Find information on thousands of medical conditions and prescription drugs.

Epinephrine

Epinephrine (INN), also epinephrin (both pronounced ep-i-NEF-rin), or adrenaline (BAN) is a hormone and a neurotransmitter. The Latin roots ad-+renes and the Greek roots epi-+nephros both literally mean "on/to the kidney" (referring to the adrenal gland, which secretes epinephrine). Epinephrine is sometimes shortened to epi in medical jargon. more...

Home
Diseases
Medicines
A
B
C
D
E
E-Base
Ecstasy (drug)
Edecrin
Edrophonium
Edrophonium chloride
Efavirenz
Effexor
Eflornithine
Elavil
Eldepryl
Elidel
Eligard
Elitek
Elixomin
Elixophyllin
Ellagic acid
Elmiron
Eloxatin
Elspar
Emtriva
Emylcamate
Enalapril
Enalaprilat
Enalaprilat
Endep
Enflurane
Enoxaparin sodium
Entacapone
Enulose
Epi-pen
Epinephrine
Epirubicin
Epitol
Epivir
Epogen
Eprosartan
Ergocalciferol
Ergoloid Mesylates
Ergotamine
Eryc
Eryped
Erythromycin
Esgic
Eskalith
Esmolol
Estazolam
Estazolam
Estrace
Estraderm
Estradiol
Estradiol
Estradiol valerate
Estring
Estrogel
Estrone
Estrostep
Ethacridine
Ethambutol
Ethchlorvynol
Ethosuximide
Ethotoin
Etiracetam
Etodolac
Etopophos
Etoposide
Etorphine
Evista
Exelon
Exemestane
Hexal Australia
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

Epinephrine is a catecholamine, a sympathomimetic monoamine derived from the amino acids phenylalanine and tyrosine. Its ATC code is C01CA24.

William Bates reported in the New York Medical Journal in May 1886 the discovery of a substance produced by the suprarenal gland. Epinephrine was isolated and identified in 1895 by Napoleon Cybulski, Polish physiologist. The discovery was repeated in 1897 by John Jacob Abel. Jokichi Takamine discovered the same hormone in 1900, without knowing about the previous discovery; but, in later years, counterevidence is shown from the experiment note that Kaminaka leaves that the Takamine team is the discoverer of first adrenaline. It was first artificially synthesized in 1904 by Friedrich Stolz.

Actions in the body

Epinephrine plays a central role in the short-term stress reaction—the physiological response to threatening or exciting conditions (see fight-or-flight response). It is secreted by the adrenal medulla. When released into the bloodstream, epinephrine binds to multiple receptors and has numerous effects throughout the body. It increases heart rate and stroke volume, dilates the pupils, and constricts arterioles in the skin and gut while dilating arterioles in leg muscles. It elevates the blood sugar level by increasing hydrolysis of glycogen to glucose in the liver, and at the same time begins the breakdown of lipids in fat cells. Epinephrine has a suppressive effect on the adaptive immune system.

Epinephrine is used as a drug to promote peripheral vascular resistance via alpha-stimulated vasoconstriction in cardiac arrest and other cardiac disrhythmias resulting in diminished or absent cardiac output, such that blood is shunted to the body's core. This beneficial action comes with a significant negative consequence, increased cardiac irritability, which may lead to additional complications immediately following an otherwise successful resuscitation. Alternatives to this treatment include vasopressin, a powerful antidiuretic which also promotes peripheral vascular resistance leading to blood shunting via vasoconstriction, but without the attendant increase to myocardial irritability.

Because of its suppressive effect on the adaptive immune system, epinephrine is used to treat anaphylaxis and sepsis. Allergy patients undergoing immunotherapy can get an epinephrine rinse before the allergen extract is administered, thus reducing the immune response to the adminsitered allergen. It is also used as a bronchodilator for asthma if specific beta-2-adrenergic agonists are unavailable or ineffective. Adverse reactions to epinephrine include palpitations, tachycardia, anxiety, headache, tremor, hypertension, and acute pulmonary edema.

Read more at Wikipedia.org


[List your site here Free!]


Epinephrine is efficacious for outpatient treatment of bronchiolitis
From Journal of Family Practice, 3/1/04 by Joseph J. Saseen

Hartling L, Wiebe N, Russell K, Patel H, Klassen TP. A meta-analysis of randomized controlled trials evaluating the efficacy of epinephrine for the treatment of acute viral bronchiolitis. Arch Pediatr Adolesc Med 2003; 157:957-964.

* BACKGROUND

Inhaled epinephrine is the most frequently prescribed bronchodilator for acute viral bronchiolitis. It stimulates alpha-receptors in the bronchiolar vasculature and may potentially be more effective than other commonly used bronchodilators (ie, albuterol and ipratropium). Although some data suggest that epinephrine is more effective than placebo in ambulatory patients, its benefit has not been universally accepted due to inconsistent findings in clinical trials and a lack of demonstrated response in hospitalized patients.

* POPULATION STUDIED

In this meta-analysis, the researchers included randomized, double-blind, clinical trials evaluating the efficacy of epinephrine vs placebo or epinephrine vs other bronchodilators in the treatment of bronchiolitis for hospitalized or ambulatory patients aged 2 years or younger. Bronchiolitis was defined as wheezing (with or without cough, tachypnea, and increased respiratory effort) associated with clinical evidence of a viral infection (eg, coryza and fever).

* STUDY DESIGN AND VALIDITY

One researcher searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and reference lists from articles to identify eligible clinical trials. Non-English-language publications were translated for evaluation. The researcher included a study if it reported at least 1 of the following outcome measures: clinical score, oxygen saturation (via oximetry), admission rates, length of hospital stay, respiratory rate, heart rate, and results of pulmonary function tests.

Two reviewers independently evaluated trials for inclusion, and only those that both agreed upon were selected. A standard form was used to note study characteristics, participants, intervention, outcomes, funding sources, and results (specifically, clinical scores of efficacy). Clinical scores were converted to standardized mean differences, since the trials used 6 different clinical scores. The Jadad scale (a validated 5-point quality assessment tool) was used to assess randomization, double-blinding, withdrawals, and dropouts from included studies. Quality ranged from very poor to very good, and all studies were included.

This research has several limitations, some of which are common to meta-analysis methodology. There is no universally accepted assessment tool for evaluating clinical response in bronchiolitis. The endpoints and reported clinical results from these studies varied. Clinical scores of efficacy were established to provide some common marker of response. They were derived by extracting data from tables, recalculations of reported results (eg, 95% confidence intervals, standard deviations, means, medians), graphs, and, in some instances, by requesting additional data from the original investigators.

Only a few studies had common clinical scores, resulting in a small number of subjects included in the multiple comparisons. A statistically significant heterogeneity was seen among the trials, and most clinical scores reflected only short-term markers of efficacy (up to 4 hours post-treatment). Additionally, the method to attain consensus for discrepancies between the 2 independent investigators that reviewed studies for inclusion was not described. (Level of evidence: 1a-)

* OUTCOMES MEASURED

Inpatient and outpatient study data were compared independently. Clinical scores of response at different times after treatment, changes in oxygen saturation, "improvement," length of stay, and pallor after treatment were reported. The researchers converted the data into standardized mean differences in clinical scores (effect size).

* RESULTS

Fourteen clinical trials (7 inpatient, 6 outpatient, and 1 unknown) were included in this meta-analysis. All the studies were small, with the largest including only 194 patients.

Compared with placebo, epinephrine showed no difference in clinical scores 30 minutes after treatment, oxygenation, or length of stay in the inpatient studies. Clinical scores modestly improved 60 minutes after treatment. In the outpatient studies, epinephrine produced modest improvement in clinical scores compared with placebo 60 minutes after treatment, but not at 30 minutes. Oxygenation modestly improved after 30 minutes but no difference in oxygenation was seen after 60 minutes.

For the vague global outcome of "improvement," the number needed to treat was 1.7 (95% confidence interval, 1.3-2.5). No difference was seen in admission rates.

When comparing epinephrine with albuterol, no differences were seen in any measured outcomes in inpatients; however, some outcomes were different among outpatients. Changes in oxygenation after 60 minutes, "improvement," and pallor were statistically better with epinephrine compared with albuterol.

* PRACTICE RECOMMENDATIONS

Epinephrine provides small short-term benefits in ambulatory patients with acute bronchiolitis; however, it is not definitely better than albuterol.

Data do not support using epinephrine for inpatient bronchiolitis. This question remains unanswered due to the small size of the studies included in this meta-analysis and the absence of a reliable clinical scoring system to measure response in bronchiolitis.

Joseph J. Saseen, PharmD, University of Colorado Health Sciences Center, Departments of Clinical Pharmacy and Family Medicine, Denver E-mail: joseph.saseen@uchsc.edu.

COPYRIGHT 2004 Dowden Health Media, Inc.
COPYRIGHT 2004 Gale Group

Return to Epinephrine
Home Contact Resources Exchange Links ebay