에피네프린
Epinephrine
Levo-epinephrine
다른 이름: EpiPen · Twinject · Adrenaline · Epinephrine HCl · Epinephrine bitartrate · Levo-epinephrine · Epinephrinum · L-epinephrine
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
검토된 비계산 근거검토된 비계산 근거 (2)
근거 표시 전용 — 자동 계산 불가
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.
근거 표시 전용 — 자동 계산 불가
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.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
에피네프린(일반적으로 아드레날린으로 알려짐)은 부신 수질에서 생성되는 강력한 내인성 카테콜아민입니다. 교감신경계의 주요 "투쟁-도피" 호르몬입니다.
수의학에서는 주로 다음과 같은 목적으로 사용되는 필수적인 응급 구명 약물입니다:
- 심폐뇌소생술(CPCR): 심정지(무수축) 시 자발순환을 회복시키기 위해 사용.
- 중증 아나필락시스: 기관지 확장 및 혈관 수축을 유도하여 생명을 위협하는 알레르기 반응을 신속하게 역전시키기 위해 사용.
- 국소 마취 보조제: 국소 마취제(예: 리도카인)에 첨가하여 국소 혈관 수축을 유도함으로써 전신 흡수를 지연시키고 마취 효과를 연장하며 시술 부위의 출혈을 줄임.
임상 요점: 에피네프린은 매우 강력하며 치료 지수가 매우 좁습니다. 올바른 농도를 사용하도록 각별한 주의를 기울여야 합니다. 1:1,000(1 mg/mL) 농도와 1:10,000(0.1 mg/mL) 농도를 절대 혼동하지 마십시오.
작용 기전
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.
안전성·주의사항
금기사항
- 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
부작용
- 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)
주의
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.
약물 상호작용
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).
모니터링
- Cardiac rate and rhythm (ECG)
- Respiratory rate and auscultation (especially during anaphylaxis)
- Urine flow (if possible)
- Blood pressure
- Blood gases (if indicated and possible)
약동학
흡수
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.
분포
Does not cross the blood-brain barrier. Crosses the placenta and is distributed into milk.
대사
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.
배설
Excreted as inactive metabolites.
과다투여
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.
제품
제형
- 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
동물용의약품
- 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.)
인용의약품
- 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
규제 현황
투여 중단 기간: cattle meat 0 days · cattle milk 0 days
Commonly referred to as Adrenaline in EU regulatory documents.
투여 중단 기간: cattle meat 0 days · cattle milk 0 days
Commonly referred to as Adrenaline.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
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.
보호자 정보
에피네프린은 중증 알레르기 반응(아나필락시스)에 사용되는 응급 구명 약물입니다.
- 응급 상황에만 사용: 반려동물에게 사전 충전형 주사기(예: 에피펜)가 처방된 경우, 수의사의 지시에 따라 이미 알려진 중증 알레르기 반응에만 사용하십시오.
- 즉각적인 치료 모색: 에피네프린을 투여한 후에도 즉시 반려동물을 동물 응급 병원으로 데려가야 합니다. 약효가 빨리 떨어지며 알레르기 반응이 다시 나타날 수 있습니다.
- 투여 방법: 수의사가 시범을 보인 올바른 주사 방법(일반적으로 근육 또는 피하 주사)을 숙지하십시오.
- 보관: 빛을 피해 실온에 보관하십시오. 유통기한이 지났거나, 액체가 분홍색이나 갈색으로 변했거나, 부유물이 보이는 경우 사용하지 마십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.