Epinephrine Risks, Warnings, and Complications

FOR INJECTION INTO THE THIGH ONLY: You should only use the auto-injectors containing epinephrine in the anterolateral thigh (middle or side of the thigh). Do not inject this medicine into the buttock. It may not work effectively to treat anaphylactic reactions if you do so. Injecting this medicine into the hands or feet may cause narrowing of the blood vessels and reduced blood flow to the area, requiring treatment. Go to the nearest emergency room immediately for further treatment if you accidentally inject epinephrine into any part of the body other than the thigh.

Also, epinephrine should not be injected intravenously (into a vein). Large doses or accidental intravenous injection can result in dangerously high blood pressure and cerebral hemorrhage (bleeding in the brain). In case of accidental intravenous injection, seek emergency care. 

Note that you may be administered epinephrine intravenously in a healthcare setting by trained healthcare providers for anaphylactic reactions or cardiac arrest. Nebulized epinephrine may be used to treat asthma exacerbations, bronchospasm (narrowing of the airways), stridor, croup, and laryngeal or pharyngeal edema (swelling).

SULFITE ALLERGY: Epinephrine formulations contain sodium metabisulfite, which can cause allergic-type reactions, including asthmatic episodes and life-threatening anaphylaxis in certain people. Nonetheless, epinephrine is still the preferred treatment for serious hypersensitivity reactions in emergency situations because the alternatives are not satisfactory. If you have a sulfite allergy, do not avoid using epinephrine to treat serious allergic reactions in emergency situations.

RISK IN PEOPLE WITH HEART PROBLEMS: Epinephrine should be used with caution in people with heart disease, including cardiac arrhythmias (heart rhythm abnormalities), coronary artery disease, and hypertension (high blood pressure). It should also be used with caution in people who are taking medications that can increase the risk of heart arrhythmias, for example, digitalis, diuretics (water pills), and antiarrhythmic agents. In such individuals, epinephrine may cause or worsen angina pectoris (chest pain) or cause ventricular arrhythmias. However, the presence of these conditions is not a contraindication to the use of epinephrine in life-threatening situations.

STORAGE: Epinephrine should be stored away from light in the provided carrier tube at 25°C (77°F) (it can be stored at temperature ranges of 15°C-30°C (59°F-86°F). Do not refrigerate the epinephrine auto-injector devices. Before using the device, make sure the solution in the auto-injector is clear of particles and is not discolored. Obtain a replacement if the solution is discolored or contains particles.