· Treatment of cardiovascular arrest

· Treatment of anaphylactic shock

· Treatment of distress, cardio-circulatory with states of anaphylactic shock, haemorrhagic, traumatic, infectious or secondary to cardiac surgery

Treatment of cardiac arrest

Adults

Route I.V .: bolus 1 mg (1 ml) every 3 to 5 minutes until recovery from hemodynamic state

The tracheobronchial route may be used alternatively to the IV route at a dose of 3 mg (3 ml) diluted in 10 ml of 0.9% sodium chloride solution in single dose.

Infants and Children

Route IV: In bolus of 0.01 mg / kg, then if necessary, an additional dose of 0.1 mg / kg every 3-5 minutes until recovery of haemodynamic state. >

The tracheobronchial route may be used alternatively to the IV route at a dose of 0.1 to 0.3 mg / kg as a single dose. >
Treatment of anaphylactic shock, established

Adults

Route I.M .: 0.5-1 mg (0.5-1, ml), repeated every 5 minutes if necessary.
Route IV: 1 ml dilution (1 mg) in 10 ml of 0.9% sodium chloride solution followed by intravenous bolus administration of 1 ml of the diluted solution, ie 0.1 mg of adrenaline . The boluses will be repeated until recovery, from the hemodynamic state. Close monitoring will be introduced.

0.3 ml of the solution (undiluted) is 0.3 mg of adrenaline, and improvement usually appears within 3 to 5 minutes after the injection, subcutaneously. A second injection of 0.3 ml of the solution (undiluted) can be made 10 to 15 minutes, later if necessary.
Infants and Children

The doses will be in the child, either by I.M. or subcutaneously (0.01 mg / kg)
· Less than 2 years (up to 12 kg): 0.05 to 0.1 ml of the solution (undiluted) of 0.05 to 0.1 mg of adrenaline

· From 2 to 6 years (12 to 18 kg): 0.15 ml of the solution (undiluted) ie 0.15 mg of adrenaline >
· 6 to 12 years (18 to 33 kg): 0.2 ml of the solution (undiluted) ie 0.2 mg of adrenaline.
Treatment of distress, cardiovascular with states of shock

Administration at the syringe of a continuous dose of between 0.01 microgram / kg / minute and 0.5 microgram / kg / minute, the mean dosage being titrated according to the desired therapeutic effect.

No information in the marketing authorization.

Pharmacotherapeutic group: CARDIAC STIMULANTS, GLUCOSIDES, CARDIOTONICS EXCLUDED, ATC code: C01CA24

Adrenaline is a direct-acting sympathomimetic amine with effects on both alpha and beta-adrenergic receptors (beta 1 and beta 2), but with a more pronounced beta effect at low therapeutic doses while That the alpha effect is more marked at high therapeutic doses.

The use of adrenaline is based mainly on the following properties

· Vasoconstriction device

· Positive and positive inotropic bathmotrope cardiac action

· Relaxing action of the bronchial musculature and inhibition of the release of mediators of inflammation and allergy

Not applicable.

· Rhythm disorders (especially ventricular)

· Severe obstructive cardiomyopathy

· Coronary insufficiency

This medication being indicated in an emergency situation, these contraindications are:

Warnings

Adrenaline, Aguettant 1 mg / ml SULFITE is indicated only as an emergency treatment. Medical follow-up is essential after administration.

Any intravenous administration of adrenaline may lead to disorders: ventricular rhythm with risk of ventricular fibrillation, sometimes lethal

Cardiopulmonary bypass surgery requires cardiac monitoring, narrow and, if possible, electrocardiographic monitoring.

Adrenaline should be administered by I.M or SC in the event of anaphylactic reaction prodromes such as

· Generalized pruritus of the mucous membranes or erythema

· Labial or oropharyngeal edema

· Chest tightness

· Profuse sweating

· Hypotension.

In all types of shock, administer adrenaline only after blood volume re-establishment.
This medicinal product contains 3.15 mg sodium per ml solution for injection: take this into account in people on a strictly sodium-based diet

The attention of sportsmen and sportswomen will be drawn to the fact that this specialty contains an active ingredient which can induce a positive reaction of the tests performed during the antidoping tests. Code>
Concomitant use of this drug intravenously or intramuscularly is not recommended in combination with halogenated volatile anesthetics, imipraminic antidepressants or mixed adrenergic-serotonergic drugs (see Interactions with other medicinal products and others; Forms of interactions with other medicines and other forms of interaction)

Precautions for use

Following adrenaline administration, adverse reactions may occur in patients with severe renal impairment, hypercalcemia, hypokalaemia, diabetics, women, pregnant.

Repeated local injections may cause necrosis at the site of injection by vasoconstriction

Interactions, with adrenaline used IV or IM

Associations, not recommended (see section Caveats and precautions for use Warnings and special instructions)

+ Halogenated volatile anesthetics (desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane)
Severe ventricular rhythm disorders by increased cardiac excitability

Antidepressants imipraminic (amitriptyline, amoxapine, clomipramine, desipramine, dosulepine, doxepine, imipramine, maprotiline, nortriptyline, opipramol, trimipramine)
Paroxysmal hypertension with possibility of disturbance of rhythm (inhibition of the sympathomimetic entry in the fiber, sympathetic).

+ Adrenergic-serotonergic drugs (amitriptyline, clomipramine, imipramine, milnacipran, oxtitriptan, sibutramine, venlafaxine)
Paroxysmal hypertension with possibility of disturbance of rhythm (inhibition of the sympathomimetic entry in the fiber, sympathetic).

Associations subject to precautions for use

+ Non-selective MAOIs (iproniazide, nialamide)

Increased sympathomimetic pressure, usually moderate. A, use only under strict medical supervision.

+; MAOI A selective (moclobemide, toloxatone)

By extrapolation from MAOIs: non-selective: risk of increased action; To be used only under strict medical supervision,

+; Linézolide

By extrapolation from MAOIs: non-selective: risk of increased action; To be used only under strict medical supervision,

Interactions with adrenaline, used subcutaneously

Associations that are the subject of precautions for use

+ Halogenated volatile anesthetics (desflurane, enflurane, halothane, isoflurane, methoxyflurane, sevoflurane)
Severe ventricular rhythm disorders, increased cardiac excitability. Limit the intake, for example: less than 0.1 mg of adrenaline in 10 minutes or 0.3 mg in 1 hour in adults

Antidepressants imipraminic (amitriptyline, amoxapine, clomipramine, desipramine, dosulepine, doxepine, imipramine, maprotiline, nortriptyline, opipramol, trimipramine)
Severe ventricular rhythm disorders, increased cardiac excitability. Limit the intake, for example: less than 0.1 mg of adrenaline in 10 minutes or 0.3 mg in 1 hour in adults

+ Adrenergic-serotonergic drugs (amitriptyline, clomipramine, imipramine, milnacipran, oxtitriptan, sibutramine, venlafaxine)
Severe ventricular rhythm disorders, increased cardiac excitability. Limit the intake, for example: less than 0.1 mg of adrenaline in 10 minutes or 0.3 mg in 1 hour in adults

+ Non-selective MAOIs (iproniazide, nialamide)

Severe ventricular rhythm disorders, increased cardiac excitability. Limit the intake, for example: less than 0.1 mg of adrenaline in 10 minutes or 0.3 mg in 1 hour in adults

After dilution in 0.09% sodium chloride solution, the product should be used immediately.
In the absence of compatibility studies, this drug should not be mixed with other medicines.
Never dilute in alkaline solutions

Incompatible materials: alkali, copper, iron, silver, zinc and other metals, gums, agents, antioxidants and tannins
An overdose or accidental intravascular injection of adrenaline may cause high blood pressure, severe injury, cerebral, cardiac and vascular potentially fatal (cerebral hemorrhage, arrhythmias, rhythm such as transient bradycardia followed by Tachycardia, which may lead to arrhythmia, myocardial necrosis, acute pulmonary edema, renal insufficiency)

The effects of adrenaline may be antagonized, depending on the condition of the patient, by the administration of fast-acting vasodilators of adrenergic alpha-adrenergic drugs, noradrenaline, or even beta-adrenergic blockers. However, since the half-life of adrenaline is very short, it is not always necessary to have recourse to these drugs.

Pregnancy

Studies in animals have demonstrated a teratogenic effect.

Clinical use of adrenaline in a limited number of pregnancies has not revealed any particular malformative or fetotoxic effects to date, but additional studies are needed to assess the consequences; Of an exposure during pregnancy.

Given the indications in the situation, emergency, adrenaline can be used, if necessary, during pregnancy.


The passage of adrenaline into breast milk is not known. In view of the potential adverse effects to the newborn breast-fed, breast-feeding is not recommended during treatment with adrenaline. >
The undesirable effects depend on the sensitivity of the patient and the administered dose.


Less frequent effects include hallucinations, syncope, hyperglycaemia, hypokalaemia, metabolic acidosis, mydriasis, urinary retention, muscle tremors

Cardiac arrhythmia (tachycardia, sinus, ventricular fibrillation / cardiac arrest), high blood pressure (sometimes causing cerebral haemorrhage), vasoconstriction (eg, For example cutaneous, mucous membranes and kidneys), angina pectoris, even risk of acute myocardial infarction

· Treatment of cardiovascular arrest · Treatment of anaphylactic shock · Treatment of distress, cardiovascular disease with states of anaphylactic shock, haemorrhagic, traumatic, infectious or secondary cardiac surgery.