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Epinephrine tartrate 0.18% / 1 ml 10s solution for injection in ampoules




The instruction for medical use


the Trade name
of Adrenalin-Zdorovye

the International unlicensed

name Epinephrine Dosage Form Solution for injections of 0.18%, 1 ml

of 1 ml of solution contains
active agent – adrenaline of hydrotartrate of 1.82 mg
excipients: sodium metabisulphite (E 223), sodium chloride, water for injections

the Description
Transparent colourless solution

Pharmacotherapeutic group
Drugs for treatment of heart diseases. Cardiotonic means of neglikozidny origin. Adreno- and a dopamine – stimulators. Epinephrine.
ATX C01CA24 code.

The pharmacological

Pharmacokinetics Later properties of intramuscular or hypodermic introduction epinephrine is quickly soaked up, the maximum concentration in blood is reached in 3-10 minutes.
The therapeutic effect develops almost instantly at intravenous administration (action duration − 1-2 minutes), in 5-10 minutes after hypodermic introduction (the maximum effect − in 20 minutes), at intramuscular introduction time of the beginning of effect is variable.
Gets through a placental barrier, into breast milk, does not get through a blood-brain barrier.
Also catechol-au-methyltransferase (in metanefrin) in cells of a liver, kidneys, a mucous membrane of intestines, axons is metabolized by monoamine oxidase (in vanililmindalny acid).
Elimination half-life at intravenous administration makes 1-2 minutes. Excretion of metabolites is carried out by kidneys. It is allocated with breast milk.
A pharmacodynamics
of Adrenalin-Zdorovye the − cardiostimulating, vasoconstrictive, hypertensive, anti-hypoglycemic means. Stimulates α- and β-adrenoceptors of various localization. Shows the significant action on unstriated muscles of internals, cardiovascular and respiratory systems, activates carbohydrate and lipidic metabolism.
The mechanism of action is caused by activation of adenylatecyclase of an internal surface of cellular membranes, increase in intracellular concentration of tsAMF and Ca2+. The first phase of action is caused, first of all, stimulation of β-adrenoceptors of various bodies and is shown by tachycardia, increase in warm emission, excitability and conductivity of a myocardium, arteriolo- and a bronkhodilatation, decrease in a tone of a uterus, mobilization of a glycogen from a liver and fatty acids from fat depos. In the second phase there is an excitement of α-adrenoceptors that leads to vasoconstriction of abdominal organs, skins, mucous membranes (skeletal muscles − to a lesser extent), to increase in arterial blood pressure (mainly − systolic), the general peripheric resistance of vessels.
The efficiency of drug depends on a dose. In very low doses, at rate of administering less than 0.01 mkg/kg/min., can reduce arterial blood pressure owing to vasodilatation of skeletal muscles. At the rate of administering of 0.04-0.1 mkg/kg/min. increases the frequency and force of warm reductions, stroke output of blood and minute volume of blood, reduces the general peripheric resistance of vessels, higher than 0.2 mkg/kg/min. − narrow vessels, increases arterial blood pressure (mainly − systolic) and the general peripheric resistance of vessels. The pressor effect can cause short-term reflex delay of heart rate. Relaxes unstriated muscles of bronchial tubes. Doses higher than 0.3 mkg/kg/min. reduce a renal blood stream, blood supply of internals, a tone and motility of digestive tract.
Increases conductivity, excitability and automatism of a myocardium. Increases the need of a myocardium for oxygen. Inhibits the release of a histamine and leukotrienes induced by antigens, eliminates a spasm of bronchioles, prevents edematization of their mucous membrane. Affecting α-adrenoceptors of skin, mucous membranes and internals, causes vasoconstriction, reduction in the rate of absorption of mestnoanesteziruyushchy means, increases duration of action and lowers toxic influence of local anesthesia. Stimulation β2-адренорецепторов is followed by strengthening of removal of potassium from a cell and can lead to a hypopotassemia. At intrakavernozny introduction reduces a krovenapolneniye of cavernous bodies.
Expands pupils, promotes decrease in products of intraocular liquid and intraocular pressure. Causes a hyperglycemia (strengthens a glycogenolysis and a gluconeogenesis) and increases the content in blood plasma of free fatty acids, improves fabric exchange. Poorly stimulates the central nervous system, shows antiallergic and anti-inflammatory action.

– allergic reactions of immediate type: the acute anaphylaxis which developed at use of medicines, serums, blood transfusion, stings of insects or contact with allergens
– stopping of bad attacks of bronchial asthma
– arterial hypotension of various genesis (posthemorrhagic, intoxication, infectious)
– a hypopotassemia, including owing to insulin overdose
– an asystolia, cardiac arrest
– extension of effect of local anesthetics
– AV the blockade of the III degree which sharply developed

the Route of administration and doses
Appoint intramusculary, subcutaneously, intravenously (by drop infusion), vnutriserdechno (performing resuscitation in cardiac arrest). At intramuscular introduction the effect of drug develops quicker, than at hypodermic. Dosing mode individual.
Acute anaphylaxis: enter intravenously slowly 0.5 ml divorced in 20 ml of 40% of solution of glucose. Further, if necessary, continue intravenous drop administration with a speed of 1 mkg/min. for what 1 ml of solution of adrenaline dissolve in 400 ml of isotonic sodium of chloride or 5% of glucose. If the condition of the patient allows, it is better to carry out intramuscular or hypodermic introduction of 0.3-0.5 ml in a divorced or not divorced look.
Bronchial asthma: enter subcutaneously 0.3-0.5 ml in a divorced or not divorced look. In need of repeated introduction it is possible to enter this dose every 20 minutes (to 3 times). Perhaps intravenous administration of 0.3-0.5 ml in a divorced look.
As vasoconstrictor is entered intravenously by drop infusion with a speed of 1 mkg/min. (with possible increase up to 2-10 mkg/min.).
Asystolia: enter vnutriserdechno 0.5 ml divorced in 10 ml of 0.9% of solution of sodium of chloride. During resuscitation measures − on 1 ml (in a divorced look) intravenously slowly each 3-5 minutes.
An asystolia at newborns: enter intravenously 0.01 ml/kg of body weight each 3-5 minutes, slowly.
Acute anaphylaxis: enter subcutaneously or intramusculary to children aged till 1 year – 0.05 ml, at the age of 1 year – 0.1 ml, 2 years – 0.2 ml, 3-4 years – 0.3 ml, 5 years – 0.4 ml, 6-12 years – 0.5 ml. In need of introduction repeat every 15 minutes (up to 3 times).
Bronchospasm: enter subcutaneously 0.01 ml/kg of body weight (as much as possible − to 0.3 ml). In need of introduction repeat each 15 minutes (up to 3-4 times) or each 4 hours.

Side effects
– a headache
– a disturbing state
– a tremor
– nausea, vomiting
– anorexia
– a hyperglycemia
– stenocardia, bradycardia or tachycardia, heart consciousness, decrease or increase in arterial blood pressure (even at hypodermic introduction in usual doses owing to increase in arterial blood pressure perhaps subarachnoidal hemorrhage and a hemiplegia)
– an asthma
– nervousness, dizziness, fatigue, a sleep disorder
– muscular twitchings
– psychoneurotic disorders (psychomotor excitement, a disorientation)
– memory disturbance
– agressive or panic behavior
– shizofrenopodobny disorders, paranoia
– increase in rigidity and a tremor (at patients with Parkinson’s disease)
– a Quincke’s disease, a bronchospasm
– skin rash, a multiformny erythema
– the increased sweating, thermal control disturbance, a cold snap of extremities
Is rare:
– ventricular arrhythmias, thorax pain
– changes of the ECG (including decrease in amplitude of a tooth of T)
– complicated and urodynia (in a prostate hyperplasia)
– a hypopotassemia
– a fluid lungs
– pain or burning in the place of an intramuscular injection, at repeated injections of adrenaline can be noted necrosis owing to vasoconstrictive effect of adrenaline

of the Contraindication
– the increased individual sensitivity to drug components
– a hypertrophic subaortic stenosis
– a heavy aortal stenosis
– a tachyarrhythmia, fibrillation of ventricles
– arterial or pulmonary hypertension
– an ischemic disease of lungs
– the profound atherosclerosis
– occlusal diseases of vessels
– a pheochromocytoma
– closed-angle glaucoma
– shock not of allergenic genesis
– a convulsive syndrome
– a thyrotoxicosis
– diabetes
– the general anesthesia using inhalation means: Ftorotanum, cyclopropane, chloroform
– the period of pregnancy and a lactation, ІІ the period of childbirth
– use on sites of fingers of hands and legs, on sites of a nose, genitals

the Medicinal interactions
by Antagonists of epinephrine are blockers α- and β – adrenoceptors.
At simultaneous use of the drug Adrenalin-Zdorovye with other medicines perhaps:
− with narcotic analgetics and somnolent medicines − easing of their effects,
− with cardiac glycosides, quinidine, tricyclic antidepressants, a dopamine, means for an inhalation anesthesia (chloroform, enfluran, a halothane, izofluran, metoksifluran), cocaine − increase in risk of developing arrhythmias, − with other sympathomimetic means − strengthening of severity of side effects from a cardiovascular system,
− with antihypertensive drugs (including with diuretics) − decrease in their efficiency,
− with monoamine oxidase inhibitors (including furasolidone, Procarbazinum, selegilin) − the sudden and significant increase in arterial blood pressure, hyperpyrexial crisis, a headache, heart arrhythmias, vomiting,
− with nitrates − weakening of their therapeutic action,
− with phenoxybenzamine − strengthening of hypotensive effect and tachycardia,
− with Phenytoinum − the sudden lowering of arterial pressure and bradycardia depending on a dose and the rate of administering of adrenaline,
− with drugs of hormones of a thyroid gland − mutual strengthening of action,
− with astemizoly, tsizapridy, terfenadiny – lengthening of a QT interval on the ECG,
− from diatrizoatama, yotalamovy or yoksaglovy acids − strengthening of neurologic effects,
− with ergot alkaloids − strengthening of vasopressor effect up to the profound ischemia and a gangrenosis,
− with hypoglycemic medicines (including insulin) − decrease in hypoglycemic effect,
– with nedepolyaziruyushchy muscle relaxants – is possible decrease in myorelaxation effect,
– with hormonal contraceptives – can reduce efficiency.

Special instructions
of Vnutriserdechno it is entered in an asystolia if other ways of its elimination are inaccessible, at the same time there is an increased risk of development of a cardiac tamponade and pheumothorax.
In need of performing infusion it is necessary to use the device with measuring adaptation for the purpose of regulation of speed of infusion. Infusion should be carried out to large, it is better in the central vein. When performing infusion carrying out monitoring of potassium concentration in blood serum, arterial blood pressure, a diuresis, the ECG, the central venous pressure, pulmonary pressure is recommended.
Drug use by sick diabetes increases a glycemia in this connection higher doses of insulin or derivatives of sulphonylurea are required.
It is undesirable to apply adrenaline it is long as narrowing of peripheral vessels can lead to development of necrosis or gangrene.
At the treatment termination the dose of adrenaline should be reduced gradually as sudden cancellation of therapy can lead to heavy hypotension.
With care appoint to patients with ventricular arrhythmia, coronary heart disease, fibrillation of auricles, arterial hypertension, pulmonary hypertensia, in a myocardial infarction (in case of need of use of drug in a myocardial infarction it is necessary to remember that adrenaline can strengthen ischemia due to increase in need of a myocardium for oxygen), a metabolic acidosis, a hypercapnia, a hypoxia, a hypovolemia, a thyrotoxicosis, at patients with occlusal diseases of vessels (an arterial embolism, atherosclerosis, a Thrombangiitis obliterans, a cold injury, a diabetic endarteritis, a Raynaud’s disease, with cerebral atherosclerosis, Parkinson’s disease, with a convulsive syndrome, with a prostatauxe.
At a hypovolemia before use of sympathomimetics it is necessary to carry out the corresponding hydration of patients.
Use in pediatrics.
It is necessary to observe extra care at administration of drug to children (dosing different). Recommendations of drug dosing to children are provided in the section “Route of Administration and Doses”.
Use during pregnancy and a lactation
is not applied during childbirth to correction of hypotension as drug can detain the second period of childbirth due to relaxation of muscles of a uterus. At introduction in high doses for weakening of reduction of a uterus can cause a long atony of a uterus with bleeding.
In need of use of drug it is necessary to stop feeding by a breast as there is a high probability of development of side effects in the child.
Features of influence of medicine on ability to run vehicles and to work with difficult mechanisms.
During drug treatment the control of motor transport and occupation is not recommended by other potentially dangerous types of activity demanding the increased concentration of attention and speed of psychomotor reactions.

Symptoms: excessive increase in arterial blood pressure, a mydriasis, the tachyarrhythmia which is replaced by bradycardia, disturbance of a warm rhythm (including fibrillation of auricles and ventricles), a cold snap and pallor of integuments, vomiting, fear, concern, a tremor, a headache, a metabolic acidosis, a myocardial infarction, craniocereberal hemorrhage (especially at patients of advanced age), a fluid lungs, a renal failure.
Treatment: termination of administration of drug. Symptomatic therapy, use α- and β-adrenoblockers, high-speed nitrates. In arrhythmia appoint parenteral administration of β-adrenoblockers (propranolol).

The form of release and packing
On 1 ml of drug spill in ampoules from glass.
Apply with paint the marking text on an ampoule or paste the label.
On 5 or 10 ampoules together with the instruction for medical use in the state and Russian languages and a disk to the cutting ceramic place in a cardboard box with partitions.
On 5 ampoules place in blister strip packaging from a film of polyvinylchloride and aluminum foil.
One or two blister strip packagings on 5 ampoules together with the instruction for medical use in the state and Russian languages and a disk to the cutting ceramic are placed in a cardboard box.
It is allowed when packing drug in ampoules with a ring of a break or with a point and a notch not to put the disk cutting ceramic.

To Store storage conditions in the place protected from light, at a temperature from 8 of 0C up to 15 0C.
To store out of children’s reach!

A period of storage
2 years
not to use drug after the expiration date specified on packing!

Prescription status
According to the prescription

LLC Pharmaceutical Company Zdorovye Producer, Ukraine

the Owner of the registration certificate
of LLC Pharmaceutical Company Zdorovye, Ukraine

the Address of the organization accepting in the territory of the Republic of Kazakhstan claims from consumers on quality of products (goods) the Address: LLC Pharmaceutical Company Zdorovye. Ukraine, 61013, Kharkiv, Shevchenko St., 22. Phone number: (057) 714-96-22Факс: (057) 714-96-22Эл. address:
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