Epinephrine for Anaphylaxis

Here is a quick summary on the use of epinephrine and anaphylaxis. This review may help prevent errors that sometimes occur.

The Route
For anaphylaxis, epinephrine should be administered intramuscularly (IM) for anaphylaxis. The intravenous (IV) route of administration is for patients not responding to the IM doses and those with severe physiologic compromise.


The Dose
Ratios were used in the past for strengths of epinephrine (1:1000, 1:10,000) and many of us still remember these concentrations. However, the products are now labeled as:
1 mg/mL for the 1:1000 epinephrine, and
0.1 mg/mL for the 1:10,000 epinephrine (this is the CPR IV injection strength).

The adult dose is 0.2 to 0.5 mg IM
The pediatric patient’s dose should always be calculated according to the patient’s weight. (0.01 mg/kg up to a maximum of 0.5 mg IM)


Wrong Dose and Wrong Route
Wrong-dose and wrong-route errors occur when adults with anaphylaxis are treated with the cardiac resuscitation dose (1 mg IV) rather than the recommended anaphylaxis dose (0.2 to 0.5 mg IM)


EpiPen Jr (epinephrine injection, USP) 0.15 mg.
EpiPen (epinephrine injection, USP) 0.3 mg.

EpiPen Jr contain an epinephrine dose (0.15 mg) appropriate for a child weighing between 15 to 30 kg.
The ‘adult’ device, EpiPen, contains an epinephrine dose (0.3 mg) for children and adults weighing 30 kg or more.

Current guidelines for pediatric use of epinephrine suggest that giving a dose that is slightly above the ideal dose appears to be a better option than giving a dose that is below the recommended dose. Physicians may opt to prescribe the ‘adult’ device for children who weigh close to 30 kg.

Two (2) devices at a time should be prescribed because up to 30% of anaphylaxis reactions require the administration of more than 1 dose of epinephrine.



Dr. Ricks is a native Texan, born in Liberty Texas. He graduated from University of Texas Southwestern Medical School and has been a medical doctor for 42 years. Specializing in Internal Medicine, Emergency Medicine, and Hospital Care (Hospitalist). He has produced numerous medical educational videos for aspiring school students and the general public. Dr. Ricks is currently sharing his experience as a physician with other healthcare professionals to improve their relationship with patients, patient satisfaction, and patient retention.

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