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Racepinephrine Hydrochloride

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ACTIVE PHARMA INGREDIENTS

25 API Suppliers, 13 USDMF, 5 CEP/COS, 3 JDMF, 3 EU WC, 21 NDC API, 15 Listed Suppliers, $ API Reference Price

25 API Suppliers
13 USDMF
5 CEP/COS
3 JDMF
3 EU WC
21 NDC API
15 Listed Suppliers
$ API Reference Price

DEVELOPMENTS

73 Drugs in Development

73 Drugs in Development

INTERMEDIATES

3 Intermediates Suppliers

3 Intermediates Suppliers

FINISHED DOSAGE FORMULATIONS

282 FDF Dossiers, 92 FDA Orange Book, 121 Europe, 19 Canada, 20 Australia, 15 South Africa, 15 Listed Dossiers

282 FDF Dossiers
92 FDA Orange Book
121 Europe
19 Canada
20 Australia
15 South Africa
15 Listed Dossiers

DRUG PRODUCT COMPOSITIONS

INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - 0.15MG/DELIVERY, INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - 0.3MG/DELIVERY, SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.15MG/DELIVERY, SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.1MG/DELIVERY, SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.3MG/DELIVERY, SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - EQ 1MG BASE/ML (EQ 1MG BASE/ML), SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - EQ 30MG BASE/30ML (EQ 1MG BASE/ML), SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - 10MG/10ML (1MG/ML), SOLUTION;INTRAVENOUS, INTRAOCULAR, INTRAMUSCULAR, SUBCUTANEOUS - 1MG/ML (1MG/ML), SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - 30MG/30ML (1MG/ML), SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - 0.15MG/0.3ML (0.15MG/0.3ML), SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - 0.3MG/0.3ML (0.3MG/0.3ML), INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.15MG/DELIVERY, INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.3MG/DELIVERY, INJECTABLE;INJECTION - 0.005MG/ML;0.5%, INJECTABLE;INJECTION - 0.005MG/ML;1%, INJECTABLE;INJECTION - 0.005MG/ML;1.5%, INJECTABLE;INJECTION - 0.005MG/ML;2%, INJECTABLE;INJECTION - 0.01MG/ML;1%, INJECTABLE;INJECTION - 0.01MG/ML;2%, INJECTABLE;INJECTION - 0.02MG/ML;2%, INJECTABLE;INJECTION - 0.5%, INJECTABLE;INJECTION - 1%, INJECTABLE;INJECTION - 1.5%, INJECTABLE;INJECTION - 2%

drugProductComposition
INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - 0.15MG/DELIVERY
INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - 0.3MG/DELIVERY
SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.15MG/DELIVERY
SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.1MG/DELIVERY
SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.3MG/DELIVERY
SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - EQ 1MG BASE/ML (EQ 1MG BASE/ML)
SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - EQ 30MG BASE/30ML (EQ 1MG BASE/ML)
SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - 10MG/10ML (1MG/ML)
SOLUTION;INTRAVENOUS, INTRAOCULAR, INTRAMUSCULAR, SUBCUTANEOUS - 1MG/ML (1MG/ML)
SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - 30MG/30ML (1MG/ML)
SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - 0.15MG/0.3ML (0.15MG/0.3ML)
SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - 0.3MG/0.3ML (0.3MG/0.3ML)
INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.15MG/DELIVERY
INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.3MG/DELIVERY
INJECTABLE;INJECTION - 0.005MG/ML;0.5%
INJECTABLE;INJECTION - 0.005MG/ML;1%
INJECTABLE;INJECTION - 0.005MG/ML;1.5%
INJECTABLE;INJECTION - 0.005MG/ML;2%
INJECTABLE;INJECTION - 0.01MG/ML;1%
INJECTABLE;INJECTION - 0.01MG/ML;2%
INJECTABLE;INJECTION - 0.02MG/ML;2%
INJECTABLE;INJECTION - 0.5%
INJECTABLE;INJECTION - 1%
INJECTABLE;INJECTION - 1.5%
INJECTABLE;INJECTION - 2%

RELATED EXCIPIENT COMPANIES

9 Rochem International Inc, 18 SPI Pharma, 1 DKSH, 1 Pharm-RX Chemical, 4 Faran Shimi Pharmaceutical, 6 Boai NKY Pharmaceuticals Ltd, 12 Gangwal Healthcare, 1 Nanjing Well Pharmaceutical, 2 Pfanstiehl, 1 Capital Farma, 11 Actylis, 2 Alcedo Pharmachem, 5 Anhui Sunhere Pharmaceutical Excipients Co.,Ltd, 9 BASF, 8 Beneo, 1 Bioplus Life Sciences, 2 DFE Pharma, 7 Gangwal Chemicals, 1 Huzhou Sunflower Pharmaceutical, 2 Ideal Cures Pvt Ltd, 3 Ingredion Pharma Solutions, 8 Kerry, 13 Microlex e.U, 2 Novo Excipients, 2 Pharmatrans-Sanaq, 5 Pluviaendo, 2 Prachin Chemical, 33 Roquette, 2 Seppic, 5 Shanghai Shenmei Pharmaceutical Technology Co., Ltd, 2 Shijiazhuang Huaxu Pharmaceutical, 8 Sigachi Industries, 1 Ulanqab Kema New Material, 3 Vasa Pharmachem, 3 Zhejiang Huakang Pharmaceutical

EXCIPIENTS BY APPLICATIONS

71 Fillers, Diluents & Binders, 38 Taste Masking, 38 Direct Compression, 23 Thickeners and Stabilizers, 21 Chewable & Orodispersible Aids, 20 Coating Systems & Additives, 20 Disintegrants & Superdisintegrants, 18 Film Formers & Plasticizers, 16 Granulation, 15 Lubricants & Glidants, 15 Co-Processed Excipients, 13 Parenteral, 11 Controlled & Modified Release, 7 Solubilizers, 4 Emulsifying Agents, 3 API Stability Enhancers, 2 Topical, 1 Soft Gelatin, 1 Rheology Modifiers

DIGITAL CONTENT

24 DATA COMPILATION #PharmaFlow, 1 STOCK RECAP #PipelineProspector, 467 NEWS #PharmaBuzz

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24 DATA COMPILATION #PharmaFlow
1 STOCK RECAP #PipelineProspector
467 NEWS #PharmaBuzz

GLOBAL SALES INFORMATION

4 US Medicaid Prescriptions, 105 Finished Drug Prices, 19 Annual Reports

globalSalesInformation
4 US Medicaid Prescriptions
105 Finished Drug Prices
19 Annual Reports

MARKET PLACE

20 APIs, 26 FDF Dossiers

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20 APIs
26 FDF Dossiers

PATENTS & EXCLUSIVITIES

99 US Patents

patents
99 US Patents

REF. STANDARDS & IMPURITIES

1 USP , 3 Others

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1 USP
3 Others

Epinephrine

Synopsis

ACTIVE PHARMA INGREDIENTS

API Suppliers

USDMF

CEP/COS

JDMF

EU WC

KDMF

NDC API

VMF

Listed Suppliers

API REF. PRICE (USD/KG)

$ 17,014

MARKET PLACE

API

FDF

3INTERMEDIATES

FINISHED DOSAGE FORMULATIONS

282

FDF Dossiers

FDA Orange Book

121

Europe

Canada

Australia

South Africa

Listed Dossiers

73DRUGS IN DEVELOPMENT

DRUG PRODUCT COMPOSITIONS

REF. STANDARDS OR IMPURITIES

EDQM

USP

Others

PATENTS & EXCLUSIVITIES

US Patents

US Exclusivities

Health Canada Patents

DIGITAL CONTENT

Data Compilation #PharmaFlow

Stock Recap #PipelineProspector

Weekly News Recap #Phispers

467

News #PharmaBuzz

GLOBAL SALES INFORMATION

US Medicaid (USD)

116,756,756

Annual Reports (USD Million)

3,808

Finished Drug Prices

195 RELATED EXCIPIENT COMPANIES

337EXCIPIENTS BY APPLICATIONS

Chemistry

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Also known as: L-adrenaline, Adrenaline, L-epinephrine, 51-43-4, Adrenalin, Levoepinephrine

Molecular Formula

C₉H₁₃NO₃

Molecular Weight

183.20 g/mol

InChI Key

UCTWMZQNUQWSLP-VIFPVBQESA-N

The active sympathomimetic hormone from the ADRENAL MEDULLA. It stimulates both the alpha- and beta- adrenergic systems, causes systemic VASOCONSTRICTION and gastrointestinal relaxation, stimulates the HEART, and dilates BRONCHI and cerebral vessels. It is used in ASTHMA and CARDIAC FAILURE and to delay absorption of local ANESTHETICS.

Epinephrine is an alpha-Adrenergic Agonist, and beta-Adrenergic Agonist, and Catecholamine. The mechanism of action of epinephrine is as an Adrenergic alpha-Agonist, and Adrenergic beta-Agonist.

1 2D Structure

Epinephrine

2 Identification

2.1 Computed Descriptors

2.1.1 IUPAC Name

4-[(1R)-1-hydroxy-2-(methylamino)ethyl]benzene-1,2-diol

2.1.2 InChI

InChI=1S/C9H13NO3/c1-10-5-9(13)6-2-3-7(11)8(12)4-6/h2-4,9-13H,5H2,1H3/t9-/m0/s1

2.1.3 InChI Key

UCTWMZQNUQWSLP-VIFPVBQESA-N

2.1.4 Canonical SMILES

CNCC(C1=CC(=C(C=C1)O)O)O

2.1.5 Isomeric SMILES

CNC[C@@H](C1=CC(=C(C=C1)O)O)O

2.2 Synonyms

2.2.1 MeSH Synonyms

1. 4-(1-hydroxy-2-(methylamino)ethyl)-1,2-benzenediol

2. Acetate, Epinephrine

3. Adrenaline

4. Adrenaline Acid Tartrate

5. Adrenaline Bitartrate

6. Adrenaline Hydrochloride

7. Epifrin

8. Epinephrine Acetate

9. Epinephrine Bitartrate

10. Epinephrine Hydrochloride

11. Epinephrine Hydrogen Tartrate

12. Epitrate

13. Lyophrin

14. Medihaler-epi

2.2.2 Depositor-Supplied Synonyms

1. L-adrenaline

2. Adrenaline

3. L-epinephrine

4. 51-43-4

5. Adrenalin

6. Levoepinephrine

7. Nephridine

8. (-)-epinephrine

9. Adnephrine

10. Chelafrin

11. Epinefrina

12. Epinephran

13. Epirenan

14. Epipen

15. (-)-adrenaline

16. Adrenal

17. Epifrin

18. Renoform

19. Vasoconstrictine

20. Primatene Mist

21. Bronkaid Mist

22. Sus-phrine

23. Hypernephrin

24. Renostypticin

25. Supracapsulin

26. Supranephrane

27. Suprarenaline

28. Adrenalinum

29. Adrenine

30. Glauposine

31. Hemisine

32. Hemostasin

33. Hemostatin

34. Levorenin

35. Levorenine

36. Lyophrin

37. Mucidrina

38. Nieraline

39. Paranephrin

40. Renaglandin

41. Renaleptine

42. Renalina

43. Scurenaline

44. Simplene

45. Styptirenal

46. Takamina

47. Twinject

48. Vasotonin

49. Bosmin

50. Exadrin

51. Tonogen

52. (r)-adrenaline

53. Adrin

54. (-)-(r)-epinephrine

55. L-epirenamine

56. Antiasthmatique

57. Esphygmogenina

58. Methylarterenol

59. Supranephrine

60. Adrenamine

61. Adrenapax

62. Adrenasol

63. Adrenodis

64. Adrenohorma

65. Adrenosan

66. Adrenutol

67. Astmahalin

68. Astminhal

69. Balmadren

70. Bernarenin

71. Biorenine

72. Brevirenin

73. Bronkaid

74. Drenamist

75. Dylephrin

76. Glaucosan

77. Glycirenan

78. Haemostasin

79. Haemostatin

80. Hektalin

81. Hyporenin

82. Intranefrin

83. Isoptoepinal

84. Kidoline

85. Myosthenine

86. Sindrenina

87. Soladren

88. Sphygmogenin

89. Stryptirenal

90. Supradin

91. Supranefran

92. Supranol

93. Takamine

94. Tokamina

95. Vasodrine

96. Corisol

97. Glaucon

98. Mytrate

99. Suprel

100. Asthma-nefrin

101. Asmatane Mist

102. 4-[(1r)-1-hydroxy-2-(methylamino)ethyl]benzene-1,2-diol

103. L(-)-epinephrine

104. Sympathin I

105. (r)-epinephrine

106. Asthma Meter Mist

107. Epiglaufrin

108. Adrenalin-medihaler

109. Levorenen

110. Eppy

111. Dyspne-inhal

112. R-(-)-epinephrine

113. Adrenalin In Oil

114. Epinefrin [czech]

115. Epinephrinum

116. Epinefrin

117. Renostyptin

118. Surrenine

119. Susphrine

120. Citanest Forte

121. 1-epinephrine

122. 1-adrenalin

123. Epipen Jr.

124. Vaponefrin

125. (r)-(-)-adrenaline

126. Rcra Waste Number P042

127. L-epinephrine (synthetic)

128. Adrenalina [dcit]

129. Adrenatrate

130. Epinefrina [inn-spanish]

131. Epinephrinum [inn-latin]

132. Metanephrin

133. Renaglandulin

134. Renostypricin

135. Vasoconstrictor

136. Epirenin

137. Renagladin

138. Surenine

139. Vasoton

140. L-adrenalin

141. R-adrenaline

142. Suprarenin

143. Methylaminoethanolcatechol

144. Auvi-q

145. (r)-(-)-epinephrine

146. L-methylaminoethanolcatechol

147. D-adrenaline

148. Sus-phrine Sulfite-free

149. Lyodrin

150. Symjepi

151. (r)-(-)-adnephrine

152. L-epinehphrine

153. (r)-(-)-epirenamine

154. L-1-(3,4-dihydroxyphenyl)-2-methylaminoethanol

155. 4-[(1r)-1-hydroxy-2-(methylamino)ethyl]-1,2-benzenediol

156. (-)-3,4-dihydroxy-alpha-((methylamino)methyl)benzyl Alcohol

157. Rcra Waste No. P042

158. 1,2-benzenediol, 4-(1-hydroxy-2-(methylamino)ethyl)-, (r)-

159. Adrenalin (tn)

160. Micronefrin

161. Epitrate

162. Levo-methylaminoethanolcatechol

163. (-)-r-epinephrine

164. Racepinefrine, (r)-

165. Ai3-19015

166. Adrenalin Chloride

167. Sus-phrine Sulphite-free

168. Lopac-e-4642

169. 1,2-benzenediol, 4-[(1r)-1-hydroxy-2-(methylamino)ethyl]-

170. 1-1-(3,4-dihydroxyphenyl)-2-methylaminoethanol

171. Chembl679

172. Ykh834o4bh

173. Adrenan

174. Adrine

175. D-epinephrine

176. (r)-4-[1-hydroxy-2-(methylamino)ethyl]-1,2-benzenediol

177. D-epifrin

178. Chebi:28918

179. Benzyl Alcohol, 3,4-dihydroxy-alpha-((methylamino)methyl)-, (-)-

180. Asthmanefrin

181. Nsc-62786

182. 4-(1-hydroxy-2-(methylamino)ethyl)-1,2-benzenediol

183. Ncgc00015417-01

184. Ncgc00142615-03

185. Ncgc00142615-08

186. Adrenalina

187. 1,2-benzenediol, 4-((1r)-1-hydroxy-2-(methylamino)ethyl)-

188. 1,2-benzenediol, 4-(1-hydroxy-2-(methylamino)ethyl)-, (theta)-

189. Dsstox_cid_2986

190. Adrenaline (l-adrenaline)

191. Dsstox_rid_76819

192. Dsstox_gsid_22986

193. Rac Epinephrine

194. (-)-3,4-dihydroxy-a-[2-(methylamino)ethyl]benzyl Alcohol

195. Adrenaclick

196. Exadri

197. 1,2-benzenediol, 4-[1-hydroxy-2-(methylamino)ethyl]-, (r)-

198. Epipen E Z Pen

199. L-epinephine

200. Asthmahaler Mist

201. Epi E Z Pen Jr

202. Ana-guard

203. Ana-kit

204. Cas-51-43-4

205. Epipen Ez Pen

206. L-adrenaline Base

207. (-)-adrenalin

208. Twinject 0.3

209. Epi Ez Pen Jr

210. Adrop

211. Epinephrine [usan:inn:jan]

212. Epipen Auto-injector

213. Ccris 4812

214. Twinject 0.15

215. Auvi-q Auto-injector

216. Epipen Jr

217. Hsdb 4289

218. Bronkaid Suspension Mist

219. Einecs 200-098-7

220. Nsc 62786

221. Epipen Jr. Auto-injector

222. Unii-ykh834o4bh

223. (r)-4-(1-hydroxy-2-(methylamino)ethyl)benzene-1,2-diol

224. Epinephrin

225. Levoreninum

226. Anapen

227. Nsc62786

228. 4-((1r)-1-hydroxy-2-(methylamino)ethyl)-1,2-benzenediol

229. Bupivacaine Hcl And Epinephrine

230. Benzyl Alcohol, 3,4-dihydroxy-.alpha.-[(methylamino)methyl]-, (-)-

231. Benzyl Alcohol, 3,4-dihydroxy-.alpha.-((methylamino)methyl)-, (-)-

232. Epinephrine [usp:inn:ban:jan]

233. Ale

234. Iop

235. Epinephrine (usp)

236. Epipen (tn)

237. Nchembio747-comp9

238. Twinject 0.30

239. Adrenaline/epinephrine

240. Adrenaline (jp15)

241. Adrenaline (jp17)

242. Epitrate (salt/mix)

243. Auvi-q (tn)

244. Adrenaline [jan]

245. Epinephrine (usp/inn)

246. Epinephrine [mi]

247. Epinephrine [inn]

248. Adrenalinum [hpus]

249. Epinephrine [hsdb]

250. Bmse000316

251. 4-[1-hydroxy-2-(methylamino)ethyl]-1,2-benzenediol #

252. Adrenaline [mart.]

253. Citanest Forte (salt/mix)

254. L-adrenaline (epinephrine)

255. Schembl3814

256. 3,4-dihydroxy-.alpha.-((methylamino)methyl)benzyl Alcohol

257. Epinephrine [usp-rs]

258. Epinephrine [who-dd]

259. Epinephrine [who-ip]

260. Gtpl479

261. Bidd:gt0119

262. E4250_sigma

263. Adrenaline [ep Impurity]

264. Dtxsid5022986

265. Bdbm44818

266. Cid_6852374

267. Hy-b0447b

268. Zinc39089

269. Adrenaline [ep Monograph]

270. Component Of E-pilo (salt/mix)

271. Epinephrine [orange Book]

272. Hms3884h06

273. Epinephrine [usp Monograph]

274. 104655-05-2

275. Bcp09042

276. Epinephrinum [who-ip Latin]

277. Tox21_111562

278. Bdbm50029050

279. Hsci1_000215

280. Pdsp1_001120

281. Pdsp2_001104

282. S2522

283. 51-43-4 (free Base)

284. Octocaine Component Epinephrine

285. Akos024283500

286. Iontocaine Component Epinephrine

287. Tox21_111562_1

288. Ccg-204593

289. D29a657

290. Db00668

291. Sdccgsbi-0050486.p002

292. Smp1_000227

293. (-)-epinephrine, >=97.0% (nt)

294. Epinephrine Component Of Octocaine

295. Ncgc00142615-01

296. Ncgc00142615-04

297. Ncgc00142615-05

298. Ncgc00142615-06

299. Ncgc00142615-07

300. Ncgc00142615-09

301. Ncgc00142615-18

302. Ac-13188

303. Ac-31211

304. As-13813

305. Epinephrine Component Of Iontocaine

306. 4,5-beta-trihydroxy-n-methylphenethylamine

307. A0173

308. Sw219274-1

309. (-)-epinephrine;l-adrenaline;(-)-adrenalin

310. C00788

311. D00095

312. D88222

313. Ab00573227-11

314. Ab00573227-12

315. Ab00573227-13

316. Ab00573227_14

317. Ab00573227_15

318. Q132621

319. 4-(1-hydroxy-2-methylamino-ethyl)benzene-1,2-diol

320. Q-200601

321. Sr-01000075267-8

322. Noradrenaline Tartrate Impurity A [ep Impurity]

323. 4-[(1r)-1-hydroxy-2-methylaminoethyl]benzene-1,2-diol

324. Lidosite Topical System Kit Component Epinephrine

325. Z2686405805

326. (-)-3,4-dihydroxy-a-[(methylamino)methyl]-benzyl Alcohol

327. Adrenaline, European Pharmacopoeia (ep) Reference Standard

328. Epinephrine Component Of Lidosite Topical System Kit

329. (-)-3,4-dihydroxy-alpha-[(methylamino)methyl]-benzyl Alcohol

330. (-)-3,4-dihydroxy-alpha-[2-(methylamino)ethyl]benzyl Alcohol

331. 4-[(1r)-1-hydroxy-2-(methylamino)ethyl]pyrocatechol;tartaric Acid

332. (-)-3,4-dihydroxy-.alpha.-((methylamino)methyl)benzyl Alcohol

333. Adrenaline With Impurity F, European Pharmacopoeia (ep) Reference Standard

334. 2,3-dihydroxybutanedioic Acid;4-[(1r)-1-hydroxy-2-(methylamino)ethyl]benzene-1,2-diol

335. 2,3-bis(oxidanyl)butanedioic Acid;4-[(1r)-2-(methylamino)-1-oxidanyl-ethyl]benzene-1,2-diol

2.3 Create Date

2004-09-16

3 Chemical and Physical Properties

Molecular Formula	C₉H₁₃NO₃
Molecular Weight	183.20 g/mol
XLogP3	-1.4
Hydrogen Bond Donor Count	4
Hydrogen Bond Acceptor Count	4
Rotatable Bond Count	3
Exact Mass	183.08954328 g/mol
Monoisotopic Mass	183.08954328 g/mol
Topological Polar Surface Area	72.7 Å²
Heavy Atom Count	13
Formal Charge	0
Complexity	154
Isotope Atom Count	0
Defined Atom Stereocenter Count	1
Undefined Atom Stereocenter Count	0
Defined Bond Stereocenter Count	0
Undefined Bond Stereocenter Count	0
Covalently Bonded Unit Count	1

4 Drug and Medication Information

4.1 Drug Information

1 of 16
Drug Name	Adrenalin
PubMed Health	Epinephrine (Into the nose)
Drug Classes	Decongestant
Drug Label	Adrenalin (epinephrine injection, USP) is a clear, colorless, sterile solution containing 1 mg/mL (1:1000) epinephrine, packaged as 1 mL of solution in a single-use clear glass vial or 30 mL of solution in a multiple-dose amber glass vial. In the 1...
Active Ingredient	Epinephrine hydrochloride
Dosage Form	Injectable
Route	Intramuscular, intraocular, subcutaneous; Intramuscular, subcutaneous
Strength	eq 1mg base/ml (eq 1mg base/ml); eq 30mg base/30ml (eq 1mg base/ml)
Market Status	Prescription
Company	Par Sterile Products

2 of 16
Drug Name	Auvi-q
PubMed Health	Epinephrine (Injection)
Drug Classes	Anaphylaxis Agent, Anesthetic Adjunct, Bronchodilator, Vasopressor
Drug Label	AuviQ (epinephrine injection, USP) 0.3 mg and 0.15 mg is an auto-injector and a combination product containing drug and device components.AuviQ includes audible (electronic voice instructions, beeps) and visible (LED lights) cues for use.Ea...
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	eq 0.15mg/delivery; eq 0.3mg/delivery
Market Status	Prescription
Company	Sanofi Aventis Us

3 of 16
Drug Name	Epinephrine
PubMed Health	Epinephrine
Drug Classes	Anaphylaxis Agent, Anesthetic Adjunct, Antiglaucoma, Bronchodilator, Decongestant, Vasopressor
Drug Label	Each EpiPen Auto-Injector delivers a single dose of 0.3 mg epinephrine injection, USP, 1:1000 (0.3 mL) in a sterile solution. Each EpiPen Jr Auto-Injector delivers a single dose of 0.15 mg epinephrine injection, USP, 1:2000 (0.3 mL) in a sterile...
Active Ingredient	Epinephrine hydrochloride
Dosage Form	Solution
Route	Iv (infusion)
Strength	eq 1mg base/ml (eq 1mg base/ml)
Market Status	Prescription
Company	Belcher Pharms

4 of 16
Drug Name	Epipen
PubMed Health	Epinephrine
Drug Classes	Anaphylaxis Agent, Anesthetic Adjunct, Antiglaucoma, Bronchodilator, Decongestant, Vasopressor
Drug Label	Each EpiPen Auto-Injector delivers a single dose of 0.3 mg epinephrine injection, USP, 1:1000 (0.3 mL) in a sterile solution. Each EpiPen Jr Auto-Injector delivers a single dose of 0.15 mg epinephrine injection, USP, 1:2000 (0.3 mL) in a sterile...
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	0.3mg/delivery
Market Status	Prescription
Company	Mylan Speclt

5 of 16
Drug Name	Epipen jr.
Drug Label	EpiPen (epinephrine injection, USP) 0.3 mg and EpiPen Jr (epinephrine injection, USP) 0.15 mg are auto-injectors and combination products containing drug and device components.Each EpiPen Auto-Injector, 0.3 mg delivers a single dose of 0.3 mg epineph...
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	0.15mg/delivery
Market Status	Prescription
Company	Mylan Speclt

6 of 16
Drug Name	Septocaine
Active Ingredient	Articaine hydrochloride; epinephrine bitartrate
Dosage Form	Injectable
Route	Injection
Strength	eq 0.0085mg base/1.7ml (4%; eq 0.01mg base/ml); eq 0.017mg base/1.7ml (4%; 4%; eq 0.005mg base/ml)
Market Status	Prescription
Company	Deproco

7 of 16
Drug Name	Twinject 0.15
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	eq 0.15mg/delivery
Market Status	Prescription
Company	Amedra Pharms

8 of 16
Drug Name	Twinject 0.3
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	eq 0.3mg/delivery
Market Status	Prescription
Company	Amedra Pharms

9 of 16
Drug Name	Auvi-q
PubMed Health	Epinephrine (Injection)
Drug Classes	Anaphylaxis Agent, Anesthetic Adjunct, Bronchodilator, Vasopressor
Drug Label	AuviQ (epinephrine injection, USP) 0.3 mg and 0.15 mg is an auto-injector and a combination product containing drug and device components.AuviQ includes audible (electronic voice instructions, beeps) and visible (LED lights) cues for use.Ea...
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	eq 0.15mg/delivery; eq 0.3mg/delivery
Market Status	Prescription
Company	Sanofi Aventis Us

10 of 16
Drug Name	Epinephrine
PubMed Health	Epinephrine
Drug Classes	Anaphylaxis Agent, Anesthetic Adjunct, Antiglaucoma, Bronchodilator, Decongestant, Vasopressor
Drug Label	Each EpiPen Auto-Injector delivers a single dose of 0.3 mg epinephrine injection, USP, 1:1000 (0.3 mL) in a sterile solution. Each EpiPen Jr Auto-Injector delivers a single dose of 0.15 mg epinephrine injection, USP, 1:2000 (0.3 mL) in a sterile...
Active Ingredient	Epinephrine hydrochloride
Dosage Form	Solution
Route	Iv (infusion)
Strength	eq 1mg base/ml (eq 1mg base/ml)
Market Status	Prescription
Company	Belcher Pharms

11 of 16
Drug Name	Epipen
PubMed Health	Epinephrine
Drug Classes	Anaphylaxis Agent, Anesthetic Adjunct, Antiglaucoma, Bronchodilator, Decongestant, Vasopressor
Drug Label	Each EpiPen Auto-Injector delivers a single dose of 0.3 mg epinephrine injection, USP, 1:1000 (0.3 mL) in a sterile solution. Each EpiPen Jr Auto-Injector delivers a single dose of 0.15 mg epinephrine injection, USP, 1:2000 (0.3 mL) in a sterile...
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	0.3mg/delivery
Market Status	Prescription
Company	Mylan Speclt

12 of 16
Drug Name	Epipen jr.
Drug Label	EpiPen (epinephrine injection, USP) 0.3 mg and EpiPen Jr (epinephrine injection, USP) 0.15 mg are auto-injectors and combination products containing drug and device components.Each EpiPen Auto-Injector, 0.3 mg delivers a single dose of 0.3 mg epineph...
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	0.15mg/delivery
Market Status	Prescription
Company	Mylan Speclt

13 of 16
Drug Name	Septocaine
Active Ingredient	Articaine hydrochloride; epinephrine bitartrate
Dosage Form	Injectable
Route	Injection
Strength	eq 0.0085mg base/1.7ml (4%; eq 0.01mg base/ml); eq 0.017mg base/1.7ml (4%; 4%; eq 0.005mg base/ml)
Market Status	Prescription
Company	Deproco

14 of 16
Drug Name	Twinject 0.15
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	eq 0.15mg/delivery
Market Status	Prescription
Company	Amedra Pharms

15 of 16
Drug Name	Twinject 0.3
Active Ingredient	Epinephrine
Dosage Form	Injectable
Route	Intramuscular, subcutaneous
Strength	eq 0.3mg/delivery
Market Status	Prescription
Company	Amedra Pharms

16 of 16
Drug Name	Adrenalin
PubMed Health	Epinephrine (Into the nose)
Drug Classes	Decongestant
Drug Label	Adrenalin (epinephrine injection, USP) is a clear, colorless, sterile solution containing 1 mg/mL (1:1000) epinephrine, packaged as 1 mL of solution in a single-use clear glass vial or 30 mL of solution in a multiple-dose amber glass vial. In the 1...
Active Ingredient	Epinephrine hydrochloride
Dosage Form	Injectable
Route	Intramuscular, intraocular, subcutaneous; Intramuscular, subcutaneous
Strength	eq 1mg base/ml (eq 1mg base/ml); eq 30mg base/30ml (eq 1mg base/ml)
Market Status	Prescription
Company	Par Sterile Products

4.2 Therapeutic Uses

Adrenergic alpha-Agonists; Adrenergic beta-Agonists; Adrenergic Agonists; Bronchodilator Agents; Mydriatics; Sympathomimetics; Vasoconstrictor Agents

National Library of Medicine's Medical Subject Headings online file (MeSH, 1999)

Epinephrine is the drug of choice in the emergency treatment of severe acute anaphylactic reactions including anaphylactic shock. Symptoms such as urticaria, pruritus, angioedema, and swelling of the lips, eyelids, and tongue which may result from reactions to drugs, sera, insect stings, food, or other allergens may be relieved by epinephrine. Epinephrine should be given to all patients with signs of systemic reactions, particularly hypotension, airway swelling, or definite breathing difficulty. Circulatory support during anaphylactic shock requires rapid volume resuscitation and vasopressor therapy to support blood pressure; epinephrine is the drug of choice for the treatment of both vasodilation/hypotension and cardiac arrest associated with anaphylaxis. /Included in US product label/

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1389

Epinephrine may be added to solutions of some local anesthetics to decrease the rate of vascular absorption of the anesthetic, thereby localizing anesthesia and prolonging the duration of anesthesia; the risk of systemic toxicity from the local anesthetic is also decreased. Epinephrine may be applied topically to control superficial bleeding from arterioles or capillaries in the skin, mucous membranes, or other tissues. Bleeding from larger vessels is not controllable by topical application of epinephrine. /Included in US product label/

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1390

Epinephrine is used for its a-adrenergic stimulatory effects to increase blood flow in advanced cardiovascular life support (ACLS) during cardiopulmonary resuscitation (CPR). The principal beneficial effects of the drug in patients with cardiac arrest result from increases in aortic diastolic blood pressure and in myocardial and cerebral blood flow during resuscitation. The value and safety of the beta-adrenergic effects of epinephrine are controversial because they may increase myocardial work and reduce subendocardial perfusion. Epinephrine remains a drug of choice and a high priority for ACLS in cardiac arrest to facilitate return of spontaneous circulation. /Included in US product label/

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1389

For more Therapeutic Uses (Complete) data for EPINEPHRINE (15 total), please visit the HSDB record page.

4.3 Drug Warning

Epinephrine should not be used in cardiogenic shock because it increases myocardial oxygen demand, nor should it be used in hemorrhagic or traumatic shock.

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1389

Vet: epinephrine injection (1:1000): do not use in acute hypotension produced by phenothiazine derived tranquilizers, since further depression of blood pressure can occur. Do not use when cyclopropane or halogenated anesthetics are used because of possible cardiac collapse. Do not use in treatment of vascular shock. Do not use in patients known to be sensitive to epinephrine ... Use with caution in hyperthyroid animals; animals being treated with thyroid, digitalis, or mercurial diuretics. Do not use injection if it is brown or contains a precipitate.

Aronson, C.E. (ed.). Veterinary Pharmaceuticals & Biologicals, 1980-1981. Media, Pa.: Harwal Publishing Co., 1980., p. 16-48

A prospective study where topical epinephrine was used on burn and non-burn patients and five patients served as controls without epinephrine usage. Catecholamine concentrations were measured and to estimate the systemic effects of epinephrine, serum lactate and pyruvate concentrations were analyzed and perioperative haemodynamic changes recorded. Compared to the baseline values, there was a significant increase in the heart rate, serum epinephrine and lactate concentrations and LP-ratios in the burn patients and an increase in the epinephrine concentrations in the non-burn patients at 1 and 2 h. Epinephrine and lactate concentrations and LP-ratios were also higher in the burn patients compared to the other groups. Altogether, there were no changes in the control group. This study showed that the use of topical epinephrine has systemic effects on hemodynamics and serum epinephrine concentrations. Increased epinephrine concentrations in burn patients suggest increased absorption properties in these patients. The increased lactate concentrations and LP-ratios suggest tissue ischaemia, likely in skin.

PMID:19481869 Papp AA et al; Burns 35 (6): 832-9 (2009).

Some manufacturers state that epinephrine is contraindicated for parenteral use during the second stage of labor; parenteral administration of the drug to maintain blood pressure during spinal anesthesia for delivery can cause acceleration of fetal heart rate and should not be used in obstetric patients when maternal systolic/diastolic blood pressure exceeds 130/80 mm Hg. Epinephrine should be administered cautiously by oral inhalation to pregnant patients. Epinephrine should be used during pregnancy only if the potential benefits justify the possible risks to the fetus. There is some evidence that epidural administration of lidocaine with epinephrine during labor is safe.

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1393

For more Drug Warnings (Complete) data for EPINEPHRINE (21 total), please visit the HSDB record page.

4.4 Minimum/Potential Fatal Human Dose

The minimum lethal human dose by subcutaneous injection is estimated as 4 mg.

Dart, R.C. (ed). Medical Toxicology. Third Edition, Lippincott Williams & Wilkins. Philadelphia, PA. 2004., p. 548

4.5 Drug Indication

Epinephrine injection is indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to stinging insects (e.g., order Hymenoptera, which include bees, wasps, hornets, yellow jackets and fire ants) and biting insects (e.g., triatoma, mosquitos), allergen immunotherapy, foods, drugs, diagnostic testing substances (e.g., radiocontrast media) and other allergens, as well as idiopathic anaphylaxis or exercise-induced anaphylaxis. Injectable epinephrine is intended for immediate/urgent administration in patients, who are found to be at increased risk for anaphylaxis, including individuals with a history of anaphylaxis. Selection of the appropriate dosage strength is determined according to body weight. Epinephrine's cardiac effects may be of use in restoring cardiac rhythm in cardiac arrest due to various causes but is not used in cardiac failure or in hemorrhagic, traumatic, or cardiogenic shock. Epinephrine is used as a hemostatic agent. It is also used in treating mucosal congestion of hay fever, rhinitis, and acute sinusitis; to relieve bronchial asthmatic paroxysms; in syncope due to complete heart block or carotid sinus hypersensitivity; for symptomatic relief of serum sickness, urticaria, angioneurotic edema; for resuscitation in cardiac arrest following anesthetic accidents; in simple (open angle) glaucoma; for relaxation of uterine musculature and to inhibit uterine contractions. Epinephrine injection can be utilized to prolong the action of local anesthetics. In addition to the above, epinephrine is used as an over the counter (OTC) agent for the intermittent symptoms of asthma, such as wheezing, tightness of chest and shortness of breath. It is also used for the maintenance of mydriasis during intraocular surgery.

FDA Label

5 Pharmacology and Biochemistry

5.1 Pharmacology

Epinephrine is a sympathomimetic drug. It causes an adrenergic receptive mechanism on effector cells and mimics all actions of the sympathetic nervous system except those on the facial arteries and sweat glands. Important effects of epinephrine include increased heart rate, myocardial contractility, and renin release via beta-1 receptors. Beta-2 effects produce bronchodilation which may be useful as an adjunct treatment of asthma exacerbations as well as vasodilation, tocolysis, and increased aqueous humor production. In croup, nebulized epinephrine is associated with both clinically and statistically significant transient reduction of croup symptoms 30 minutes post-treatment. Epinephrine also alleviates pruritus, urticaria, and angioedema and may be helpful in relieving gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxing effects on the smooth muscle of the stomach, intestine, uterus, and urinary bladder.

5.2 MeSH Pharmacological Classification

Adrenergic alpha-Agonists

Drugs that selectively bind to and activate alpha adrenergic receptors. (See all compounds classified as Adrenergic alpha-Agonists.)

Vasoconstrictor Agents

Drugs used to cause constriction of the blood vessels. (See all compounds classified as Vasoconstrictor Agents.)

Adrenergic beta-Agonists

Drugs that selectively bind to and activate beta-adrenergic receptors. (See all compounds classified as Adrenergic beta-Agonists.)

Sympathomimetics

Drugs that mimic the effects of stimulating postganglionic adrenergic sympathetic nerves. Included here are drugs that directly stimulate adrenergic receptors and drugs that act indirectly by provoking the release of adrenergic transmitters. (See all compounds classified as Sympathomimetics.)

Bronchodilator Agents

Agents that cause an increase in the expansion of a bronchus or bronchial tubes. (See all compounds classified as Bronchodilator Agents.)

Mydriatics

Agents that dilate the pupil. They may be either sympathomimetics or parasympatholytics. (See all compounds classified as Mydriatics.)

5.3 FDA Pharmacological Classification

5.3.1 Active Moiety

EPINEPHRINE

5.3.2 FDA UNII

YKH834O4BH

5.3.3 Pharmacological Classes

Adrenergic beta-Agonists [MoA]; Catecholamine [EPC]; Catecholamines [CS]; alpha-Adrenergic Agonist [EPC]; beta-Adrenergic Agonist [EPC]; Adrenergic alpha-Agonists [MoA]

5.4 ATC Code

C01CA24

S76 | LUXPHARMA | Pharmaceuticals Marketed in Luxembourg | Pharmaceuticals marketed in Luxembourg, as published by d'Gesondheetskeess (CNS, la caisse nationale de sante, www.cns.lu), mapped by name to structures using CompTox by R. Singh et al. (in prep.). List downloaded from https://cns.public.lu/en/legislations/textes-coordonnes/liste-med-comm.html. Dataset DOI:10.5281/zenodo.4587355

A - Alimentary tract and metabolism

A01 - Stomatological preparations

A01A - Stomatological preparations

A01AD - Other agents for local oral treatment

A01AD01 - Epinephrine

B - Blood and blood forming organs

B02 - Antihemorrhagics

B02B - Vitamin k and other hemostatics

B02BC - Local hemostatics

B02BC09 - Epinephrine

C - Cardiovascular system

C01 - Cardiac therapy

C01C - Cardiac stimulants excl. cardiac glycosides

C01CA - Adrenergic and dopaminergic agents

C01CA24 - Epinephrine

R - Respiratory system

R01 - Nasal preparations

R01A - Decongestants and other nasal preparations for topical use

R01AA - Sympathomimetics, plain

R01AA14 - Epinephrine

R - Respiratory system

R03 - Drugs for obstructive airway diseases

R03A - Adrenergics, inhalants

R03AA - Alpha- and beta-adrenoreceptor agonists

R03AA01 - Epinephrine

S - Sensory organs

S01 - Ophthalmologicals

S01E - Antiglaucoma preparations and miotics

S01EA - Sympathomimetics in glaucoma therapy

S01EA01 - Epinephrine

5.5 Absorption, Distribution and Excretion

Absorption

Following I.V. (intravenous) injection, epinephrine disappears rapidly from the blood stream. Subcutaneously or I.M. (intramuscular) administered epinephrine has a rapid onset and short duration of action. Subcutaneous (SC) administration during asthmatic attacks may produce bronchodilation within 5 to 10 minutes, and maximal effects may occur within 20 minutes. The drug becomes fixed in the tissues rapidly,.

Route of Elimination

The majority of the dose of epinephrine is seen excreted in the urine,. About 40% of a parenteral dose of epinephrine is excreted in urine as metanephrine, 40% as VMA, 7% as 3-methoxy-4-hydroxyphenoglycol, 2% as 3,4-dihydroxymandelic acid, and the rest as acetylated derivatives. These metabolites are excreted mainly as the sulfate conjugates and, to a lesser extent, the glucuronide conjugates. Only small amounts of the drug are excreted completely unchanged.

Clearance

Intravenous injection produces an immediate and intensified response. Following intravenous injection, epinephrine disappears rapidly from the blood stream.

Following topical application of radiolabeled epinephrine to the eye in rabbits, highest concentrations of the drug in tissues and fluids other than the eye occurred in the pituitary gland, with lower concentrations in the intestine, fat, adrenal gland, kidney, heart, lung, spleen, ovary, pancreas, liver, uterus, muscle, brain, and serum. In humans, systemically absorbed epinephrine crosses the placenta but not the blood-brain barrier. Systemically absorbed epinephrine distributes into milk.

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 2926

Epinephrine is not effective after oral admin because it is rapidly conjugated and oxidized in GI mucosa and liver. Absorption from sc tissues occurs slowly because of local vasoconstriction ... Absorption is more rapid after im than after sc injection ... Epinephrine is rapidly inactivated in the body.

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill, 2006., p. 247

In a prospective, randomized, five-way crossover study in rabbits, ... plasma epinephrine concentrations /were measured/ before, and at intervals up to 180 min after epinephrine administration by intramuscular or subcutaneous injection, or by inhalation, with intravenous epinephrine and intramuscular saline as the positive and negative controls, respectively. Maximum plasma epinephrine concentrations were higher, and occurred more rapidly, after intramuscular injection than after subcutaneous injection or inhalation, and were 7719+/-3943 (S.E.M.) pg/mL at 32.5+/-6.6 min, 2692+/-863 pg/mL at 111.7+/-30.8 min and 1196+/-369 pg/mL at 45. 8+/-19.2 min, respectively. Intravenous injection of epinephrine resulted in a plasma concentration of 3544+/-422 pg/mL at 5 min, and an elimination half-life (t(1/2)) of 11.0+/-2.5 min. In the saline control study, the endogenous epinephrine concentration peaked at 518+/-142 pg/mL. CONCLUSION: In this model, absorption of epinephrine was significantly faster after intramuscular injection than after subcutaneous injection or inhalation. The extent of absorption was satisfactory after both intramuscular and subcutaneous injections. Neither the rate nor the extent of absorption was satisfactory after administration by inhalation.

PMID:10870098 Gu X et al; Biopharm Drug Dispos 20 (8): 401-5 (1999).

3 groups of 5 greyhounds received 1.5 ug/kg epinephrine 1:200,000 in either lidocaine 0.5%, bupivacaine 0.5% or 0.9% saline. Dogs were anesthetized and 40% of the allocated epinephrine solution was infiltrated beneath the perianal skin and each of the 4 quadrants of the rectal mucosa was injected with the remainder of the solution. Plasma epinephrine, lidocaine, bupivacaine, lactate, glucose and potassium concn were measured at 1, 2, 5, 10 and 30 min following infiltration. Peak plasma epinephrine concn were recorded 2 min following rectal mucosal infiltration in all 3 groups. Plasma epinephrine concn were significantly higher (p < 0.01) in the lidocaine group at 1 and 2 min following infiltration. Both plasma bupivacaine and lidocaine peaked 10 min after infiltration and thereafter tended to decr towards baseline concn. Plasma bupivacaine concn were significantly higher (p < 0.01) than plasma lidocaine concn throughout the study period. There were no significant differences in metabolic or biochemical indices within or between the 3 groups. However, both plasma glucose and lactate concn were elevated and peaked 10 min after infiltration, while plasma potassium concn remained unchanged throughout the study period. Heart rate in the bupivacaine group was significantly reduced at 30 min following infiltration (p < 0.05). There were no significant differences observed in the mean arterial and pulse pressures among the 3 groups.

PMID:2758538 Flynn N et al; Can J Anaesth 36 (4): 397-401 (1989)

Epinephrine is well absorbed after subcutaneous or IM injection; absorption can be hastened by massaging the injection site. Both rapid and prolonged absorption occur after subcutaneous injection of the longer-acting aqueous suspension (no longer commercially available in the US). Epinephrine also is absorbed following endotracheal administration, although serum concentrations achieved may be only 10% of those with an equivalent IV dose.. After oral inhalation of epinephrine in the usual dosage, absorption is slight and the effects of the drug are restricted mainly to the respiratory tract. Absorption increases somewhat when larger doses are inhaled, and systemic effects may occur.

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1394

5.6 Metabolism/Metabolites

Epinephrine is rapidly inactivated mainly by enzymic transformation to metanephrine or normetanephrine, either of which is then conjugated and excreted in the urine in the form of both sulfates and glucuronides. Either sequence results in the formation of 3-methoxy-4- hydroxy-mandelic acid(vanillylmandelic acid, VMA) which is shown to be detectable in the urine. Epinephrine is rapidly inactivated in the body mostly by the enzymes COMT (catechol-O-methyltransferase) and MAO (monoamine oxidase). The liver is abundant in the above enzymes, and is a primary, although not essential, tissue in the degradation process.

The pharmacologic actions of epinephrine are terminated mainly by uptake and metabolism in sympathetic nerve endings. Circulating drug is metabolized in the liver and other tissues by a combination of reactions involving the enzymes catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO). The major metabolites are metanephrine and 3-methoxy-4-hydroxymandelic acid (vanillylmandelic acid, VMA) both of which are inactive. About 40% of a parenteral dose of epinephrine is excreted in urine as metanephrine, 40% as VMA, 7% as 3-methoxy-4-hydroxyphenoglycol, 2% as 3,4-dihydroxymandelic acid, and the remainder as acetylated derivatives. These metabolites are excreted mostly as the sulfate conjugates and, to a lesser extent, the glucuronide conjugates. Only small amounts of the drug are excreted unchanged.

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 1394

Circulating epinephrine is metabolized in the liver and is taken up into adrenergic neurons and metabolized by MAO and catechol-O-methyltransferase to metadrenaline, sulfate conjugates, and hydroxy derivatives of mandelic acid.

Dart, R.C. (ed). Medical Toxicology. Third Edition, Lippincott Williams & Wilkins. Philadelphia, PA. 2004., p. 548

Epinephrine has known human metabolites that include Epinephrine sulfate.

S73 | METXBIODB | Metabolite Reaction Database from BioTransformer | DOI:10.5281/zenodo.4056560

5.7 Biological Half-Life

The plasma half-life is approximately 2-3 minutes. However, when administered by subcutaneous or intramuscular injection, local vasoconstriction may delay absorption so that epinephrine's effects may last longer than the half-life suggests.

Elimination half life is 1 minute.

Dart, R.C. (ed). Medical Toxicology. Third Edition, Lippincott Williams & Wilkins. Philadelphia, PA. 2004., p. 548

5.8 Mechanism of Action

Epinephrine acts on alpha and beta-adrenergic receptors. Epinephrine acts on alpha and beta receptors and is the strongest alpha receptor activator. Through its action on alpha-adrenergic receptors, epinephrine minimizes the vasodilation and increased the vascular permeability that occurs during anaphylaxis, which can cause the loss of intravascular fluid volume as well as hypotension. Epinephrine relaxes the smooth muscle of the bronchi and iris and is a histamine antagonist, rendering it useful in treating the manifestations of allergic reactions and associated conditions. This drug also produces an increase in blood sugar and increases glycogenolysis in the liver. Through its action on beta-adrenergic receptors, epinephrine leads to bronchial smooth muscle relaxation that helps to relieve bronchospasm, wheezing, and dyspnea that may occur during anaphylaxis.

The mechanism of rise in blood pressure ... is threefold: a direct myocardial stimulation that increases the strength of ventricular contraction (positive inotropic action), an increased heart rate (positive chronotropic action), vasoconstriction in many vascular beds, especially in precapillary resistance vessels of skin, mucosa, and kidney, along with marked constriction of veins.

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill, 2006., p. 243

... Epinephrine affects respiration primarily by relaxing bronchial muscle. It has a powerful bronchodilator action, most evident when bronchial muscle is contracted because of disease, as in bronchial asthma, or in response to drugs or various autacoids. In such situations, epinephrine has a striking therapeutic effect as a physiological antagonist to substances that cause bronchoconstriction. The beneficial effects of epinephrine in asthma also may arise from inhibition of antigen-induced release of inflammatory mediators from mast cells, and to a lesser extent from diminution of bronchial secretions and congestion within the mucosa. Inhibition of mast cell secretion is mediated by beta2 receptors, while the effects on the mucosa are mediated by alpha receptors

Hardman, J.G., L.E. Limbird, P.B., A.G. Gilman. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New York, NY: McGraw-Hill, 2006., p. 246

The electrophysiologic effects of circulating epinephrine in humans were examined in four study groups of 10 subjects each. In 10 subjects without structural heart disease (Group 1) and in 10 patients with coronary disease or dilated cardiomyopathy (Group 2) epinephrine infusion at 25 and 50 ng/kg body weight per min for 14 min resulted in an elevation of the plasma epinephrine concentration in the physiologic range. In both groups it produced a dose-dependent decrease in the effective refractory period of the atrium, atrioventricular node and ventricle and improvement in atrioventricular node conduction. Epinephrine facilitated the induction of sustained ventricular tachycardia in 3 of the 20 subjects. In Group 3, a beta-adrenergic blocking dose of propranolol was added to the infusion of 50 ng/kg per min of epinephrine. Propranolol not only reversed the effects of epinephrine, but also lengthened these variables compared with baseline values. In group 4, propranolol was administered first, followed by 50 ng/kg per min of epinephrine. Propranolol alone slowed atrioventricular node conduction and mildly prolonged the refractory periods. In the presence of beta-blockade, epinephrine had no effect on atrioventricular node properties but resulted in a lengthening of the atrial and ventricular effective refractory periods. In conclusion, epinephrine in physioloic doses shortens the effective refractory period of the atrium, atrioventricular node and ventricle, improves atrioventricular node conduction and may facilitate the induction of sustained ventricular tachycardia. The overall electrophysiologic effects of epinephrine result from stimulation of beta-receptors. Stimulation of alpha-receptors by epinephrine has no effect on the atrioventricular node but prolongs the effective refractory period of the atrium and ventricle, partially offsetting the shortening of refractory periods mediated by beta-receptor stimulation.

PMID:2835408 Morady F et al; J Am Coll Cardiol 11 (6): 1235-44 (1988)

Epinephrine plays a key role in the control of vasomotor tone; however, the participation of the NO/cGMP pathway in response to beta-adrenoceptor activation remains controversial. To evaluate the involvement of the endothelium in the vascular response to epinephrine, we assessed NO production, endothelial NO synthase phosphorylation, and tissue accumulation of cGMP in the perfused arterial mesenteric bed of rat. Epinephrine elicited a concentration-dependent increase in NO (EC(50) of 45.7 pM), which was coupled to cGMP tissue accumulation. Both NO and cGMP production were blocked by either endothelium removal (saponin) or NO synthase inhibition (N(omega)-nitro-L-arginine). Blockade of beta(1)- and beta(2)-adrenoceptors with 1 microM propranolol or beta(3)-adrenoceptor with 10 nM SR 59230A displaced rightward the concentration-NO production curve evoked by epinephrine. Selective stimulation of beta(1)-, beta(2)-, or beta(3)-adrenoceptors also resulted in NO and cGMP production. Propranolol (1 microM) inhibited the rise in NO induced by isoproterenol or the beta(2)-adrenoceptor agonists salbutamol, terbutaline, or fenoterol. Likewise, 10 nM SR 59230A reduced the effects of the beta(3)-adrenoceptor agonists BRL 37344, CGP 12177, SR 595611A, or pindolol. The NO production induced by epinephrine and BRL 37344 was associated with the activation of the phosphatidylinositol 3-kinase/Akt pathway and phosphorylation of eNOS in serine 1177. In addition, in anaesthetized rats, bolus administration of isoproterenol, salbutamol, or BRL 37344 produced NO-dependent reductions in systolic blood pressure. These findings indicate that beta(1)-, beta(2)-, and beta(3)-adrenoceptors are coupled to the NO/cGMP pathway, highlighting the role of the endothelium in the vasomotor action elicited by epinephrine and related beta-adrenoceptor agonists.

PMID:19429833 Figueroa XF et al; Am J Physiol Heart Circ Physiol 297 (1): H134-43 (2009)

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Number of Transactions

Total Quantity (KGS)

Total Value (USD)

Quantity (KGS) & Unit rate (USD/KGS) over time

API Imports and Exports

Importing Country	Total Quantity (KGS)	Average Price (USD/KGS)	Number of Transactions

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DOSAGE - INJECTABLE;INTRAMUSCULAR, SUBCUTANEO...DOSAGE - INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - 0.15MG/DELIVERY

USFDA APPLICATION NUMBER - 19430

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USFDA APPLICATION NUMBER - 19430

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USFDA APPLICATION NUMBER - 201739

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USFDA APPLICATION NUMBER - 201739

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DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS,...DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - EQ 1MG BASE/ML (EQ 1MG BASE/ML)

USFDA APPLICATION NUMBER - 204200

DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS,...DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - EQ 30MG BASE/30ML (EQ 1MG BASE/ML)

USFDA APPLICATION NUMBER - 204640

DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS,...DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - 10MG/10ML (1MG/ML)

USFDA APPLICATION NUMBER - 205029

DOSAGE - SOLUTION;INTRAVENOUS, INTRAOCULAR, I...DOSAGE - SOLUTION;INTRAVENOUS, INTRAOCULAR, INTRAMUSCULAR, SUBCUTANEOUS - 1MG/ML (1MG/ML)

USFDA APPLICATION NUMBER - 205029

DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS,...DOSAGE - SOLUTION;INTRAMUSCULAR, INTRAVENOUS, SUBCUTANEOUS - 30MG/30ML (1MG/ML)

USFDA APPLICATION NUMBER - 205029

DOSAGE - SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS...DOSAGE - SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - 0.15MG/0.3ML (0.15MG/0.3ML)

USFDA APPLICATION NUMBER - 207534

DOSAGE - SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS...DOSAGE - SOLUTION;INTRAMUSCULAR, SUBCUTANEOUS - 0.3MG/0.3ML (0.3MG/0.3ML)

USFDA APPLICATION NUMBER - 207534

DOSAGE - INJECTABLE;INTRAMUSCULAR, SUBCUTANEO...DOSAGE - INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.15MG/DELIVERY

USFDA APPLICATION NUMBER - 20800

DOSAGE - INJECTABLE;INTRAMUSCULAR, SUBCUTANEO...DOSAGE - INJECTABLE;INTRAMUSCULAR, SUBCUTANEOUS - EQ 0.3MG/DELIVERY

USFDA APPLICATION NUMBER - 20800

DOSAGE - INJECTABLE;INJECTION - 0.005MG/ML;0....DOSAGE - INJECTABLE;INJECTION - 0.005MG/ML;0.5%