Epinephrine

EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments, oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop.

Epinephrine injection should be stored at room temperature (approximately 25 °C).

Preserve in tight, light-resistant containers.

SMALL SPILLS AND LEAKAGE: If you spill this chemical, you should dampen the solid spill material with 5% acetic acid, then transfer the dampened material to a suitable container. Use absorbent paper dampened with 5% acetic acid to pick up any remaining material. Your contaminated clothing and the absorbent paper should be sealed in a vapor-tight plastic bag for eventual disposal. Wash all contaminated surfaces with 5% acetic acid followed by washing with a soap and water solution. Do not reenter the contaminated area until the Safety Officer (or other responsible person) has verified that the area has been properly cleaned.

SRP: Expired or waste pharmaceuticals shall carefully take into consideration applicable DEA, EPA, and FDA regulations. It is not appropriate to dispose by flushing the pharmaceutical down the toilet or discarding to trash. If possible return the pharmaceutical to the manufacturer for proper disposal being careful to properly label and securely package the material. Alternatively, the waste pharmaceutical shall be labeled, securely packaged and transported by a state licensed medical waste contractor to dispose by burial in a licensed hazardous or toxic waste landfill or incinerator.

Generators of waste (equal to or greater than 100 kg/mo) containing this contaminant, EPA hazardous waste number p042, must conform with USEPA regulations in storage, transportation, treatment and disposal of waste.

1. A good candidate for fluidized bed incineration at a temperature range of 450 to 980 °C and residence times of seconds for liquids and gases, and longer for solids. 2. A good candidate for rotary kiln incineration at a temperature range of 820 to 1,600 °C and residence times of seconds for liquids and gases, and hours for solids. 3. A good candidate for liquid injection incineration at a temperature range of 650 to 1,600 °C and a residence time of 0.1 to 2 seconds.

RECOMMENDED RESPIRATOR: Where the neat test chemical is weighed and diluted, wear a NIOSH-approved half face respirator equipped with a combination filter cartridge, i.e. organic vapor/acid gas/HEPA (specific for organic vapors, HCl, acid gas, SO2 and a high efficiency particulate filter). (NTP, 1992)

Use in patients taking propranolol and other nonselective beta blockers may produce severe hypertension owing to blockade of beta-2-mediated vasodilation, resulting in unopposed alpha-vasoconstriction.

Epinephrine should not be administered concomitantly with other sympathomimetic agents because of the possibility of additive effects and increased toxicity.

Administration of epinephrine in patients receiving cyclopropane or halogenated hydrocarbon general anesthetics that increase cardiac irritability and seem to sensitize the myocardium to epinephrine may result in arrhythmias including PVCs, tachycardia, or fibrillation. Epinephrine is contraindicated for use with chloroform, trichloroethylene, or cyclopropane and should be used cautiously, if at all, with other halogenated hydrocarbon anesthetics such as halothane. Epinephrine may not be absorbed rapidly enough to cause serious adverse effects when applied topically as a hemostatic in patients undergoing short surgical procedures such as tonsillectomy and adenoidectomy using halothane anesthesia. Prophylactic administration of lidocaine or prophylactic IV administration of propranolol 0.05 mg/kg may protect against ventricular irritability if epinephrine is used during anesthesia with a halogenated hydrocarbon anesthetic. In one study, arrhythmias occurring after parenteral use of epinephrine during general anesthesia responded promptly to IV propranolol 0.05 mg/kg.

The effects of epinephrine 1/200,000 added to mg of epidural morphine were investigated in 3 healthy male volunteers, during 26 hr observation sessions. Cutaneous hypalgesia was intense, faster in onset, and longer in duration after epinephrine-morphine than after plain morphine. Apparently, epinephrine 1/200,000 reduces manifestations of cord and brainstem uptake. The need for the reduction of the customary dose of epidural morphine, while epinephrine is used as an adjuvant, is discussed.

For more Interactions (Complete) data for EPINEPHRINE (20 total), please visit the HSDB record page.

TERRESTRIAL FATE: Based on a classification scheme(1), an estimated Koc value of 73(SRC), determined from a structure estimation method(2), indicates that epinephrine is expected to have high mobility in soil(SRC). The pKa1 of epinephrine, a catecholamine(7), is 8.28(3), indicating that this compound will exist partially in the cation form in the environment and cations generally adsorb more strongly to soils containing organic carbon and clay than their neutral counterparts(4). Volatilization from moist soil is not expected because epinephrine partially exists as a cation and cations do not volatilize. Volatilization of the neutral species of epinephrine from moist soil surfaces is not expected to be an important fate process(SRC) given an estimated Henry's Law constant of 7.1X10-19 atm-cu m/mole(SRC), using a fragment constant estimation method(5). Epinephrine is not expected to volatilize from dry soil surfaces(SRC) based upon an estimated vapor pressure of 7.4X10-8 mm Hg at 25 °C(SRC), determined from a fragment constant method(6). Epinephrine deteriorates rapidly on exposure to air or light, turning red from oxidation to adrenochrome(7). Biodegradation data were not available(SRC, 2009); however, the compound was not affected by various strains of Mycobacterium(8).

AQUATIC FATE: Based on a classification scheme(1), an estimated Koc value of 73(SRC), determined from a structure estimation method(2), indicates that epinephrine is not expected to adsorb to suspended solids and sediment(SRC). A pKa1 of 8.28(3) indicates epinephrine will exist partially in the cation form at pH values of 5 to 9 and therefore volatilization from water surfaces is not expected to be an important fate process(4). According to a classification scheme(5), an estimated BCF of 3.162(SRC), from its log Kow of -2.59(6) and a regression-derived equation(7), suggests the potential for bioconcentration in aquatic organisms is low(SRC). Epinephrine deteriorates rapidly on exposure to air or light, turning red from oxidation to adrenochrome(8). Biodegradation data were not available(SRC, 2009); however, the compound was not affected by various strains of Mycobacterium(9).

ATMOSPHERIC FATE: According to a model of gas/particle partitioning of semivolatile organic compounds in the atmosphere(1), epinephrine, which has an estimated vapor pressure of 7.4X10-8 mm Hg at 25 °C(SRC), determined from a fragment constant method(2), is expected to exist solely in the particulate phase in the ambient atmosphere. Particulate-phase epinephrine may be removed from the air by wet or dry deposition(SRC). Epinephrine deteriorates rapidly on exposure to air or light, turning red from oxidation to adrenochrome(3).

The following link will take the user to the National Toxicology Program (NTP) Test Agent Search Results page, which tabulates all of the "Standard Toxicology & Carcinogenesis Studies", "Developmental Studies", and "Genetic Toxicity Studies" performed with this chemical. Clicking on the "Testing Status" link will take the user to the status (i.e., in review, in progress, in preparation, on test, completed, etc.) and results of all the studies that the NTP has done on this chemical. /Epinephrine hydrochloride/[Available from: http://ntp-apps.niehs.nih.gov/ntp_tox/index.cfm?fuseaction=ntpsearch.searchresults&searchterm=55-31-2]

Using a structure estimation method based on molecular connectivity indices(1), the Koc of epinephrine can be estimated to be 73(SRC). According to a classification scheme(2), this estimated Koc value suggests that epinephrine is expected to have high mobility in soil. The pKa1 of epinephrine is 8.28(3), indicating that this compound will partially exist in cation form in the environment and cations generally adsorb more strongly to soils containing organic carbon and clay than their neutral counterparts(4).

Epinephrine is a naturally occurring hormone, which is released from the adrenal medulla and is involved in the regulation of blood pressure and smooth muscle constriction(1). Epinephrine naturally occurs at the ends of sympathetic nerve fibers where they serve as chemical mediators for carrying nerve impulses(2).

/HUMAN EXPOSURE STUDIES/ Normal human beings have shown no significant changes in the a- and b-waves after injection of 1 mg of epinephrine, ... /during/ ERG /electroretinogram/ studies.

/SIGNS AND SYMPTOMS/Pulmonary edema with rales, rhonchi, dyspnea, frothy or bloody sputum, and an atypical chest x-ray picture may occur after an epinephrine overdose. pulmonary edema usually develops within 20 minutes. It is unclear whether this pulmonary edema is cardiogenic or acute lung injury.

/SIGNS AND SYMPTOMS/ Gas gangrene after IM administration of epinephrine has been reported. Three cases of gas gangrene after IM injection of epinephrine have occurred subsequent to administration of the drug into either the buttock or thigh. Two cases have resulted in death and only one case had appropriate treatment with gas gangrene antiserum, steroids, and antibiotics that resulted in survival of the patient. It appears that clostridium organisms become deposited into muscle tissue during penetration of the skin and that the vasoconstrictor properties of adrenaline enhance the effects of the infection.

/SIGNS AND SYMPTOMS/ Syncope has been reported in pediatric patients after administration of 0.05 to 0.2 mL of epinephrine in the treatment of asthma attacks. Syncope is often accompanied with pallor, unconsciousness, weakness, tachycardia, and hypotension.

For more Human Toxicity Excerpts (Complete) data for EPINEPHRINE (20 total), please visit the HSDB record page.

Drug Induced Liver Injury Rank (DILIrank 2.0)

Epinephrine

vNo-DILI-concern

0

No match

DOI:10.1016/j.drudis.2016.02.015

Bronchodilator active ingredients. The active ingredients of the product consist of any of the following when used within the dosage limits established for each ingredient: Epinephrine and epinephrine bitartrate are included on this list.

Vasoconstrictor active ingredients. The active ingredient of the product consists of any of the following when used in the concentration or within the concentration range established for each ingredient. Epinephrine and epinephrine hydrochloride are included on this list.

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl epinephrine, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act.

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl epinephrine bitartrate, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act. /Epinephrine bitartrate/

P042; As stipulated in 40 CFR 261.33, when epinephrine, as a commercial chemical product or manufacturing chemical intermediate or an off-specification commercial chemical product or a manufacturing chemical intermediate, becomes a waste, it must be managed according to federal and/or state hazardous waste regulations. Also defined as a hazardous waste is any container or inner liner used to hold this waste or any residue, contaminated soil, water, or other debris resulting from the cleanup of a spill, into water or on dry land, of this waste. Generators of small quantities of this waste may qualify for partial exclusion from hazardous waste regulations (40 CFR 261.5(e)).

Persons in charge of vessels or facilities are required to notify the National Response Center (NRC) immediately, when there is a release of this designated hazardous substance, in an amount equal to or greater than its reportable quantity of 1000 lb or 454 kg. The toll free number of the NRC is (800) 424-8802. The rule for determining when notification is required is stated in 40 CFR 302.4 (section IV.D.3.b).

Epinephrine may be applied topically to control superficial bleeding from arterioles or capillaries in the skin, mucous membrane, or other tissues. Bleeding from larger vessels is not controllable by topical application of epinephrine.

Epinephrine has been used to relax uterine musculature and inhibit uterine contractions in premature labor; however the cardiovascular effects and other adverse effects limit the usefullness of the drug for this purpose. Some manufacturers state that epinephrine injection is contraindicated during the second stage of labor.

Drug of choice for emergency treatment of severe allergic reactions to insect stings or bites, foods, drugs, and other allergens.

Used in the treatment of idiopathic or exercise-induced anaphylaxis

For more Uses (Complete) data for EPINEPHRINE (9 total), please visit the HSDB record page.

Use (kg; approx.) in Germany (2009): >10

Adrenalone /SRP: Adrenalone is the keto form of epinephrine/

2-(benzylmethylamino)-1-(3,4-dihydroxyphenyl)ethanone

Noradrenaline

(1977) 5.58X10+5 g (princpl custms dists)

(1979) 6.45X10+5 g (princpl custms dists

(1983) 5.49X10+7 g

(1975) Probably greater than 4.54x10+5 g

(1979) No Data

Reaction of pyrocatechol with chloroacetyl chloride, followed by reaction with methylamine, catalytic redn, and separation of racemic mixt with d-tartaric acid.

Isolation from animal adrenal glands.

From the adrenal glands of sheep and cattle or syntehtically from pyrocatechol

EpiPen Auto-Injector

Grade: USP

Adrenalin-medihaler

Adrenamine

For more Formulations/Preparations (Complete) data for EPINEPHRINE (91 total), please visit the HSDB record page.