Ephedrine Hydrochloride

Indications

Ephedrine Hydrochloride is used for: Bronchial asthma, Hypotension, Diabetic neuropathic oedema

Adult Dose

Oral Acute bronchospasm Adult: As ephedrine HCl: 15-60 mg tid. Max: 150 mg/day. Diabetic neuropathic oedema 30-60 mg 3 times/day. Elderly: Initial: 50% of adult dose. Parenteral Reversal of spinal or epidural anaesthesia-induced hypotension Adult: As ephedrine HCl: 3-6 mg by slow IV inj every 3-4 min as required. Max total dose: 30 mg. Elderly: Same as adult dose.

Child Dose

Oral Acute bronchospasm Child: As ephedrine HCl: 1-5 yr 15 mg tid; 6-12 yr 30 mg tid; >12 yr Same as adult dose. Parenteral Reversal of spinal or epidural anaesthesia-induced hypotension Child: 0.5 mg/kg or 16.7 mg/m2 4-6 hrly by SC or IM inj or alternatively, 0.75 mg/kg or 25 mg/m2 4 times daily by SC or IV inj.

Renal Dose

Administration

May be taken with or without food. IV Preparation Must be diluted before administration as an IV bolus to 5 mg/mL by withdrawing 50 mg (1 mL) dilute with 9 mL 0.9% NaCl or D5W

Contra Indications

Hypersensitivity. Hypertension, thyrotoxicosis, BPH. Lactation.

Precautions

Ischaemic heart disease, hyperthyroidism, diabetes mellitus, hypertension, angle-closure glaucoma, renal impairment; prostatic enlargement; pregnancy, elderly. Lactation Unknown if excreted in breast milk

Pregnancy-Lactation

Pregnancy Ephedrine crosses the placenta; used at deliver for prevention and/or treatment of maternal hypotension associated with spinal anesthesia Fetal/neonatal adverse reactions Cases of potential metabolic acidosis in newborns at delivery with maternal ephedrine exposure have been reported in the literature These reports describe umbilical artery pH of ?7.2 at the time of delivery Monitor newborn for signs and symptoms of metabolic acidosis Monitoring of infant’s acid-base status is warranted to ensure that an episode of acidosis is acute and reversible Lactation Unknown if excreted in breast milk

Interactions

Reduces antihypertensive effect of bethanidine and guanethidine. May increase clearance of dexamethasone. Increased incidence of adverse effects when used with theophylline. Potentially Fatal: Severe HTN when combined with MAOIs or withi 2 wk of discontinuance of MAOI treatment. Increased risk of arrhythmias with cardiac glycosides, quinidine or tricyclic antidepressants. Increased vasoconstriction or pressor effects with ergot alkaloids or oxytocin.

Side Effects

Side effects of Ephedrine Hydrochloride : Gastrointestinal disorders: Nausea, vomiting Cardiac disorders: Tachycardia, palpitations (thumping heart), reactive hypertension, bradycardia, ventricular ectopics, heart rhythm/rate variability Nervous system disorders: Dizziness Psychiatric disorders: Restlessness Potentially Fatal: Delusions, hallucinations. Seen with hypersensitivity and overdosage. Acute CNS and CVS stimulation presenting as vomiting, fever, hypertension, psychosis. Cardiac arrhythmias.

Mode of Action

Ephedrine has both alpha- and beta-adrenergic acitivity with pronounced stimulating effects on the CNS. It increases cardiac output, induces peripheral vasoconstriction, bronchodilation, reduces intestinal tone and motility, and relaxes the bladder while contracting the sphincter muscle. It also has stimulant action on the resp center and dilates the pupil witho affecting light reflexes.