ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Ephedrine
ICU INDICATIONS:
- Drug-induced hypotension (particularly in association with bradycardia)
Note: used commonly in Anaesthesia, particularly to offset vasodilation from regional neuraxial blockade. It is of limited use in ICU where other agents are preferred
PRESENTATION AND ADMINISTRATION:
IV:
Vial contains 30 mg in 1 mL
Dilute 30 mg to a total of 10 mL using Normal saline (giving a concentration of 3 mg/mL)
Store at room temperature
Protect from light
Compatible with the following IV fluids: Normal saline, 5% Dextrose,10% Dextrose, Glucose and sodium chloride, Hartmanns
DOSAGE:
IV:
3 - 9 mg (1 - 3 mL) given as IV bolus. Repeat as required
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
IV:
0.25 - 1 mg/kg (max 5 mg/dose)
CLINICAL PHARMACOLOGY:
Ephedrine stimulates both alpha and beta receptors and its peripheral actions are due partly to norepinephrine release and partly to direct effect on receptors. Ephedrine may deplete norepinephrine stores in sympathetic nerve endings, so that tachyphylaxis to cardiac and pressor effects of the drug may develop.
CONTRAINDICATIONS:
- Hypersensitivity to ephedrine
WARNINGS:
Ephedrine may cause hypertension resulting in intracranial haemorrhage. Ephedrine may induce anginal pain in patients with coronary insufficiency or ischaemic heart disease. The drug also may induce potentially fatal arrhythmias in patients with organic heart disease or who are receiving drugs that sensitise the myocardium
PRECAUTIONS:
General:
Ephedrine should be used cautiously in patients with hyperthyroidism, hypertension, heart disease (including coronary insufficiency, angina pectoris and patients receiving digitalis), cardiac arrhythmias, diabetes or unstable vasomotor system
Laboratory Tests:
No tests in addition to routine ICU tests are required
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
Ephedrine should not be administered concomitantly with other sympathomimetic drugs because of possible additive effects and increased toxicity.
Alpha-adrenergic blocking agents may reduce the vasopressor response to ephedrine by causing vasodilation.
Beta-adrenergic blocking drugs may block the cardiac and bronchodilating effects of ephedrine.
Ephedrine also should be used cautiously with other drugs (e.g. digitalis glycosides) that sensitise the myocardium to the actions of sympathomimetic agents.
ADVERSE REACTIONS:
Cardiovascular system:
Hypertension, tachyarrhythmias, palpitations
Neurological system:
Headache, restlessness, anxiety, tension, tremor, weakness, dizziness, confusion, delirium hallucinations
Gastrointestinal system:
Nausea or vomiting