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Nordrine (Ephedrine)
Therapeutic Group: Anesthetic / Critical Care » Regional Anesthetic
Presentation
Nordrine

Nordrine Inj: Each ampoule contains 25 mg Ephedrine Hydrochloride BP in 5 ml solution.

Descriptions
Ephedrine is a sympathomimetic which stimulates both alpha and beta adrenergic receptors, and also releases noradrenaline from storage site. The main effects of therapeutic doses of Ephedrine are relaxation of bronchial smooth muscle, cardiac stimulation and increased systolic and usually diastolic blood pressure via an increase in cardiac output and peripheral vasoconstriction. Ephedrine also decreases intestinal tone and motility, relaxes the bladder wall, contracts the sphincter muscle, relaxes the detrusor muscle, and decreases uterine activity. Ephedrine also has central nervous system stimulant effects. Tachyphylaxis to the effects of Ephedrine may also occur after use for a short while possibly due to the depletion of noradrenaline stores.

Ephedrine is rapidly absorbed after intramuscular or subcutaneous administration. The onset of action after intramuscular administration is 10-20 minutes and the duration of pressor and cardiac responses to Ephedrine is 1 hour after intravenous administration of 10-25 mg or intramuscular or subcutaneous administration of 25-50 mg. Small quantities of Ephedrine are metabolised in the liver, but the majority of Ephedrine is excreted unchanged in the urine. The plasma half life of Ephedrine is 3-6 hours. Elimination of Ephedrine is increased (and hence the half life is decreased) with decreasing pH of the urine. Ephedrine is presumed to cross the placenta, and to be excreted into breast milk.
Indications
Ephedrine is indicated in the treatment of shock unresponsive to fluid replacement. It is also indicated in the treatment of hypotension secondary to spinal anaesthesia. Ephedrine Hydrochloride Injection has also been used in the treatment of bronchial asthma and reversible bronchospasm although more selective agents (beta-adrenergic agonists) are now available.
Dosage & Administration
As a pressor:
Adult dose: The usual adult dose is 25-50 mg (range 10-50 mg) administered intramuscularly or subcutaneously. Additional doses should be based on patient response. The intravenous route may be used if an immediate response is required. The dosage for the intravenous route is 10-25 mg which may be repeated every 5-10 minute until the desired response is obtained.
Paediatric dose: The recommended paediatric dose is 3 mg/kg/day or 100 mg/m2/day via the intravenous or subcutaneous route, given in 4-6 divided doses.
During therapy with a pressor agent, blood pressure should be elevated to slightly less than the patient's normal blood pressure. In previously normotensive patients, systolic blood pressure should be maintained at 80-100 mmHg. In previously hypertensive patients, systolic blood pressure should be maintained at 30-40 mmHg below their usual blood pressure. In some patients with very severe hypotension, maintenance of even lower blood pressure may be desirable if blood or fluid volume replacement has not been completed.
Bronchospasm:
Adult dose: The usual adult dose is 12.5-25 mg, given intramuscularly, subcutaneously or intravenously. Further dosage should be determined by patient's response.
Paediatric dose: The usual paediatric dose is 3 mg/kg or 100 mg/m2 intravenously or subcutaneously given in 4-6 divided doses.
Side Effects
pallor, fever, headache, dryness of nose, mouth and throat, angina, palpitations, bradycardia, tachycardia, hypertension, hypotension, extrasystole and pericardial pain. Arrhythmias, including ventricular fibrillation, may occur, especially in patients with organic heart disease or those receiving other drugs that sensitise the heart to arrhythmias, nausea, vomiting, mild epigastric distress, nervousness, anxiety, restlessness, insomnia, mood or mental changes, fear, irritability, trembling, shortness of breath, respiratory difficulty, dyspnoea, difficult or painful urination, sweating.
Precautions
Ephedrine Hydrochloride should be used with caution, if at all, in patients with hypertension or hyperthyroidism, since there is an increased risk of adverse effects in these patients.

Ephedrine Hydrochloride should also be used with caution in geriatric males, especially those with prostatic hypertrophy, since Ephedrine may cause acute urinary retention.
Ephedrine Hydrochloride should also be used with caution in diabetic patients since drug induced hyperglycaemia may result in loss of diabetic control.
Ephedrine Hydrochloride should also be used with caution in patients with cardiovascular disease including angina, cardiac arrhythmia and coronary insufficiency, since the cardiovascular effects of Ephedrine may exacerbate these conditions. Ephedrine may intensify the ischaemia in myocardial infarction by increasing myocardial oxygen demands.
Contraindications
Ephedrine Hydrochloride Injection is contraindicated in closed angle glaucoma.
Ephedrine Hydrochloride is contraindicated in patients with pheochromocytoma.
Ephedrine Hydrochloride is contraindicated in patients with asymmetric septal hypertrophy (idiopathic hypertrophic subaortic stenosis).
Ephedrine Hydrochloride is contraindicated in patients undergoing therapy with monoamine oxidase inhibitors (MAO inhibitors), or within 14 days of ceasing such therapy.
Ephedrine Hydrochloride is contraindicated in patients undergoing general anaesthesia with cyclopropane or halothane or other halogenated hydrocarbons.
Ephedrine Hydrochloride is contraindicated in patients with tachyarrhythmias or ventricular fibrillation.
Ephedrine Hydrochloride is also contraindicated in patients with hypersensitivity to Ephedrine and in patients with psychoneurosis.
Use in Pregnancy & Lactation
Pregnancy: Ephedrine Hydrochloride Injection may accelerate the fetal heart rate when used to control maternal hypotension during spinal anaesthesia for delivery. Ephedrine Hydrochloride Injection should not be used if the maternal blood pressure is greater than 130/80 Hg.
Lactation: Ephedrine Hydrochloride is distributed into breast milk, and therefore Ephedrine Hydrochloride Injection is not recommended for use during lactation because of the risk of adverse effects in the infant.
Overdose
Symptoms associated with overdosage of Ephedrine include headache, severe nausea or vomiting, chills or fever, dizziness or lightheadedness, anxiety, nervousness, restlessness, mood changes, convulsions, severe weakness, blurred vision or enlarged pupils, ongoing fast heartbeat, severe or ongoing chest pain, severe hypertension or hypotension, and severe breathing difficulties.
Paranoid psychosis, delusions and hallucinations may also follow Ephedrine overdosage.
Treatment of overdose involves the following measures:
reduce dosage or discontinue administration of Ephedrine
general supportive therapy, including monitoring and maintaining vital signs, blood gases, electrolytes and ECG.
The following additional measures may need to be considered:
b-blockers (eg. propranolol) to control tachycardia and arrhythmia
phentolamine or nitropruside to reduce severe hypertension
diazepam to control convulsions. General anaesthesia and neuromuscular blocking agents may need to be considered to
treat refractory seizures
dexamethasone to treat pyrexia
Commercial Packaging
Nordrine Inj: Each box contains 10 ampoules of 5 ml solution.
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