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.
(For additional information see "Epinephrine (adrenaline) (nasal): Drug information")
Nasal decongestant: Intranasal: Apply 1 mg/mL solution locally as drops or spray or with sterile swab as needed.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
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
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.
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)
Yes
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.
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]
Intranasal: Apply as drops or with sterile swab.
Intranasal: May be diluted with isotonic saline for a less concentrated solution (refer to manufacturer's labeling).
Epinephrine is sensitive to light and air. Protection from light is recommended. Oxidation turns drug pink, then a brown color. Solutions should not be used if they are discolored or contain a precipitate.
Treatment of nasal congestion (FDA approved in ages ≥6 years and adults)
EPINEPHrine may be confused with ePHEDrine
Substrate of COMT
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 drug interactions program by clicking on the “Launch drug interactions program” link above.
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 drug interactions program
Alpha1-Blockers: May diminish the therapeutic effect of Alpha-/Beta-Agonists. 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
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
Refer to the EPINEPHrine (Systemic) monograph.
Heart rate, blood pressure
Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in local vasoconstriction and relief of nasal congestion
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)
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