation that has failed to respond adequately to inhaled bronchodilator (e.g., salbutamol) therapy.
• Septic shock (adjunct): Adrin is used as an adjunct vasopressor to raise mean arterial blood pressure in adults with hypotension associated with septic shock that is inadequately responsive to first-line vasopressors and fluid resuscitation.

Combination / Adjunct Use

• Local anesthetic additive: Adrin is combined with local anesthetics (e.g., lidocaine) to prolong the duration of local/regional anesthesia and reduce surgical-site bleeding through local vasoconstriction.
• Croup: Nebulized racemic or L-Adrin is used in hospital settings for moderate-to-severe croup (laryngotracheobronchitis) to reduce airway edema.

Use of Adrin outside emergency settings (e.g., as a vasoconstrictor additive) should follow standard clinical protocols and physician guidance.

Each ampoule/vial of Adrenaline injection typically contains Adrenaline (as Adrenaline acid tartrate or Adrenaline hydrochloride, equivalent to Adrenaline base) 1 mg/mL, along with sodium chloride, sodium metabisulfite as an antioxidant/preservative, and water for injection. Prefilled auto-injector and nebulizer solution strengths also exist. Always confirm exact strength and formulation on the product label, as concentrations (e.g., 1:1000 vs 1:10,000) differ by route of administration.

Adrin (also known as epinephrine) is an endogenous catecholamine hormone and neurotransmitter naturally produced by the adrenal medulla. As a medicine, Adrin is a potent, direct-acting sympathomimetic agonist at both alpha- and beta-adrenergic receptors. It is used as an emergency, life-saving medicine for anaphylaxis and cardiac arrest, and as a supportive agent in severe asthma, septic shock, and as an additive to local anesthetics.

Adrin acts rapidly and has a short duration of action, which is why it is typically given as an injection (intramuscular, subcutaneous, intravenous, or intracardiac depending on the emergency) rather than by mouth.

Sympathomimetic agent / Emergency anti-anaphylactic agent (Adrin)

Adrenaline is a direct-acting agonist at alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors, with relatively balanced but dose-dependent effects.

• Alpha-1 effects: Vasoconstriction of skin, mucosa, and splanchnic vasculature, which raises systemic vascular resistance and blood pressure, and reduces mucosal edema and angioedema in anaphylaxis.
• Beta-1 effects: Increased heart rate (positive chronotropy) and myocardial contractility (positive inotropy), improving cardiac output during cardiac arrest and shock.
• Beta-2 effects: Bronchodilation (relieving bronchospasm in anaphylaxis and severe asthma) and stabilization of mast cells, reducing further release of histamine and other inflammatory mediators.

Onset of action after intramuscular injection is rapid (within minutes), and the plasma half-life is very short (approximately 2 to 3 minutes), which is why repeat dosing or continuous infusion is often required in ongoing emergencies. Adrenaline is metabolized primarily by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) in the liver and other tissues, and excreted in urine as inactive metabolites.

Adrin is administered parenterally - never taken by mouth, as it is inactivated in the gastrointestinal tract. Intramuscular injection into the anterolateral thigh is preferred for anaphylaxis, as it provides faster and more reliable absorption than subcutaneous injection. Intravenous administration is reserved for cardiac arrest, severe refractory hypotension, or in-hospital critical care settings with cardiac monitoring, due to the risk of arrhythmia and hypertensive crisis with rapid IV push of undiluted solution. Auto-injector devices are designed to be administered directly through clothing into the outer thigh in an anaphylaxis emergency. Avoid injection into the buttocks, fingers, toes, hands, feet, nose, ears, or genitals due to the risk of reduced blood flow to these areas.

• Non-selective beta-blockers (e.g., propranolol): Can blunt the beneficial beta-adrenergic effects of Adrin and lead to unopposed alpha-adrenergic stimulation, causing severe hypertension and reflex bradycardia; use with caution and be prepared to manage blood pressure.
• Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants: May potentiate the cardiovascular effects of Adrin, increasing the risk of severe hypertension and arrhythmias.
• Other sympathomimetics: Concurrent use with other sympathomimetic agents (e.g., other vasopressors, decongestants) can have additive cardiovascular effects, including hypertension and arrhythmias.
• Volatile anesthetics (e.g., halothane) and digoxin: May sensitize the myocardium to the arrhythmogenic effects of Adrin.
• Alpha-blockers (e.g., phentolamine): Antagonize the vasoconstrictive alpha-effects of Adrin and may unmask its beta-2 vasodilatory effect, causing hypotension.

None of these interactions are a reason to withhold Adrin in a genuine anaphylaxis or cardiac arrest emergency; they should be managed supportively while treating the emergency.

Common, generally transient effects of Adrin used in emergencies include:

• Anxiety, restlessness, or a feeling of fear
• Tremor
• Palpitations and rapid heart rate
• Headache
• Sweating and pallor
• Dizziness
• Nausea or vomiting

Less common but more serious effects can include significant hypertension, cardiac arrhythmias (including ventricular arrhythmias), pulmonary edema, and, rarely, cerebral hemorrhage, particularly with excessive dosing or rapid intravenous administration. These serious effects require prompt medical evaluation.

Pregnancy: Adrin should be used in pregnancy only if clearly needed, such as for treatment of anaphylaxis or cardiac arrest, where the potential maternal benefit clearly outweighs any potential risk to the fetus - in a true emergency, treating the mother is the priority for fetal survival as well. For non-emergency use, Adrin should be used with caution as it may reduce uterine blood flow; consult a physician for individualized guidance.

Lactation: It is not known whether Adrin is excreted in breast milk in clinically significant amounts. Because of its very short half-life, an occasional emergency dose is unlikely to pose a risk to a breastfeeding infant, but a physician should be consulted regarding breastfeeding after Adrin administration, especially with repeated or infusion dosing.

• Cardiac arrhythmias: Adrin can provoke or worsen cardiac arrhythmias, including ventricular fibrillation; use with caution in patients with known arrhythmias outside of cardiac arrest resuscitation.
• Hypertension and cardiovascular disease: Adrin can cause marked increases in blood pressure and myocardial oxygen demand; use with caution in patients with hypertension, coronary artery disease, or arteriosclerosis, though this should not delay treatment of true anaphylaxis.
• Hyperthyroidism: Adrin may exacerbate symptoms of hyperthyroidism.
• Diabetes mellitus: Adrin can raise blood glucose levels; monitor glucose in diabetic patients receiving repeated doses.
• Narrow-angle glaucoma: Caution is advised for non-emergency use, as Adrin may increase intraocular pressure.
• Extremities and end-arterial circulation: Avoid injecting Adrin (particularly with local anesthetics) into the fingers, toes, nose, ears, or genitals because of the risk of vasoconstriction-related tissue ischemia.
• Sulfite sensitivity: Some Adrin formulations contain sodium metabisulfite, which may cause allergic-type reactions in sulfite-sensitive individuals; this should not preclude emergency use in anaphylaxis.

None of the cautions above are reasons to withhold or delay Adrin in a genuine emergency (anaphylaxis or cardiac arrest); prompt administration is essential in these situations.

Overdose of Adrin can cause severe hypertension, dangerous cardiac arrhythmias (including ventricular fibrillation), pulmonary edema, and, rarely, cerebral hemorrhage or stroke. Symptoms may include severe headache, chest pain, marked palpitations, extreme anxiety, and difficulty breathing.

If an overdose is suspected, seek immediate emergency medical attention or contact a poison control center right away. Treatment must be provided in a hospital or emergency setting with continuous cardiac monitoring; do not attempt to manage a suspected Adrin overdose at home.

Store Adrin injection between 20-25°C, protected from light; do not freeze. Discard the solution if it appears discolored (pinkish or brown) or contains a precipitate, as this indicates oxidation. Keep out of reach of children.

• Elderly: Adrin should be used with caution in elderly patients, who may have unrecognized cardiovascular disease and be more sensitive to hypertensive and arrhythmogenic effects; however, Adrin should not be withheld in a true anaphylaxis or cardiac arrest emergency.
• Renal impairment: No specific dose adjustment is established; Adrin is used based on clinical response with monitoring.
• Hepatic impairment: No specific dose adjustment is established, though patients may have altered catecholamine metabolism; use with clinical monitoring.
• Cardiovascular disease: Use with caution outside of emergencies; see Precautions and Warnings.

Adrin is used as a short-term, emergency treatment. In anaphylaxis, doses may be repeated every 5-15 minutes as needed until symptoms resolve or emergency medical services take over care. In cardiac arrest, Adrin is given repeatedly per ACLS protocol for the duration of the resuscitation attempt. It is not intended for long-term or maintenance use.

Catecholamine; Sympathomimetic (alpha- and beta-adrenergic agonist); Vasopressor; Bronchodilator; Anti-anaphylactic agent (Adrenaline)

Adrenaline acts as a non-selective agonist at alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors. In anaphylaxis, alpha-1 stimulation reverses vasodilation and reduces mucosal edema, beta-1 stimulation increases cardiac output, and beta-2 stimulation relaxes bronchial smooth muscle and stabilizes mast cells to limit further mediator release. In cardiac arrest, alpha-1-mediated vasoconstriction raises coronary and cerebral perfusion pressure during chest compressions.

C

Adrin is a well-established, first-line emergency treatment for anaphylaxis in children of all ages, including infants, using weight-based dosing (0.01 mg/kg intramuscularly, maximum single dose 0.3 mg) or an appropriately weight-banded auto-injector. Pediatric auto-injectors are typically available in specific weight-based strengths; parents/caregivers of at-risk children should be trained by a physician in their correct use.

Use of Adrin for cardiac arrest in children follows pediatric ACLS weight-based dosing under medical supervision. Safety and efficacy of Adrin for non-emergency indications in children have not been separately established and such use should be guided by a pediatrician.