Ephedrine

What is Ephedrine?

• Ephedrine is an alpha- and beta- adrenergic agonist and a norepinephrine-releasing agent used to prevent low blood pressure during anesthesia.
• It has also been used for asthma, narcolepsy, and obesity but is not the preferred treatment.

Ephedrine

Ephedrine-3d-CPK

Ephedrine2

What are the uses of this medicine?

• Ephedrine sulfate injection is indicated for the treatment of clinically important hypotension occurring in the setting of anesthesia.
• It is also used in the treatment of allergic disorders, such as bronchial asthma.
• The drug has long been used as a pressor agent, particularly during spinal anesthesia when hypotension frequently ooccurs.
• In Stokes-Adams syndrome with complete heart block, ephedrine has a value similar to that of epinephrine.
• It is indicated as a central nervous system stimulant in narcolepsy and depressive states.
• It is also used in myasthenia gravis.

How does this medicine work?

• Ephedrine sulfate is a sympathomimetic amine that directly acts as an agonist at α- and ß­ adrenergic receptors and indirectly causes the release of norepinephrine from sympathetic neurons.
• Pressor effects by direct alpha- and beta-adrenergic receptor activation are mediated by increases in arterial pressures, cardiac output, and peripheral resistance.
• Indirect adrenergic stimulation is caused by norepinephrine release from sympathetic nerves.

Who Should Not Use this medicine ?

This medicine cannot be used in patients who:

• have allergic reactions to ephedrine sulfate.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• Oxytocin and oxytocic drugs (i.e., methylergonovine, ergonovine)
• Clonidine
• propofol
• monoamine oxidase inhibitors (MAOIs)
• atropine
• α-adrenergic antagonists
• β-adrenergic receptor antagonists
• reserpine
• quinidine
• mephentermine
• Guanethidine
• Rocuronium
• Epidural anesthesia
• Theophylline
• Cardiac glycosides

Is this medicine FDA approved?

• Ephedrine was first isolated in 1885 and came into commercial use in 1926.
• It is on the World Health Organization's List of Essential Medicines.
• It is available as a generic medication.
• It can normally be found in plants of the Ephedra genus.

How should this medicine be used?

Recommended dosage: Dosing for the Treatment of Clinically Important Hypotension in the Setting of Anesthesia:

• The recommended dosage for the treatment of clinically important hypotension in the setting of anesthesia is an initial dose of 5 to 10 mg administered by intravenous bolus.
• Administer additional boluses as needed, not to exceed a total dosage of 50 mg.

For remaining indications: ADULTS:

• The usual parenteral dose is 25 to 50 mg given subcutaneously or intramuscularly. Intravenously, 5 to 25 mg may be administered slowly, repeated in 5 to 10 minutes, if necessary.

CHILDREN:

• The usual subcutaneous or intramuscular dose is 0.5 mg/kg of body weight or 16 .7 mg/square meter of body surface every 4 to 6 hours.

Administration:

• Ephedrine sulfate injection must be diluted before administration to achieve the desired concentration as an intravenous bolus or intravenous infusion.
• Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
• Do not use if the solution is colored or cloudy, or if it contains particulate matter.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Injection: 50 mg/mL ephedrine sulfate in single-dose vial

This medicine is available in fallowing brand namesː

• Akovaz, Corphedra

What side effects can this medication cause?

The most common side effects of this medicine include:

• Nausea
• vomiting
• Tachycardia
• palpitations (thumping heart)
• reactive hypertension
• bradycardia
• ventricular ectopics
• R-R variability
• Dizziness
• Restlessness

• Some patients have nausea, vomiting and anorexia. Vesical sphincter spasm may occur and result in difficult and painful urination. Urinary retention may develop in males with prostatism.
• Primordial pain and cardiac arrhythmias may occur following administration of Ephedrine Sulfate Injection, USP

What special precautions should I follow?

• Serious postpartum hypertension has been described in patients who received both a vasopressor (i.e., methoxamine, phenylephrine, ephedrine) and an oxytocic (i.e., methylergonovine, ergonovine). Some of these patients experienced a stroke. Carefully monitor the blood pressure of individuals who have received both ephedrine and an oxytocic.
• Data indicate that repeated administration of ephedrine can result in tachyphylaxis. Clinicians treating anesthesia-induced hypotension with ephedrine sulfate injection should be aware of the possibility of tachyphylaxis and should be prepared with an alternative pressor to mitigate unacceptable responsiveness.
• When used to prevent hypotension, ephedrine has been associated with an increased incidence of hypertension compared with when ephedrine is used to treat hypotension.
• Special care should be used when administering Ephedrine Sulfate Injection, USP to patients with heart disease, angina pectoris, diabetes, hyperthyroidism, prostatic hypertrophy or hypertension and to patients receiving digitalis.
• Prolonged use may produce a syndrome resembling an anxiety state. Tolerance to ephedrine sulfate may develop, but temporary discontinuance to the drug restores its original effectiveness.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• rapid rise in blood pressure
• convulsions
• nausea
• vomiting
• chills
• cyanosis
• irritability
• nervousness
• fever
• suicidal behavior
• tachycardia
• dilated pupils
• blurred vision
• opisthotonos
• spasms
• pulmonary edema
• gasping respirations
• coma
• respiratory failure
• hypertension, followed later by hypotension accompanied by anuria

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• In the case of an overdose, careful monitoring of blood pressure is recommended. If blood pressure continues to rise to an unacceptable level, parenteral antihypertensive agents can be administered at the discretion of the clinician.
• If respirations are shallow or cyanosis is present, artificial respiration should be administered.
• Vasopressors are contraindicated.
• In cardiovascular collapse blood pressure should be maintained.
• For hypertension, 5 mg phentolamine mesylate diluted in saline may be administered slowly intravenously, or 100 mg may be given orally.
• Convulsions may be controlled by diazepam or paraldehyde.
• Cool applications and dexamethasone 1 mg/kg, administered slowly intravenously, may control pyrexia.

Can this medicine be used in pregnancy?

• It is not known whether the drug can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.
• Ephedrine Sulfate Injection, USP should be given to a pregnant woman only if clearly indicated.

Can this medicine be used in children?

• Safety and effectiveness in pediatric patients have not been established.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• ephedrine sulfate

Inactive ingredients:

• Water

Who manufactures and distributes this medicine?

Distributed by:

• Par Pharmaceutical
• Chestnut Ridge, NY

What should I know about storage and disposal of this medication?

• Store ephedrine sulfate injection, 50 mg/mL, at 20° to 25°C (68° to 77°F), with excursions permitted to 15°C to 30°C (59°F to 86°F).
• Protect from light.
• Store in carton until time of use.
• For single use only.
• Discard unused portion.

• Dailymed label info on Ephedrine
• FDA Ephedrine