Adrinor Injection

Indication:

Adrinor Injection is indicated for the treatment of-

• Emergency Treatment of Acute Anaphylaxis: Immediate management of severe, life-threatening systemic allergic reactions (anaphylactic shock) triggered by drugs, vaccines, insect stings, food, or other allergens.
  Right Decisions – NHS Scotland
• Cardiopulmonary Resuscitation (CPR) / Cardiac Arrest: Restoring cardiac activity in cases of fine/coarse ventricular fibrillation (VF), pulseless ventricular tachycardia (pVT), asystole, and pulseless electrical activity (PEA).
  Sheffield Children’s Hospital
• Acute Asthma & Severe Bronchospasm: Relieving severe, refractory airway obstruction when conventional beta-2 selective agonists are ineffective.
• Croup / Acute Stridor: Nebulized administration to reduce subglottic airway edema in pediatric croup.
  Don’t Forget the Bubbles
• Local Hemostasis: Topically or co-administered with local anesthetics to prolong anesthetic effect and control localized bleeding.

”রেজিস্ট্রার চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন”

Dogase & Adminstration:

Acute Anaphylaxis (Intramuscular – IM Route):

Administer in the anterolateral aspect of the middle third of the thigh (using Adrenaline 1 in 1,000 / 1 mg/mL).

Crucial Note: Doses may be repeated at 5-minute intervals if laryngeal obstruction, bronchospasm, or circulatory shock persists.

 Cardiac Arrest (Intravenous – IV or Intraosseous – IO Route):

• Adults: 1 mg (10 mL of 1 in 10,000 solution).
• Children (Neonates to 17 years): 10 micrograms/kg (0.1 mL/kg of 1 in 10,000 solution).

Using Adrenaline 1 in 10,000 (0.1 mg/mL) solution. Repeat every 3 to 5 minutes if cardiac arrest persists.

Croup/Acute Stridor (Nebulized Route):

• Children (all ages): 400 micrograms/kg (0.4 mL/kg) of 1 in 1000 solution, up to a maximum of 5 mg (5 mL).
  Don’t Forget the Bubbles

”রেজিস্ট্রার চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন”

Pharmacology:

• Mechanism of Action: Adrenaline (Epinephrine) is a naturally occurring catecholamine and a potent direct-acting sympathomimetic agent. It acts as a powerful agonist on both alpha (α1​,α2​) and beta (β1​,β2​) adrenergic receptors.
  • Alpha-1 (α1​) Activation: Induces strong vasoconstriction in skin, mucosa, and renal vascular beds, effectively raising systemic vascular resistance to reverse severe hypotension and reducing mucosal edema (crucial in treating upper airway obstruction/laryngeal edema in anaphylaxis).
    Right Decisions – NHS Scotland
  • Beta-1 (β1​) Activation: Exerts positive inotropic (increases myocardial contractility) and chronotropic (increases heart rate) effects, boosting cardiac output and myocardial oxygen consumption.
  • Beta-2 (β2​) Activation: Relaxes bronchial smooth muscle (bronchodilation) to relieve wheezing and dyspnea, and inhibits the release of inflammatory mediators (histamine, leukotrienes) from mast cells and basophils.
• Pharmacokinetics:
  • Absorption: Rapid onset after intramuscular (IM) injection (absorption is faster and more reliable when given in the anterolateral thigh compared to the arm/deltoid). Extremely rapid onset when given intravenously (IV) or intraosseously (IO). Poorly active when administered orally due to rapid conjugation and oxidation in the gastrointestinal mucosa and liver.
    Resuscitation Council+ 1
  • Distribution: Rapidly distributed into heart, spleen, liver, and kidneys. It does not cross the blood-brain barrier effectively.
  • Metabolism & Elimination: Rapidly inactivated by enzymatic pathways involving Catechol-O-Methyltransferase (COMT) and Monoamine Oxidase (MAO). The metabolites are primarily excreted in the urine as vanillylmandelic acid (VMA). It has an extremely short plasma half-life (approximately 2–3 minutes).

Side Effects:

• Common: Anxiety, restlessness, tremors, palpitations, cold extremities, sweating, headache, dizziness, and transient tachycardia.
• Serious (usually with rapid IV administration or overdose): Severe hypertension, pulmonary edema, myocardial ischemia, angina, cerebral hemorrhage, and ventricular arrhythmias.

Drug Interaction:

• Beta-Blockers (e.g., Propranolol): Extreme risk of severe hypertension and reflex bradycardia due to unopposed alpha-mediated vasoconstriction.
• Tricyclic Antidepressants (TCAs) & MAOIs: May profoundly potentiate the pressor and cardiac effects of adrenaline.
• Halogenated Anesthetics (e.g., Halothane): Increases myocardial sensitivity to adrenaline, potentially triggering severe ventricular arrhythmias.
• Cardiac Glycosides (e.g., Digoxin): Concomitant use increases the risk of cardiac arrhythmias.

Pregnancy & Lactation:

• Pregnancy: Category C. Adrenaline should be used during pregnancy only if the potential benefit outweighs the risk to the fetus. It causes constriction of uterine vessels and may delay labor. However, in emergency anaphylaxis or cardiac arrest, it is life-saving and must not be withheld.
• Lactation: Adrenaline is excreted in breast milk. However, due to its extremely poor oral bioavailability and short half-life, it is highly unlikely to affect a nursing infant.

Over Dosage:

• Symptoms: Severe metabolic acidosis, renal failure, cerebral hemorrhage, pulmonary edema, and life-threatening ventricular arrhythmias.
• Treatment: Discontinue adrenaline administration immediately. Manage symptoms with rapid-acting alpha-blockers (e.g., Phentolamine) to manage severe hypertension, and beta-blockers (e.g., Labetalol) to treat cardiac arrhythmias. Provide supportive oxygen therapy.

Therapeutic Class:

Sympathomimetic / Vasopressor / Cardiopulmonary Resuscitation Agent.

Storage Conditions:

Store below at 30°C  temperature in a dry place. Away from light and out of reach of children. Do not use the medication after its expiration date.