ephedrine

General

Pronunciation:
e-fed-rin

Trade Name(s)

  • Akovaz
  • Corphedra

Ther. Class.
vasopressors

Pharm. Class.
adrenergics

Indications

Treatment of clinically important hypotension occurring in the setting of anesthesia.

Action

Stimulates α1 , β1 , and β2  receptors, leading to vasoconstriction and an increased cardiac output, both of which contribute to an increased blood pressure. Also causes indirect adrenergic stimulation by causing release of norepinephrine from sympathetic nerves.

Therapeutic Effect(s):

Increased blood pressure.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Crosses the placenta.

Metabolism and Excretion: Metabolized into norephedrine. Primarily excreted in urine.

Half-life: 6 hr.

TIME/ACTION PROFILE (blood pressure elevation)

ROUTEONSETPEAKDURATION
IVunknownunknownunknown

Contraindication/Precautions

Contraindicated in:

  • None.

Use Cautiously in:

  • OB:  Use only if potential maternal benefit outweighs potential risks to fetus; can cause metabolic acidosis in newborn;
  • Lactation: Use only if potential maternal benefit outweighs potential risks to child;
  • Geri:  More susceptible to adverse reactions; may require ↓ dose;
  • Pedi:  Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: dizziness, restlessness

CV: bradycardia, hypertension, palpitations, tachycardia

GI: nausea, vomiting

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

  • Concurrent use with oxytoxic medications, including  methylergonovine  or  ergonovine  can lead to significant postpartum hypertension; closely monitor blood pressure.
  • Atropine, clonidine, MAO inhibitors, and  propofol  may augment effects on blood pressure; closely monitor blood pressure.
  • α1  receptor antagonists, beta-blockers, reserpine, and  quinidine  can antagonize effects on blood pressure; closely monitor blood pressure.
  • May ↓ effects of  epidural anesthetics.
  • Concurrent use with  theophylline  may ↑ risk of nausea, nervousness, and insomnia.
  • Concurrent use with  digoxin  may ↑ risk of arrhythmias.

Route/Dosage

IV (Adults): 5–10 mg initially; may repeat dose as needed based on blood pressure (not to exceed maximum total dose = 50 mg).

Availability

Solution for injection (must be diluted): 50 mg/mL

Assessment

  • Monitor BP continuously during administration.

Potential Diagnoses

Implementation

  • IV Push:  Dilute with 0.9% NaCl or D5W before injecting. Concentration: 5 mg/mL. Do not administer solutions that are discolored or contain particulate matter.

Patient/Family Teaching

Advise patient to notify health care professional if pregnant or breast feeding before surgery.

Evaluation/Desired Outcomes

Increase in BP.

ephedrine is a sample topic from the Davis's Drug Guide.

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Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. .