EPINEPHrine (EENT)

Class: Mydriatics
ATC Class: S01EA01
VA Class: OP105
CAS Number: 51-42-3
Brands: Adrenalin Chloride, Epifrin

Introduction

An endogenous catecholamine that is a mydriatic and vasoconstrictor.

Uses for EPINEPHrine (EENT)

Open-Angle Glaucoma

Reduction of elevated IOP in patients with open-angle glaucoma. Generally used adjunctively with topical miotics, topical β-adrenergic blocking agents, osmotic agents, and/or systemically administered carbonic anhydrase inhibitors; may have an additive effect on IOP lowering. Epinephrine in conjunction with miotics may reduce miosis and ciliary spasm that often occur when miotics are used alone.

Patient response to epinephrine is highly variable; some patients are unresponsive. Repeated tonometric readings are advisable during the course of treatment, especially in geriatric patients.

Diagnosis of open-angle glaucoma by careful gonioscopic and slit lamp studies; use in patients with angle-closure glaucoma or those who may be predisposed to angle closure is contraindicated.

Mydriasis for Surgery

Although less effective than other mydriatics in normal eyes, epinephrine produces effective mydriasis when the permeability of the eye is increased by trauma (e.g., during surgery).

Induction of rapid mydriasis during surgery (e.g., cataract extraction) via topical application to the conjunctiva or injection into the anterior chamber of the eye.

Mydriasis for Synechiae

Prolonged topical contact (e.g., via a saturated cotton wick) with the eye to induce sufficient mydriasis to break posterior synechiae†.

Administered subconjunctivally concomitantly with atropine and cocaine to produce mydriasis and thereby break posterior synechiae† unresponsive to topical therapy.

Mydriasis for Ophthalmoscopy

Although generally contraindicated in patients with angle-closure glaucoma, epinephrine may be used to produce mydriasis for ophthalmoscopy† in patients predisposed to angle closure. Give a carbonic anhydrase inhibitor and an osmotic agent (e.g., glycerin) orally prior to the examination. However, even these measures may not prevent attacks of acute angle-closure glaucoma unresponsive to treatment; surgery may be required.

Superficial Bleeding

Used locally as a hemostatic agent to control superficial bleeding from arterioles and capillaries in the skin and mucous membranes of the eye, nose, mouth, throat or larynx, mainly during surgery. Ineffective for bleeding from larger vessels.

Especially useful to prevent oozing from small vessels that obscures surgical details during ophthalmic surgery.

Especially useful as a hemostatic agent in dental surgery.

Adjunct to Local Anesthesia

Added to solutions of some local anesthetics to decrease the rate of their vascular absorption (to localize and prolong the duration of anesthesia). Risk of systemic toxicity caused by the local anesthetic also is decreased, and bleeding in the operative field may be reduced.

Adjunct to Other Local Drugs

Enhancement of intraocular penetration of subconjunctivally injected drugs†. Local vasoconstriction enhances local effect secondary to decreased drug loss from the subconjunctival depot into systemic circulation, with resultant increased intraocular penetration.

Vasoconstric...