adrenaline: clinical use

Prescribing considerations

• Confirm that the product and route suit the patient, including the nasal spray’s licensed weight threshold.
• Train the patient and likely responders to recognise anaphylaxis and operate the specific device; reassess technique when the product changes.
• Ensure access to two in-date devices and reinforce immediate emergency-service contact after use.
• Consider asthma, cardiovascular disease, hypertension, diabetes, hyperthyroidism, severe renal impairment, Parkinson’s disease and medicines that affect cardiac rhythm.
• For children under 12 using the nasal product, assess whether administration should be undertaken by a caregiver.

Contraindications and cautions

• The selected SmPCs list no absolute contraindication during an allergic emergency.
• Use additional caution in coronary disease, arrhythmia syndromes including congenital long-QT syndrome or catecholaminergic polymorphic ventricular tachycardia, hypertension and older people.
• EURneffy efficacy and safety have not been established below its licensed weight threshold.
• Both selected products contain metabisulphite; this should not deter emergency treatment of anaphylaxis.

Monitoring

• After administration, assess airway, breathing, circulation, consciousness, blood pressure, heart rate and rhythm.
• Observe for inadequate response or recurrence after initial resolution, including biphasic anaphylaxis.
• Assess accidental peripheral injection promptly for impaired blood flow and inspect injection injuries for tissue damage or infection.
• In diabetes, consider blood-glucose monitoring after stabilisation.

Clinical pharmacology

Adrenaline is a non-selective alpha- and beta-adrenergic agonist. It reduces vasodilation and vascular permeability, relaxes bronchial smooth muscle and stimulates the cardiovascular system. It is rapidly metabolised, mainly by COMT and MAO, with metabolites excreted in urine.

Formulation and product differences

• EpiPen is a prefilled, disposable intramuscular auto-injector for the outer thigh and may be administered through clothing.
• EURneffy is a ready-to-use, non-pressurised nasal spray that empties on activation and must not be primed.
• EURneffy may be used with a congested nose, although congestion can alter its pharmacokinetic profile.
• EpiPen requires protection from light and temperature extremes; EURneffy has no special routine storage conditions but will not function while frozen.

Nasal preparation

Route: Nasal

Strengths: 2 mg