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. 
• For emergency treatment of allergic reactions (Type 1), including anaphylaxis. 
• For induction and maintenance of mydriasis during intraocular surgery.

Hypotension associated with septic shock : 

• Dilute epinephrine in dextrose solution prior to infusion.
• Infuse epinephrine into a large vein. o Titrate 0.05-2 mcg/kg/min to achieve desired blood pressure.
• Wean gradually.

Anaphylaxis: Administer intramuscularly or subcutaneously into the anterolateral thigh every 5-10 minutes as needed

• Adults and children over 30 kg (66 lb): 0.3-0.5 mg (0.3-0.5 mL)
• Children under 30 kg (66 lb): 0.01 mg/kg (0.01 mL/kg)

Intraocular surgery:

• Dilute 1 mL with 100 to 1000 mL of an ophthalmic irrigation fluid, for ophthalmic irrigation or intracameral injection.

Most common adverse reactions to systemically administered epinephrine are headache; anxiety; apprehensiveness; restlessness; tremor; weakness; dizziness; sweating; palpitations; pallor; peripheral coldness; nausea/vomiting; and/or respiratory difficulties. Arrhythmias, including fatal ventricular fibrillation, rapid rises in blood pressure producing cerebral hemorrhage, and angina have occurred.

None.

• Monitor patient for acute severe hypertension.
• Avoid extravasation into tissues, which can cause local necrosis.
• Do not inject into buttocks, digits, hands, or feet.
• Potential for pulmonary edema, which may be fatal.
• May constrict renal blood vessels and decrease urine formation.
• May induce potentially serious cardiac arrhythmias or aggravate angin pectoris, particularly in patients with underlying heart disease.