Epinefrina
Epinephrine
Levo-epinephrine
También conocido como: EpiPen · Twinject · Adrenaline · Epinephrine HCl · Epinephrine bitartrate · Levo-epinephrine · Epinephrinum · L-epinephrine
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Evidencia posológica v13 auditada
Evidencia revisada no calculableEvidencia revisada no calculable (2)
Solo evidencia; no apta para cálculo automático
Most species/CPR, cardiac arrest
TABLE 127.5. Agent: Epinephrine (1 : 1000). Dosage: 0.5–1 mg/kg IV, IO, IT232. Species/Comments: Most species/CPR, cardiac arrest.
Solo evidencia; no apta para cálculo automático
Snapping turtles/reduction in time to spontaneous respiration after isoflurane anesthesia
TABLE 127.5. Agent: Epinephrine (1 : 1000). Dosage: 0.1 mg/kg IM106. Species/Comments: Snapping turtles/reduction in time to spontaneous respiration after isoflurane anesthesia.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
Epinefrina (conocida comúnmente como adrenalina) es una potente catecolamina endógena producida por la médula suprarrenal. Es la principal hormona de "lucha o huida" del sistema nervioso simpático.
En medicina veterinaria, es un fármaco de emergencia crítico y vital utilizado principalmente para:
- Reanimación Cardiopulmonar Cerebral (RCPC): Para restaurar la circulación espontánea durante un paro cardíaco (asistolia).
- Anafilaxia grave: Para revertir rápidamente las reacciones alérgicas potencialmente mortales mediante la inducción de broncodilatación y vasoconstricción.
- Adyuvante en anestesia local: Se añade a los anestésicos locales (como la lidocaína) para inducir vasoconstricción local, retrasando así la absorción sistémica, prolongando el efecto anestésico y reduciendo el sangrado en el sitio de la intervención.
Perla clínica: La epinefrina es altamente potente y tiene un índice terapéutico muy estrecho. Se debe tener extremo cuidado para asegurar que se utilice la concentración correcta. Nunca confunda la concentración 1:1,000 (1 mg/mL) con la concentración 1:10,000 (0.1 mg/mL).
Mecanismo de acción
Epinephrine is a direct-acting, non-selective adrenergic agonist that stimulates both alpha (α) and beta (β) receptors via G-protein coupled pathways (activating adenylyl cyclase → ↑ cAMP).
- α1-receptors: → Induces profound smooth muscle contraction and vasoconstriction, increasing systemic vascular resistance and blood pressure.
- β1-receptors: → Directly stimulates the heart, increasing both chronotropy (heart rate) and inotropy (contractility), which increases cardiac output and myocardial oxygen demand.
- β2-receptors: → Relaxes smooth muscle, leading to profound bronchodilation (relieving bronchospasm in anaphylaxis), vasodilation in skeletal muscle, and increased glycogenolysis (raising blood sugar).
- Histamine Antagonism: Physiologically antagonizes the effects of histamine released during anaphylaxis.
Hemodynamic effects depend on the route and rate of administration: Rapid IV injection causes direct cardiac stimulation and increased systolic BP. Slow IV infusion produces a modest rise in systolic pressure, a decrease in diastolic pressure, and decreased total peripheral resistance due to dominant β2 effects.
Seguridad y advertencias
Contraindicaciones
- Narrow-angle glaucoma
- Hypersensitivity to epinephrine
- Shock due to non-anaphylactoid causes
- During general anesthesia with halogenated hydrocarbons or cyclopropane
- During labor (may delay the second stage)
- Cardiac dilatation or coronary insufficiency
- Conditions where vasopressors are contraindicated (e.g., thyrotoxicosis, diabetes, hypertension, toxemia of pregnancy)
- Injection with local anesthetics into small appendages (toes, ears, etc.) due to risk of necrosis
Efectos adversos
- Anxiety and fear
- Tremors and excitability
- Vomiting
- Hypertension (especially with overdosage)
- Cardiac arrhythmias (especially with pre-existing heart disease)
- Hyperuricemia
- Lactic acidosis (with prolonged use or overdose)
- Tissue necrosis and sloughing at the injection site (with repeated injections or injection into small appendages)
Precauciones
Hypovolemia: Epinephrine is not a substitute for adequate fluid volume replacement therapy. Cardiac Rhythms: Use with extreme caution in patients with a prefibrillatory cardiac rhythm due to excitatory effects on the heart. While useful in asystole, it can cause ventricular fibrillation; use cautiously in cases of existing ventricular fibrillation. Tissue Necrosis: Do not inject into small appendages (ears, toes, tails) as profound vasoconstriction can cause ischemic necrosis and sloughing. Concentration Errors: Always double-check the concentration (1:1,000 vs 1:10,000) before administration to avoid fatal overdoses.
Interacciones farmacológicas
May negate the therapeutic effects of epinephrine.
Do NOT use epinephrine to treat cardiac effects caused by alpha-2 agonists; may worsen hemodynamics.
Increased risk of developing severe arrhythmias. Propranolol may be used to treat if they occur.
May potentiate the effects of epinephrine.
May potentiate hypertension and antagonize epinephrine's cardiac and bronchodilating effects.
Increased risk of arrhythmias if used concurrently.
May reverse the pressor effects of epinephrine.
May potentiate the effects of epinephrine.
Hypertension may result if used concurrently.
Should not be administered together as increased toxicity may result.
May reverse the pressor effects of epinephrine.
May potentiate the pressor effects of epinephrine.
May potentiate the effects of epinephrine.
Additive effects leading to potential toxicity
May potentiate the effects of adrenaline
May potentiate the effects of adrenaline
May block the beta effects of adrenaline, facilitating an increase in blood pressure
May negate or diminish the pressor effects of adrenaline
May negate or diminish the pressor effects of adrenaline
Sensitizes the myocardium, increasing the risk of arrhythmias
Sensitizes the myocardium, increasing the risk of arrhythmias
Sensitizes the myocardium to catecholamines, increasing the risk of severe ventricular arrhythmias.
Antagonizes the beta-adrenergic effects of epinephrine, leaving unopposed alpha-adrenergic vasoconstriction which can lead to severe hypertension.
May potentiate the cardiovascular effects of epinephrine.
May reverse the pressor effects of epinephrine, potentially leading to vasodilation and hypotension (epinephrine reversal).
Monitorización
- Cardiac rate and rhythm (ECG)
- Respiratory rate and auscultation (especially during anaphylaxis)
- Urine flow (if possible)
- Blood pressure
- Blood gases (if indicated and possible)
Farmacocinética
Absorción
Well-absorbed following IM or SC administration. IM injections are slightly faster absorbed than SC; massaging the site expedites absorption. Rapidly metabolized in the GI tract and liver after oral administration (not effective PO). SC onset of action is 5-10 minutes. IV onset is immediate.
Distribución
Does not cross the blood-brain barrier. Crosses the placenta and is distributed into milk.
Metabolismo
Actions are ended primarily by uptake and metabolism into sympathetic nerve endings. Metabolized in the liver and other tissues by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) to inactive metabolites.
Eliminación
Excreted as inactive metabolites.
Sobredosis
Clinical signs of overdosage or inadvertent IV administration of SC/IM doses include:
- Sharp rises in systolic, diastolic, and venous blood pressures
- Cardiac arrhythmias
- Pulmonary edema and dyspnea
- Vomiting, headache, and chest pain
- Cerebral hemorrhages (due to severe hypertension)
- Renal failure, metabolic acidosis, and cold skin
Treatment: Because epinephrine has a relatively short duration of effect, treatment is mainly supportive. If necessary, an alpha-adrenergic blocker (e.g., phentolamine) or a beta-adrenergic blocker (e.g., propranolol) can be used to treat severe hypertension and cardiac arrhythmias. Prolonged periods of hypotension may follow, requiring treatment with norepinephrine.
Productos disponibles
Formulaciones
- Injection solution (1:1,000 / 1 mg/mL)
- Injection solution (1:10,000 / 0.1 mg/mL)
- Auto-injectors (0.15 mg, 0.3 mg)
- Aerosol for inhalation
- Topical solution
- Solution for nebulization
- Ophthalmic preparations
Veterinario
- Epinephrine HCl for Injection 1 mg/mL (1:1,000) in 1 mL amps/syringes and 10 mL, 30 mL, 100 mL vials (Amtech, Am-Vet, Vedco, Vetus, AgriPharm, Durvet, Bimeda, etc.)
Etiquetado para humanos
- Epinephrine HCl Solution for Injection: 1 mg/mL (1:1,000) in amps and vials (Adrenalin Chloride)
- Epinephrine HCl Solution for Injection auto-injectors: 1:1,000 (0.3 mg) (EpiPen, Twinject)
- Epinephrine HCl Solution for Injection auto-injectors: 1:2,000 (0.15 mg) (EpiPen Jr)
- Epinephrine HCl Solution for Injection: 1:10,000 (0.1 mg/mL) in syringes and vials
- Epinephrine bitartrate powder (aerosol) for inhalation
- Topical solutions
- Ophthalmic preparations
Estado regulador
Tiempos de retirada: cattle meat 0 days · cattle milk 0 days
Commonly referred to as Adrenaline in EU regulatory documents.
Tiempos de retirada: cattle meat 0 days · cattle milk 0 days
Commonly referred to as Adrenaline.
Sin datos reguladores para: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Store in tight containers protected from light. Epinephrine will darken (oxidize) upon exposure to light and air. Do not use if the injection is pink, brown, or contains a precipitate. Rapidly destroyed by alkalies or oxidizing agents.
Información para el cliente
La epinefrina es un medicamento de emergencia vital utilizado para reacciones alérgicas graves (anafilaxia).
- Solo para uso de emergencia: Si le han recetado jeringas precargadas (como un EpiPen) para su mascota, úsela solo en caso de reacciones alérgicas graves conocidas, tal como le indicó su veterinario.
- Busque atención inmediata: Incluso después de administrar epinefrina, debe llevar a su mascota a una clínica veterinaria de urgencias de inmediato. El efecto del medicamento desaparece rápidamente y la reacción alérgica puede reaparecer.
- Administración: Asegúrese de comprender la técnica de inyección adecuada (generalmente en el músculo o debajo de la piel) demostrada por su veterinario.
- Almacenamiento: Consérvese a temperatura ambiente y protegido de la luz. No utilice el medicamento si ha pasado su fecha de caducidad, si el líquido se ha vuelto rosado o marrón, o si observa partículas flotando en él.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.