|Adrenaline is contraindicated in patients with narrow-angle glaucoma, hypersensitivity to epinephrine, shock due to non-anaphylactoid causes, during general anesthesia with halogenated hydrocarbons or cyclopropane, during labor (may delay the second stage) and in cardiac dilatation or coronary insufficiency.
Adrenaline should not be used in the presence of cardiac dilation. Adrenaline should not be used in most patients with arrhythmias and cerebral arteriosclerosis, where vasopressor drugs may be contraindicated eg. in thyrotoxicosis, in obstetrics when maternal blood pressure is in excess of 130/80 mm/Hg. Adrenaline is also contraindicated in shock (other than anaphylactic shock), in patients with organic brain damage, during general anaesthesia with halogenated hydrocarbons or cyclopropane. Adrenaline should not be injected into fingers, toes, ears, nose or genitalia.
Adrenaline can induce a feeling of fear or anxiety, tremor, excitability, vomiting, hypertension (overdosage), arrhythmias (especially if patient has organic heart disease or has received another drug that sensitizes the heart to arrhythmias), hyperuricemia, and lactic acidosis (prolonged use or overdosage). Repeated injections can cause necrosis at the injection site. Use with caution in patients with ventricular fibrillation, prefibrillatory rhythm, tachycardia, myocardial infarction, phenothiazine induced circulatory collapse and prostatic hypertrophy. Administer slowly with caution to elderly patients and to patients with hypertension, diabetes mellitus, hyperthyroidism and psychoneurosis. Use with extreme caution in patients with long-standing bronchial asthma and emphysema who have developed degenerative heart disease. Anginal pain may be induced when coronary insufficiency is present. Use with caution in patients with narrow angle glaucoma.
Adrenaline should not be administered with other sympathomimetic agents because of the danger of additive effects and increased toxicity. Halothane and other anaesthetics such as cyclopropane and trichlorethylene increase the risk of adrenaline - induced ventricular arrhythmias and acute pulmonary oedema if hypoxia is present. Adrenaline is physically incompatible with alkalis, metals, oxidising agents, sodium warfarin, hyaluronidase and many other drugs; it forms polymers with sodium bicarbonate.
Common side effects are those of increased heart rate, an increase in blood pressure, thumping of the heart, shaking, nervousness or a transient headache. Psychomotor agitation, disorientation, impaired memory and psychosis may occur. The potentially severe adverse effects of adrenaline arise from its effect upon blood pressure and cardiac rhythm. Ventricular fibrillation may occur and severe hypertension may lead to cerebral haemorrhage and pulmonary oedema. Overdosage of adrenaline can result in severe metabolic acidosis because of elevated blood concentration of lactic acid. Symptoms seen with overdosage or inadvertent IV administration of SQ or IM dosages can include: sharp rises in systolic, diastolic, and venous blood pressures, cardiac arrhythmias, pulmonary edema and dyspnea, vomiting, headache, and chest pain. Cerebral hemorrhages may result because of the increased blood pressures. Renal failure, metabolic acidosis and cold skin may also result.