Adrenaline

Pregnancy Pregnancy: The use of this medicinal product during pregnancy is only acceptable if the potential benefits justify the possible risks to the foetus. Breastfeeding Breastfeeding: Discontinuation of breastfeeding or avoidance of administration of this medicinal product is recommended. Doping Doping: Prohibited substance - Decree No.‍‍‍‍‍‍​​​‍​​​​​​ 411/2015, of 26 November - Approves the List of Prohibited Substances and Methods for 2016 and repeals Decree No. 270/2014, of 22 December. Epinephrine (adrenaline): Local administration is not prohibited, e.g. nasal, ophthalmic, or when associated with local anaesthetics. This medicinal product should be administered with special caution in patients with cerebrovascular insufficiency and in patients with cardiac conditions such as angina pectoris or myocardial infarction, in patients with chronic pulmonary disease, and in patients with urinary difficulty due to prostatic hypertrophy. The hypokalaemic effect of adrenaline may be potentiated by other drugs that cause potassium loss, such as corticosteroids, diuretics, aminophylline, or theophylline; therefore, periodic monitoring is advisable. Hypokalaemia may increase susceptibility to cardiac arrhythmias caused by digoxin and other cardiac glycosides. In diabetic patients, the dose should be monitored and special precaution taken regarding the possibility of triggering adverse reactions, particularly related to metabolic disturbances. Special caution is recommended in elderly patients, as they are more likely to develop adverse effects to this medicinal product. Chronic administration by local injection may cause necrosis at the injection site due to vascular vasoconstriction. Injection sites should be rotated. Intramuscular injection of this medicinal product in the gluteal region should be avoided, as the vasoconstriction produced by adrenaline reduces tissue oxygen tension, facilitating the proliferation of the anaerobic micro-organism Clostridium welchii, which may be present in the gluteal region and may cause gas gangrene. Due to its vasoconstrictive properties, it should also not be administered in peripheral regions of the body, such as fingers and toes, earlobes, nose, or penis. Both intravenous and intracardiac routes should only be used in cases of extreme emergency and in a hospital setting. When adrenaline is to be administered intravenously as a single dose, the solution should be injected slowly; in the case of continuous dosing, administration should be carried out by drip infusion. When this drug is administered intracardially, the solution should be injected directly into the left ventricle if the heart is exposed, or via an intercostal puncture at the level of the fourth space if the thorax is closed. Adrenaline is not a substitute for plasma; therefore, blood volume depletion should be corrected before initiating therapy. If blood or plasma administration is indicated to increase blood volume, simultaneous administration of adrenaline may be performed provided it is administered separately (e.g., use a Y-connector system and administer the individual infusion bags simultaneously); a controlled drip system should be used. Care should be taken to avoid extravasation of adrenaline into the tissues, as the vasoconstrictive action of adrenaline may produce local necrosis. Patients who frequently receive adrenaline (and other sympathomimetics), for example asthmatic patients, may develop tolerance and a consequent need for dose increases to achieve the same therapeutic effect; in advanced cases, resistance or refractoriness to the clinical effects of this medicinal product may occur. Adrenaline is a substance included in the list of prohibited substances in the World Anti-Doping Code, the use of which is considered prohibited in competition and may result in a positive doping control result. Nevertheless, the use of adrenaline is permitted when administered in combination with local anaesthetics, or in preparations for local use, such as by the nasal or ophthalmic route.