Ephedrine

Ephedrine

ADMINISTRATION ROUTES:

• IV

ALTERNATIVE NAMES:

• Ephedrine

ICU INDICATIONS:

1. Drug-induced hypotension (particularly in association with bradycardia)

   Note: used commonly in Anaesthesia but of limited utility in the ICU setting

PRESENTATION AND ADMINISTRATION:

• IV:
  Ampoules contain 30mg in 1ml
  Dilute 30mg to a total of 10ml using normal saline (giving a concentration of 3mg/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:
  Administer by direct IV injection of 3-9mg (1-3ml) and repeat as required

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

• IV:
  0.25-1mg/kg (max 5mg/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

1. hypersensitivity to ephedrine

WARNINGS

• Ephedrine may cause hypertension resulting in intracranial hemorrhage. Ephedrine may induce anginal pain in patients with coronary insufficiency or ischemic heart disease. The drug also may induce potentially fatal arrhythmias in patients with organic heart disease or who are receiving drugs that sensitize 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 FOR THE 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 sensitize 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