ephedrine hydrochloride: clinical use

Prescribing considerations

• Reconcile sympathomimetic, decongestant, stimulant and antidepressant exposure before prescribing or administration.
• Use particular caution with cardiovascular disease, arrhythmia, hyperthyroidism, diabetes, angle-closure glaucoma, renal impairment or prostatic enlargement.
• Older people may be more sensitive to cardiovascular effects.
• Ephedrine may produce a positive anti-doping test.

Contraindications and cautions

• Hypersensitivity to ephedrine or a formulation excipient.
• Selected tablets: ischaemic heart disease, hypertension, thyrotoxicosis and prostatic hypertrophy.
• Selected injections: concomitant indirect or alpha sympathomimetics, and non-selective MAO inhibitors or use within 14 days of withdrawal.
• Selected tablets contain lactose and are unsuitable for specified rare hereditary disorders of lactose or galactose handling.

Monitoring

• Monitor blood pressure, heart rate, rhythm and clinical response during intravenous use.
• Consider ECG monitoring when arrhythmia risk is increased.
• Monitor potassium and blood glucose when clinical circumstances or interacting medicines increase risk.
• Observe for CNS stimulation, myocardial ischaemia, urinary retention and angle-closure glaucoma.

Clinical pharmacology

A mixed-acting sympathomimetic with direct alpha- and beta-receptor activity and indirect noradrenaline release. It produces peripheral vasoconstriction, cardiac stimulation and bronchodilation; renal elimination is substantial and influenced by urinary pH.

Formulation and product differences

• The selected tablets are oral bronchodilator formulations and contain lactose.
• The selected injections are clear intravenous solutions for anaesthesia-associated hypotension.
• The concentrated injection requires dilution; the lower-concentration ampoule is supplied ready at its stated concentration.
• The lower-concentration ampoule contains sodium, which may matter where sodium intake is controlled.

Tablet

Route: Oral

Strengths: 15 mg, 30 mg

Injection

Route: Parenteral

Strengths: 3 mg/mL, 30 mg/1 mL, 30 mg/mL