Epinephrine is a life saving treatment for severe allergic reactions. People who have allergies should carry an epinephrine auto-injector with them at all times. They and their loved ones should be familiar with how to use the device in emergency situations. Those who need to carry an epinephrine auto-injector should discuss the possibility of side effects and drug interactions with a doctor before use.
As anaphylaxis can be fatal, the benefits of epinephrine usually outweigh the risks. It is important always to seek emergency medical attention after using an epinephrine injection because further treatment and observation may be necessary.
A look at allergy shots, a way of preventing allergies through injections. Included is detail on how they work and the typical costs involved. People who have never been stung may have an allergy without knowing it. Learn more here about bee sting allergies. Certain situations will trigger an adrenaline rush, which is the release of adrenaline from the adrenal gland. This defense mechanism causes an…. Although these two…. Anaphylaxis is a severe allergic reaction that requires urgent medical attention.
Here, learn to recognize the symptoms and what to do next. What is an epinephrine injection? Medically reviewed by Alan Carter, Pharm. About Uses Administration Other information Side effects Summary Epinephrine, also called adrenaline, is a hormone that the adrenal glands produce in the body.
Share on Pinterest An epinephrine injection can treat severe allergic reactions. Image credit: Tony Webster, How to administer. Share on Pinterest A doctor can give instructions on how to administer a certain auto-injector. Other information and tips. Side effects and risks. Epinephrine is in a class of medications called alpha- and beta-adrenergic agonists sympathomimetic agents. It works by relaxing the muscles in the airways and tightening the blood vessels.
Epinephrine injection comes as a prefilled automatic injection device containing a solution liquid and in vials to inject subcutaneously under the skin or intramuscularly into the muscle. It is usually injected as needed at the first sign of a serious allergic reaction. Use epinephrine injection exactly as directed; do not inject it more often or inject more or less of it than prescribed by your doctor. Ask your doctor or pharmacist to show you and any of your caregivers who could be injecting the medication how to use the prefilled automatic injection device.
Training devices are available to practice how to use the automatic injection device during an emergency. Training devices do not contain medication and do not have a needle.
Before you use epinephrine injection for the first time, read the patient information that comes with it. This information includes directions for how to use the prefilled automatic injection device. Be sure to ask your pharmacist or doctor if you or your caregivers have any questions about how to inject this medication. You should inject epinephrine injection as soon as you suspect that you may be experiencing a serious allergic reaction.
Signs of a serious allergic reaction include closing of the airways, wheezing, sneezing, hoarseness, hives, itching, swelling, skin redness, fast heartbeat, weak pulse, anxiety, confusion, stomach pain, losing control of urine or bowel movements, faintness, or loss of consciousness. Talk to your doctor about these symptoms and be sure you understand how to tell when you are having a serious allergic reaction and should inject epinephrine.
Keep your automatic injection device with you or available at all times so that you will be able to inject epinephrine quickly when an allergic reaction begins. Be aware of the expiration date stamped on the device and replace the device when this date passes.
Look at the solution in the device from time to time. If the solution is discolored or contains particles, call your doctor to get a new injection device. Epinephrine injection helps to treat serious allergic reactions but does not take the place of medical treatment.
Get emergency medical treatment immediately after you inject epinephrine. Rest quietly while you wait for emergency medical treatment. Most automatic injection devices contain enough solution for one dose of epinephrine. If your symptoms continue or return after the first injection, your doctor may tell you to use a second dose of epinephrine injection with a new injection device. Be sure that you know how to inject the second dose and how to tell whether you should inject a second dose.
Only a healthcare provider should give more than 2 injections for a single allergic episode. Hydrocortisone: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine. Ibuprofen; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity.
Ibutilide: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias. Iloprost: Major Avoid use of sympathomimetic agents with iloprost.
Sympathomimetics counteract the medications used to stabilize pulmonary hypertension, including iloprost. Incretin Mimetics: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Indacaterol: Moderate Administer sympathomimetics with caution with beta-agonists such as indacaterol.
Indacaterol; Glycopyrrolate: Moderate Administer sympathomimetics with caution with beta-agonists such as indacaterol. Indapamide: Moderate Sympathomimetics can antagonize the antihypertensive effects of vasodilators when administered concomitantly. Patients should be monitored to confirm that the desired antihypertensive effect is achieved.
Insulin Degludec; Liraglutide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Insulin Glargine; Lixisenatide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Insulins: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Iobenguane I Major Discontinue sympathomimetics for at least 5 half-lives before the administration of the dosimetry dose or a therapeutic dose of iobenguane I Do not restart sympathomimetics until at least 7 days after each iobenguane I dose.
Drugs that reduce catecholamine uptake or deplete catecholamine stores, such as sympathomimetics, may interfere with iobenguane I uptake into cells and interfere with dosimetry calculations resulting in altered iobenguane I efficacy. Ionic Contrast Media: Major The intravascular injection of a contrast medium should never be made after the administration of vasopressors since they strongly potentiate neurologic effects.
Serious neurologic sequelae, including permanent paralysis, have been reported after cerebral arteriography, selective spinal arteriography, and arteriography of vessels supplying the spinal cord.
Ipratropium; Albuterol: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Irbesartan: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine. Irbesartan; Hydrochlorothiazide, HCTZ: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine.
Isocarboxazid: Contraindicated In general, sympathomimetics should be avoided in patients receiving MAOIs due to an increased risk of hypertensive crisis. This applies to sympathomimetics including stimulants for ADHD, narcolepsy or weight loss, nasal, oral, and ophthalmic decongestants and cold products, and respiratory sympathomimetics e.
Some local anesthetics also contain a sympathomimetic e. In general, medicines containing sympathomimetic agents should not be used concurrently with MAOIs or within 14 days before or after their use. Isoflurane: Moderate Monitor patients who are concomitantly receiving epinephrine and isoflurane for the development of arrhythmias.
Halogenated anesthetics, such as isoflurane, sensitize the myocardium and may potentiate the arrhythmogenic effects of epinephrine. A study investigating the epinephrine induced arrhythmogenic effect of isoflurane in adult patients undergoing transsphenoidal hypophysectomy demonstrated that the threshold dose of epinephrine i. Isoproterenol: Major Do not administer isoproterenol and epinephrine simultaneously due to additive cardiac stimulation, which may induce serious arrhythmias.
These drugs may be administered alternately provided a proper interval has elapsed between doses. Ketamine: Moderate Closely monitor vital signs when ketamine and epinephrine are coadministered; consider dose adjustment individualized to the patient's clinical situation. Epinephrine may enhance the sympathomimetic effects of ketamine. Labetalol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Levalbuterol: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Levobetaxolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Levobunolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Levomilnacipran: Major Due to the effects of levomilnacipran on noradrenergic pathways, paroxysmal hypertension and arrhythmias may occur during concurrent use of epinephrine.
Levothyroxine: Moderate Sympathomimetic amines should be used with caution in patients with thyrotoxicosis since these patients are unusually responsive to sympathomimetic amines. Based on the cardiovascular stimulatory effects of sympathomimetic drugs, the concomitant use of sympathomimetics and thyroid hormones can enhance the effects on the cardiovascular system.
Patients with coronary artery disease have an increased risk of coronary insufficiency from either agent. Concomitant use of these agents may increase this risk further. The reduction in TSH secretion is not sustained; hypothyroidism does not occur. Levothyroxine; Liothyronine Porcine : Moderate Sympathomimetic amines should be used with caution in patients with thyrotoxicosis since these patients are unusually responsive to sympathomimetic amines.
Levothyroxine; Liothyronine Synthetic : Moderate Sympathomimetic amines should be used with caution in patients with thyrotoxicosis since these patients are unusually responsive to sympathomimetic amines.
Linezolid: Major Linezolid may enhance the hypertensive effect of epinephrine. Initial doses of epinephrine, if given by intravenous infusion, should be reduced and subsequent dosing titrated to desired response.
Closely monitor blood pressure during coadministration. Linezolid is an antibiotic that is also a weak, reversible nonselective inhibitor of monoamine oxidase MAO. Therefore, linezolid has the potential for interaction with adrenergic agents, such as epinephrine.
Liothyronine: Moderate Sympathomimetic amines should be used with caution in patients with thyrotoxicosis since these patients are unusually responsive to sympathomimetic amines. Liraglutide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Lisinopril: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine. Lisinopril; Hydrochlorothiazide, HCTZ: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine.
Lixisenatide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Loop diuretics: Moderate Loop diuretics may antagonize the pressor effects and potentiate the arrhythmogenic and hypokalemic effects of epinephrine. Loratadine; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity.
Losartan: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine. Losartan; Hydrochlorothiazide, HCTZ: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine. Loxapine: Major Patients taking loxapine can have reduced pressor response to ephedrine, phenylephrine, metaraminol, or norepinephrine, but these drugs are preferred over epinephrine if a vasopressor agent is required.
The alpha-adrenergic effects of epinephrine can be blocked during concurrent administration of loxapine. This reaction can result in an apparently paradoxical condition called 'epinephrine reversal.
Macitentan: Major Avoid use of sympathomimetic agents with macitentan. Sympathomimetics counteract the medications used to stabilize pulmonary hypertension, including macitentan. Maprotiline: Moderate Use maprotiline and sympathomimetics together with caution and close clinical monitoring.
Carefully adjust dosages as clinically indicated. Mecamylamine: Major The cardiovascular effects of sympathomimetics may reduce the antihypertensive effects produced by mecamylamine. Close monitoring of blood pressure or the selection of alternative therapeutic agents may be needed. Meglitinides: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Mepenzolate: Moderate Anticholinergics, such as mepenzolate, antagonize the effects of antiglaucoma agents. Mepenzolate is contraindicated in patients with glaucoma and therefore should not be coadministered with medications being prescribed for the treatment of glaucoma. In addition, anticholinergic drugs taken concurrently with corticosteroids in the presence of increased intraocular pressure may be hazardous.
Meperidine; Promethazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Mesoridazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Metaproterenol: Major Caution and close observation should also be used when metaproterenol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Metformin; Rosiglitazone: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Methohexital: Major General anesthetics are known to increase cardiac irritability via myocardial sensitization to catecholamines. Methyclothiazide: Moderate Thiazide diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine.
Methyldopa: Moderate Antihypertensives, including methyldopa, antagonize the vasopressor effects of parenteral epinephrine. Methylergonovine: Major Avoid concomitant use of ergot alkaloids and vasopressors due to synergistic vasoconstriction and severe hypertension. Methylphenidate Derivatives: Moderate Methylphenidate derivatives can potentiate the actions of both exogenous such as dopamine and epinephrine and endogenous such as norepinephrine vasopressors.
It is advisable to monitor cardiac function if these medications are coadministered. Vasopressors include medications such as epinephrine, dopamine, midodrine, and non-prescription medications such as pseudoephedrine and phenylephrine. Methylprednisolone: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine.
Methysergide: Major Avoid concomitant use of ergot alkaloids and vasopressors due to synergistic vasoconstriction and severe hypertension.
Metolazone: Moderate Thiazide diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine. Metoprolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Metoprolol; Hydrochlorothiazide, HCTZ: Moderate Thiazide diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine. Miglitol: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Milnacipran: Major Concomitant use of milnacipran with drugs that increase blood pressure and heart rate has not been systematically evaluated and such combinations should be used with caution. Due to the effects of milnacipran on noradrenergic pathways, paroxysmal hypertension and arrhythmias may occur during concurrent use of epinephrine. Monitor heart rate and blood pressure, and the patients clinical response to therapy if co-use is necessary.
Milnacipran is associated with a mean increase in heart rate of 7 to 8 beats per minute, and higher increases in heart rate 13 beats per minute or more occur more commonly in patients treated with milnacipran than in those receiving placebo. The mean increase from baseline was 5 to 6 mmHg in systolic blood pressure SBP and diastolic blood pressure DBP , and cases of hypertension with milnacipran have been reported, some requiring immediate treatment.
Moexipril: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine.
Mometasone: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine. Monoamine oxidase inhibitors: Contraindicated In general, sympathomimetics should be avoided in patients receiving MAOIs due to an increased risk of hypertensive crisis. Moricizine: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias.
Nabilone: Moderate Concurrent use of nabilone with sympathomimetics e. In a study of 7 adult males, combinations of cocaine IV and smoked marijuana 1 g marijuana cigarette, 0 to 2. Nadolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Naproxen; Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity.
Nebivolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Nebivolol; Valsartan: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine. Nicotine: Moderate Nicotine use may potentiate the effects of the adrenergic agonists and the ergot alkaloids. If significant changes in nicotine intake occur, the dosages of these drugs may need adjustment.
Anginal pain may be induced when coronary insufficiency is present. Non-Ionic Contrast Media: Major Do not administer non-ionic contrast media intra-arterially after the administration of vasopressors since they strongly potentiate neurologic effects. Olanzapine: Moderate Olanzapine may induce significant alpha-adrenergic blockade in overdose, leading to profound hypotension.
Do not use epinephrine, dopamine, or other sympathomimetics with beta-agonist activity since the beta-stimulation may worsen hypotension in the setting of olanzapine overdose. Olanzapine; Fluoxetine: Moderate Olanzapine may induce significant alpha-adrenergic blockade in overdose, leading to profound hypotension. Olanzapine; Samidorphan: Moderate Olanzapine may induce significant alpha-adrenergic blockade in overdose, leading to profound hypotension.
Olmesartan: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine. Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine. Olmesartan; Hydrochlorothiazide, HCTZ: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine.
Opicapone: Moderate Use COMT inhibitors and epinephrine, regardless of route, together with caution due to potential for increased heart rate, arrhythmias, and excessive changes in blood pressure. Oxytocin: Moderate Oxytocin may potentiate the pressor effects of epinephrine. Severe hypertension has been reported when oxytocin was given 3 to 4 hours after prophylactic administration of a vasoconstrictor in conjunction with caudal block anesthesia.
Ozanimod: Major Coadministration of ozanimod with sympathomimetics such as epinephrine is not routinely recommended due to the potential for hypertensive crisis.
If coadministration is medically necessary, closely monitor the patient for hypertension. An active metabolite of ozanimod inhibits MAO-B, which may increase the potential for hypertensive crisis. Sympathomimetics may increase blood pressure by increasing norepinephrine concentrations and monoamine oxidase inhibitors MAOIs are known to potentiate these effects.
Concomitant use of ozanimod with pseudoephedrine did not potentiate the effects on blood pressure. However, hypertensive crisis has occurred with administration of ozanimod alone and also during coadministration of sympathomimetic medications and other selective or nonselective MAO inhibitors.
Paliperidone: Major The alpha-adrenergic effects of epinephrine can be blocked during concurrent administration of paliperidone. This blockade can cause an apparently paradoxical condition called 'epinephrine reversal'. The use of other agents for vascular support is recommended when needed. Penbutolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Pergolide: Major Avoid concomitant use of ergot alkaloids and vasopressors due to synergistic vasoconstriction and severe hypertension. Perindopril: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine. Perindopril; Amlodipine: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine.
Perphenazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Perphenazine; Amitriptyline: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Phendimetrazine: Major Phendimetrazine is a phenylalkaline sympathomimetic agent. All sympathomimetics and psychostimulants, including other anorexiants, should be used cautiously or avoided in patients receiving phendimetrazine. The combined use of these agents may have the potential for additive side effects, such as hypertensive crisis or cardiac arrhythmia.
Phenelzine: Contraindicated In general, sympathomimetics should be avoided in patients receiving MAOIs due to an increased risk of hypertensive crisis. Phenothiazines: Moderate Phenothiazines antagonize the pressor effects of epinephrine.
Phenoxybenzamine: Moderate Alpha-blockers antagonize the pressor effects of epinephrine. Phentermine: Major Because phentermine is a sympathomimetic and anorexic agent i. The combined use of these agents may have the potential for additive side effects, such as hypertensive crisis or cardiac arrhythmias.
Phentermine; Topiramate: Major Because phentermine is a sympathomimetic and anorexic agent i. Phentolamine: Moderate Alpha-blockers antagonize the pressor effects of epinephrine.
Pindolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Pioglitazone: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Pioglitazone; Glimepiride: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Pioglitazone; Metformin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Pirbuterol: Moderate Caution and close observation should also be used when pirbuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Potassium-sparing diuretics: Moderate Potassium-sparing diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine. Pramlintide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Prazosin: Moderate Alpha-blockers antagonize the pressor effects of epinephrine.
Prednisolone: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine. Prednisone: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine. Probenecid; Colchicine: Minor The response to sympathomimetics may be enhanced by colchicine. Procainamide: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias.
Procarbazine: Major Because procarbazine exhibits some monoamine oxidase inhibitory MAOI activity, sympathomimetic drugs should be avoided. As with MAOIs, the use of a sympathomimetic drug with procarbazine may precipitate hypertensive crisis or other serious side effects.
In the presence of MAOIs, drugs that cause release of norepinephrine induce severe cardiovascular and cerebrovascular responses. In general, do not use a sympathomimetic drug unless clinically necessary e. If use is necessary within 2 weeks of the MAOI drug, in general the initial dose of the sympathomimetic agent must be greatly reduced. Patients should be counseled to avoid non-prescription OTC decongestants and other drug products, weight loss products, and energy supplements that contain sympathomimetic agents.
Prochlorperazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Promethazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Promethazine; Dextromethorphan: Moderate Phenothiazines antagonize the pressor effects of epinephrine.
Promethazine; Phenylephrine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Propafenone: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias.
Propofol: Major General anesthetics are known to increase cardiac irritability via myocardial sensitization to catecholamines. Propranolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Propranolol; Hydrochlorothiazide, HCTZ: Moderate Thiazide diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine. Pseudoephedrine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity.
Pseudoephedrine; Triprolidine: Major Pseudoephedrine can potentiate the effects and increase the toxicity of other sympathomimetics by adding to their sympathomimetic activity. Quinapril: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine. Quinapril; Hydrochlorothiazide, HCTZ: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine.
Quinidine: Moderate Monitor patients who receive epinephrine while concomitantly taking antiarrhythmics for the development of arrhythmias. Racepinephrine: Major Racepinephrine is a sympathomimetic drug with agonist actions at both the alpha and beta receptors.
Patients using racepinephrine inhalation are advised to avoid other non-prescription products containing sympathomimetics since additive adverse effects on the cardiovascular and nervous system are possible, some which may be undesirable. Side effects such as nausea, tremor, nervousness, difficulty with sleep, and increased heart rate or blood pressure may be additive. Patients should avoid use of non-prescription decongestants, such as phenylephrine and pseudoephedrine, while using racepinephrine inhalations.
Patients should avoid dietary supplements containing ingredients that are reported or claimed to have a stimulant or weight-loss effect, such as ephedrine and ephedra, Ma huang, and phenylpropanolamine. Ramipril: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine. Rasagiline: Moderate The concomitant use of rasagiline and sympathomimetics was not allowed in clinical studies; therefore, caution is advised during concurrent use of rasagiline and sympathomimetics including stimulants for ADHD and weight loss, non-prescription nasal, oral, and ophthalmic decongestants, and weight loss dietary supplements containing Ephedra.
Although sympathomimetics are contraindicated for use with other non-selective monoamine oxidase inhibitors MAOIs , hypertensive reactions generally are not expected to occur during concurrent use with rasagiline because of the selective monoamine oxidase-B MAO-B inhibition of rasagiline at manufacturer recommended doses. One case of elevated blood pressure has been reported in a patient during concurrent use of the recommended dose of rasagiline and ophthalmic tetrahydrozoline.
One case of hypertensive crisis has been reported in a patient taking the recommended dose of another MAO-B inhibitor, selegiline, in combination with ephedrine. It should be noted that the MAO-B selectivity of rasagiline decreases in a dose-related manner as increases are made above the recommended daily dose and interactions with sympathomimetics may be more likely to occur at these higher doses.
Reserpine: Major Reserpine can increase the tissue sensitivity to epinephrine leading to severe hypertension and arrhythmias. Reserpine causes increased receptor sensitivity secondary to depletion of either norepinephrine or epinephrine from adrenergic nerve endings. Epinephrine should be used cautiously in patients receiving reserpine.
Riociguat: Major Avoid use of sympathomimetic agents with riociguat. Sympathomimetics counteract the medications used to stabilize pulmonary hypertension, including riociguat.
Risperidone: Major The alpha-adrenergic effects of epinephrine can be blocked during concurrent administration of risperidone. The vasoconstrictive properties of dopamine infusion can be decreased due to the alpha-adrenergic blocking capability of risperidone. Rosiglitazone: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Sacubitril; Valsartan: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine.
Safinamide: Moderate Severe hypertensive reactions, including hypertensive crisis, have been reported in patients taking monoamine oxidase inhibitors MAOIs , such as safinamide, and sympathomimetic medications, such as epinephrine.
If concomitant use of safinamide and epinephrine is necessary, monitor for hypertension and hypertensive crisis. Salmeterol: Moderate Caution and close observation should also be used when salmeterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Selegiline: Moderate Monitor blood pressure for hypertension during concomitant use of selegiline and sympathomimetics such as epinephrine.
The use of these drugs together may produce substantial elevations in blood pressure. If a hypertensive crisis occurs, selegiline should be discontinued and therapy to lower blood pressure should be instituted immediately. Selexipag: Major Avoid use of sympathomimetic agents with selexipag. Sympathomimetics counteract the medications used to stabilize pulmonary hypertension, including selexipag. Semaglutide: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Sevoflurane: Moderate Monitor patients who are concomitantly receiving epinephrine and sevoflurane for the development of arrhythmias. Halogenated anesthetics, such as sevoflurane, sensitize the myocardium and may potentiate the arrhythmogenic effects of epinephrine. A study investigating the epinephrine induced arrhythmogenic effect of sevoflurane in adult patients undergoing transsphenoidal hypophysectomy demonstrated that the threshold dose of epinephrine i.
SGLT2 Inhibitors: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Sibutramine: Major Concurrent use of sibutramine with other serotonergic agents may increase the potential for serotonin syndrome or neuroleptic malignant syndrome-like reactions.
Serotonin syndrome is characterized by rapid development of hyperthermia, hypertension, myoclonus, rigidity, autonomic instability, mental status changes e.
Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome. Solriamfetol: Moderate Monitor blood pressure and heart rate during coadministration of solriamfetol, a norepinephrine and dopamine reuptake inhibitor, and vasopressors. Coadministration of solriamfetol with other drugs that increase blood pressure or heart rate has not been evaluated. Sotalol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker.
Spironolactone: Moderate Potassium-sparing diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine. Spironolactone; Hydrochlorothiazide, HCTZ: Moderate Potassium-sparing diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine.
John's Wort, Hypericum perforatum: Major St. John's wort, Hypericum Perforatum may reduce the neuronal uptake of monoamines and should be used cautiously with sympathomimetics or drugs with sympathomimetic-like actions. Sulfonylureas: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Telmisartan: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine.
Telmisartan; Amlodipine: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine. Telmisartan; Hydrochlorothiazide, HCTZ: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine.
Terazosin: Moderate Alpha-blockers antagonize the pressor effects of epinephrine. Terbutaline: Major Concomitant use of sympathomimetics with beta-agonists might result in additive cardiovascular effects such as increased blood pressure and heart rate. Theophylline, Aminophylline: Moderate Concurrent administration of theophylline or aminophylline with sympathomimetics can produce excessive stimulation manifested by skeletal muscle activity, agitation, and hyperactivity.
Moderate Theophylline may potentiate the hypokalemic effects of epinephrine. Thiazide diuretics: Moderate Thiazide diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine. Thiazolidinediones: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Thiethylperazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Thiopental: Major General anesthetics are known to increase cardiac irritability via myocardial sensitization to catecholamines.
Thioridazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Thiothixene: Moderate The alpha-adrenergic effects of epinephrine can be blocked during concurrent administration of thiothixene. This blockade can cause an apparently paradoxical condition called epinephrine reversal, which can lead to severe hypotension, tachycardia, and, potentially, myocardial infarction. Thyroid hormones: Moderate Sympathomimetic amines should be used with caution in patients with thyrotoxicosis since these patients are unusually responsive to sympathomimetic amines.
Timolol: Minor Close monitoring of blood pressure or the selection of alternative therapeutic agents to the sympathomimetic agent may be needed in patients receiving a beta-blocker. Tolcapone: Moderate Use COMT inhibitors and epinephrine, regardless of route, together with caution due to potential for increased heart rate, arrhythmias, and excessive changes in blood pressure.
Torsemide: Moderate Loop diuretics may antagonize the pressor effects and potentiate the arrhythmogenic and hypokalemic effects of epinephrine. Trandolapril: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine. Trandolapril; Verapamil: Moderate Antihypertensives, including angiotensin-converting enzyme inhibitors, antagonize the vasopressor effects of parenteral epinephrine.
Tranylcypromine: Contraindicated In general, sympathomimetics should be avoided in patients receiving MAOIs due to an increased risk of hypertensive crisis. Treprostinil: Major Avoid use of sympathomimetic agents with treprostinil. Sympathomimetics counteract the medications used to stabilize pulmonary hypertension, including treprostinil. Triamcinolone: Moderate Corticosteroids may potentiate the hypokalemic effects of epinephrine. Triamterene: Moderate Potassium-sparing diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine.
Triamterene; Hydrochlorothiazide, HCTZ: Moderate Potassium-sparing diuretics may antagonize the pressor effects and potentiate the arrhythmogenic effects of epinephrine. Tricyclic antidepressants: Major Tricyclic antidepressants may potentiate the pressor effects of epinephrine. Monitor blood pressure and heart rate closely and carefully adjust dosages as required.
Avoid decongestants and local anesthetics that contain epinephrine. Trifluoperazine: Moderate Phenothiazines antagonize the pressor effects of epinephrine. Umeclidinium; Vilanterol: Moderate Administer sympathomimetics with caution with beta-agonists such as vilanterol.
Valsartan: Moderate Antihypertensives, including angiotensin II receptor antagonists, antagonize the vasopressor effects of parenteral epinephrine.
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