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Amdipharm Mercury Company Limited
Adrenaline Injection BP 1/1000 (1mg/1ml)
SPC Table of Contents
1. Name of the medicinal product
2. Qualitative and quantitative composition
3. Pharmaceutical form
4. Clinical particulars
4.1 Therapeutic indications
4.2 Posology and method of administration
4.3 Contraindications
4.4 Special warnings and precautions for use
4.5 Interaction with other medicinal products and other forms of interaction
4.6 Pregnancy and lactation
4.7 Effects on ability to drive and use machines
4.8 Undesirable effects
4.9 Overdose
5. Pharmacological properties
5.1 Pharmacodynamic properties
5.2 Pharmacokinetic properties
5.3 Preclinical safety data
6. Pharmaceutical particulars
6.1 List of excipients
6.2 Incompatibilities
6.3 Shelf life
6.4 Special precautions for storage
6.5 Nature and contents of container
6.6 Special precautions for disposal and other handling
7. Marketing authorisation holder
8. Marketing authorisation number(s)
9. Date of first authorisation/renewal of the authorisation
10. Date of revision of the text
Company information
More information about this medicine
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1. Name of the medicinal product
Adrenaline Injection BP 1/1000 (1mg/1ml)
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2. Qualitative and quantitative composition
Each 1ml of solution contains adrenaline acid tartrate BP equivalent to 1mg of adrenaline
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3. Pharmaceutical form
Clear, colourless, sterile, aqueous solution, intended for parenteral administration to human beings.
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4. Clinical particulars
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4.1 Therapeutic indications
Adrenaline is a direct-acting sympathomimetic agent.
Adrenaline may be used to provide rapid relief of severe hypersensitivity reaction to drugs and other allergens, and in the emergency treatment of anaphylactic shock.
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4.2 Posology and method of administration
Adrenaline Injection BP. 1/1000 (1mg/ml) may be administered undiluted by S.C. or IM injection. In the shocked patient, the intramuscular route is recommended as absorption from the intramuscular site is more rapid and reliable than from the subcutaneous site.
Severe hypersensitivity reactions, anaphylactic shock
IM Injection:
Adults: The usual dose is 500 micrograms (0.5ml of adrenaline 1/1000). If necessary, this dose may be repeated several times at 5-minute intervals according to blood pressure, pulse and respiratory function.
Half doses of adrenaline may be safer for patients who are taking amitriptyline, imipramine or a beta blocker.
Children: The following doses of adrenaline 1/1,000 are recommended:
Age
Dose
Over 12 years
500 micrograms (0.5ml)
250 micrograms (0.25ml) if child is small or prepubertal
6 - 12 years
250 micrograms (0.25ml)
6 months - 6 years
120 micrograms (0.12ml)
Under 6 months
50 micrograms (0.05ml)
If necessary, these doses may be repeated several times at 5-minute intervals according to blood pressure, pulse and respiratory function.
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4.3 Contraindications
1) Use during labour
2) Use with local anaesthesia of peripheral structures including digits, ear lobe.
3) Use in the presence of ventricular fibrillation, cardiac dilatation, coronary insufficiency, organic brain disease or atherosclerosis, except in emergencies where the potential benefit clearly outweighs the risk.
4) Use if solution is discoloured.
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4.4 Special warnings and precautions for use
Adrenaline should be used with caution in patients with hyperthyroidism, diabetes mellitus, phaeochromocytoma, narrow angle glaucoma, hypokalaemia, hypercalcaemia, severe renal impairment, prostatic adenoma leading to residual urine, cerebrovascular disease, organic brain damage or arteriosclerosis, in elderly patients, in patients with shock (other than anaphylactic shock) and in organic heart disease or cardiac dilatation (severe angina pectoris, obstructive cardiomyopathy, hypertension) as well as most patients with arrhythmias. Anginal pain may be induced when coronary insufficiency is present.
Repeat administration may produce local necrosis at the sites of injection.
Prolonged administration may produce metabolic acidosis, renal necrosis and adrenaline fastness or tachyphylaxis.
Adrenaline should be avoided or used with extreme caution in patients undergoing anaesthesia with halothane or other halogenated anaesthetics, in view of the risk of inducing ventricular fibrillation.
Do not mix with other agents unless compatibility is known.
Adrenaline should not be used during the second stage of labour (See Section 4.6).
Accidental intravascular injection may result in cerebral haemorrhage due to the sudden rise in blood pressure.
Adrenaline 1 in 1000 should not be diluted to 1 in 10,000 for use in cardiac resuscitation - when the 1 in 10,000 strength of adrenaline is required for this indication a “ready to use” preparation should be selected.
Monitor the patient as soon as possible (pulse, blood pressure, ECG, pulse oximetry) in order to assess the response to adrenaline.
The best site for IM injection is the anterolateral aspect of the middle third of the thigh. The needle used for injection needs to be sufficiently long to ensure that the adrenaline is injected into muscle. Intramuscular injections of Adrenaline into the buttocks should be avoided because of the risk of tissue necrosis.
Adrenaline Injection contains sodium metabisulphite, which can cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals.
The presence of sodium metabisulphite in parenteral Adrenaline and the possibility of allergic-type reactions should not deter use of the drug when indicated for the treatment of serious allergic reactions or for other emergency situations.
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4.5 Interaction with other medicinal products and other forms of interaction
Sympathomimetic agents/Oxytocin:
Adrenaline should not be administered concomitantly with oxytocin or other sympathomimetic agents because of the possibility of additive effects and increased toxicity.
Alpha-adrenergic blocking agents:
Alpha-blockers such as phentolamine antagonise the vasoconstriction and hypertension effects of adrenaline. This effect may be beneficial in adrenaline overdose. (See section 4.9).
Beta-adrenergic blocking agents:
Severe hypertension and reflex bradycardia may occur with non-selective beta-blocking drugs such as propranolol, due to alpha-mediated vasoconstriction.
Beta-blockers, especially non-cardioselective agents, also antagonise the cardiac and bronchodilator effects of adrenaline. Patients with severe anaphylaxis who are taking non-cardioselective beta-blockers may not respond to adrenaline treatment.
General Anaesthetics:
Administration of Adrenaline in patients receiving halogenated hydrocarbon general anaesthetics that increase cardiac irritability and seem to sensitise the myocardium to Adrenaline may result in arrhythmias including ventricular premature contractions, tachycardia or fibrillation (See section 4.4).
Antihypertensive agents:
Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine, with the risk of severe hypertension. Adrenaline increases blood pressure and may antagonise the effects of antihypertensive drugs.
Antidepressant agents:
Tricyclic antidepressants such as imipramine inhibit reuptake of directly acting sympathomimetic agents, and may potentiate the effect of adrenaline, increasing the risk of development of hypertension and cardiac arrhythmias.
Although monoamine oxidase (MAO) is one of the enzymes responsible for Adrenaline metabolism, MAO inhibitors do not markedly potentiate the effects of Adrenaline.
Phenothiazines:
Phenothiazines block alpha-adrenergic receptors.
Adrenaline should not be used to counteract circulatory collapse or hypotension caused by phenothiazines; a reversal of the pressor effects of Adrenaline may result in further lowering of blood pressure.
Other drugs:
Adrenaline should not be used in patients receiving high dosage of other drugs (e.g. cardiac glycosides) that can sensitise the heart to arrhythmias. Some antihistamines (e.g. diphenhydramine) and thyroid hormones may potentiate the effects of Adrenaline, especially on heart rhythm and rate.
Hypokalaemia:
The hypokalaemic effect of adrenaline may be potentiated by other drugs that cause potassium loss, including corticosteroids, potassium-depleting diuretics, aminophylline and theophylline.
Hyperglycaemia:
Adrenaline-induced hyperglycaemia may lead to loss of blood-sugar control in diabetic patients treated with insulin or oral hypoglycaemic agents.
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4.6 Pregnancy and lactation
Pregnancy:
Adrenaline crosses the placenta. There is some evidence of a slightly increased incidence of congenital abnormalities.
Injection of adrenaline may cause anoxia, foetal tachycardia, cardiac irregularities, extra systoles and louder heart sounds.
Adrenaline usually inhibits spontaneous or oxytocin induced contractions of the pregnant human uterus and may delay the second stage of labour. In dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with haemorrhage.
Parenteral Adrenaline should not be used during the second stage of labour.
Lactation:
Adrenaline is distributed into breast milk. Breast-feeding should be avoided in mothers receiving Adrenaline injection.
Adrenaline should not be used in pregnancy unless clearly necessary.
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4.7 Effects on ability to drive and use machines
The patients' ability to drive and use machines may be affected by the anaphylactic reaction, as well as by possible adverse reactions to adrenaline.
top
4.8 Undesirable effects
The adverse events of adrenaline mainly relate to the stimulation of both alpha- and beta-adrenergic receptors. The occurrence of undesirable effects depends on the sensitivity of the indiv
เว็บไซต์นี้ใช้คุกกี้ โดยดำเนินการต่อเพื่อเรียกดูเว็บไซต์ คุณอยู่ภายใต้นโยบายของการใช้คุกกี้ ดำเนินการต่อไปHelpAboutบริษัท Amdipharm เมอร์คิวรี่ จำกัดฉีดตื่นเต้น BP 1/1000 (1mg / 1ml)สารบัญ SPC1. ชื่อของผลิตภัณฑ์ยา2. องค์ประกอบเชิงคุณภาพ และเชิงปริมาณ3. แบบฟอร์มยา4. คลินิกใหม่4.1 บ่งชี้ที่รักษา4.2 posology และวิธีการจัดการ4.3 ข้อห้ามใช้4.4 พิเศษคำเตือนและข้อควรระวังสำหรับการใช้งาน4.5 การโต้ตอบกับผลิตภัณฑ์ยาอื่น ๆ และการโต้ตอบในรูปแบบอื่น ๆ4.6 ตั้งครรภ์และด้านการให้นม4.7 ผลความสามารถในการขับ และใช้เครื่องจักร4.8 ผลกระทบที่ไม่พึงปรารถนา4.9 ใช้ยาเกินขนาด5. pharmacological คุณสมบัติ5.1 คุณสมบัติ pharmacodynamic5.2 คุณสมบัติ pharmacokinetic5.3 ข้อมูลด้านความปลอดภัย preclinical6. ยาใหม่6.1 รายการ excipients6.2 ความเข้ากันไม่6.3 อายุ6.4 ข้อควรระวังพิเศษสำหรับเก็บ6.5 ธรรมชาติและเนื้อหาของคอนเทนเนอร์6.6 ข้อควรระวังพิเศษการกำจัดและการจัดการอื่น ๆ7. ตลาด authorisation ยึด8. ตลาด authorisation เลข9. วัน authorisation แรกอายุของ authorisation ที่10. วันปรับปรุงของข้อความข้อมูลบริษัทข้อมูลเพิ่มเติมเกี่ยวกับยานี้ด้านบน1. ชื่อของผลิตภัณฑ์ยาฉีดตื่นเต้น BP 1/1000 (1mg / 1ml)ด้านบน2. องค์ประกอบเชิงคุณภาพ และเชิงปริมาณแต่ละมล 1 ของโซลูชันประกอบด้วยตื่นเต้นกรด tartrate BP เท่ากับ 1 มิลลิกรัมของตื่นเต้นด้านบน3. แบบฟอร์มยาชัดเจน สีใส ฆ่าเชื้อ อควีโซลูชัน สำหรับมนุษย์ parenteral จัดการด้านบน4. คลินิกใหม่ด้านบน4.1 บ่งชี้ที่รักษาตื่นเต้นเป็นตัวแทน sympathomimetic ทำหน้าที่โดยตรงตื่นเต้นอาจใช้จุดอย่างรวดเร็วของปฏิกิริยารุนแรงที่ไวต่อยายาเสพติดและสารก่อภูมิแพ้อื่น ๆ และการรักษาฉุกเฉิน anaphylactic ช็อกด้านบน4.2 posology และวิธีการจัดการBP. ฉีดตื่นเต้น 1/1000 (1mg/ml) อาจจะบริหารหัวฉีดยาเอสหรือ IM ในผู้ป่วยตกใจกลัว บาดทะยักจากกระบวนการผลิตงานเป็นดูดซึมจากบาดทะยักจากเว็บไซต์มากขึ้นอย่างรวดเร็ว และเชื่อถือได้มากกว่าจากไซต์ใต้ปฏิกิริยารุนแรงที่ไวต่อยา anaphylactic ช็อกฉีด IM:ผู้ใหญ่: ยาปกติคือ 500 micrograms (0.5 ml ความตื่นเต้น 1/1000) ถ้าจำเป็น ยานี้อาจทำซ้ำหลายครั้งในช่วงเวลา 5 นาทีตามความดันโลหิต ชีพจร และการหายใจปริมาณครึ่งหนึ่งของความตื่นเต้นอาจจะปลอดภัยสำหรับผู้ป่วยที่กำลังใช้ amitriptyline, imipramine หรือเบต้าบล็อกเกอร์เด็ก: ปริมาณต่อไปนี้ความตื่นเต้น 1/1000 แนะนำ:อายุยากว่า 12 ปีmicrograms 500 (0.5 มล.) micrograms 250 (0.25 ml) ถ้าเป็นเด็กเล็ก หรือ prepubertal6 - 12 ปีmicrograms 250 (0.25 ml)6 เดือน - 6 ปีmicrograms 120 (0.12 ml)ต่ำกว่า 6 เดือนmicrograms 50 (0.05 มิลลิลิตร)ถ้าจำเป็น ปริมาณเหล่านี้อาจทำซ้ำหลายครั้งในช่วงเวลา 5 นาทีตามความดันโลหิต ชีพจร และการหายใจtop4.3 Contraindications1) Use during labour2) Use with local anaesthesia of peripheral structures including digits, ear lobe.3) Use in the presence of ventricular fibrillation, cardiac dilatation, coronary insufficiency, organic brain disease or atherosclerosis, except in emergencies where the potential benefit clearly outweighs the risk.4) Use if solution is discoloured.top4.4 Special warnings and precautions for useAdrenaline should be used with caution in patients with hyperthyroidism, diabetes mellitus, phaeochromocytoma, narrow angle glaucoma, hypokalaemia, hypercalcaemia, severe renal impairment, prostatic adenoma leading to residual urine, cerebrovascular disease, organic brain damage or arteriosclerosis, in elderly patients, in patients with shock (other than anaphylactic shock) and in organic heart disease or cardiac dilatation (severe angina pectoris, obstructive cardiomyopathy, hypertension) as well as most patients with arrhythmias. Anginal pain may be induced when coronary insufficiency is present.Repeat administration may produce local necrosis at the sites of injection.Prolonged administration may produce metabolic acidosis, renal necrosis and adrenaline fastness or tachyphylaxis.Adrenaline should be avoided or used with extreme caution in patients undergoing anaesthesia with halothane or other halogenated anaesthetics, in view of the risk of inducing ventricular fibrillation.Do not mix with other agents unless compatibility is known.Adrenaline should not be used during the second stage of labour (See Section 4.6).Accidental intravascular injection may result in cerebral haemorrhage due to the sudden rise in blood pressure.Adrenaline 1 in 1000 should not be diluted to 1 in 10,000 for use in cardiac resuscitation - when the 1 in 10,000 strength of adrenaline is required for this indication a “ready to use” preparation should be selected.Monitor the patient as soon as possible (pulse, blood pressure, ECG, pulse oximetry) in order to assess the response to adrenaline.The best site for IM injection is the anterolateral aspect of the middle third of the thigh. The needle used for injection needs to be sufficiently long to ensure that the adrenaline is injected into muscle. Intramuscular injections of Adrenaline into the buttocks should be avoided because of the risk of tissue necrosis.Adrenaline Injection contains sodium metabisulphite, which can cause allergic-type reactions, including anaphylaxis and life-threatening or less severe asthmatic episodes, in certain susceptible individuals.The presence of sodium metabisulphite in parenteral Adrenaline and the possibility of allergic-type reactions should not deter use of the drug when indicated for the treatment of serious allergic reactions or for other emergency situations.top4.5 Interaction with other medicinal products and other forms of interactionSympathomimetic agents/Oxytocin:Adrenaline should not be administered concomitantly with oxytocin or other sympathomimetic agents because of the possibility of additive effects and increased toxicity.Alpha-adrenergic blocking agents:Alpha-blockers such as phentolamine antagonise the vasoconstriction and hypertension effects of adrenaline. This effect may be beneficial in adrenaline overdose. (See section 4.9).Beta-adrenergic blocking agents:Severe hypertension and reflex bradycardia may occur with non-selective beta-blocking drugs such as propranolol, due to alpha-mediated vasoconstriction.Beta-blockers, especially non-cardioselective agents, also antagonise the cardiac and bronchodilator effects of adrenaline. Patients with severe anaphylaxis who are taking non-cardioselective beta-blockers may not respond to adrenaline treatment.General Anaesthetics:Administration of Adrenaline in patients receiving halogenated hydrocarbon general anaesthetics that increase cardiac irritability and seem to sensitise the myocardium to Adrenaline may result in arrhythmias including ventricular premature contractions, tachycardia or fibrillation (See section 4.4).Antihypertensive agents:Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine, with the risk of severe hypertension. Adrenaline increases blood pressure and may antagonise the effects of antihypertensive drugs.
Antidepressant agents:
Tricyclic antidepressants such as imipramine inhibit reuptake of directly acting sympathomimetic agents, and may potentiate the effect of adrenaline, increasing the risk of development of hypertension and cardiac arrhythmias.
Although monoamine oxidase (MAO) is one of the enzymes responsible for Adrenaline metabolism, MAO inhibitors do not markedly potentiate the effects of Adrenaline.
Phenothiazines:
Phenothiazines block alpha-adrenergic receptors.
Adrenaline should not be used to counteract circulatory collapse or hypotension caused by phenothiazines; a reversal of the pressor effects of Adrenaline may result in further lowering of blood pressure.
Other drugs:
Adrenaline should not be used in patients receiving high dosage of other drugs (e.g. cardiac glycosides) that can sensitise the heart to arrhythmias. Some antihistamines (e.g. diphenhydramine) and thyroid hormones may potentiate the effects of Adrenaline, especially on heart rhythm and rate.
Hypokalaemia:
The hypokalaemic effect of adrenaline may be potentiated by other drugs that cause potassium loss, including corticosteroids, potassium-depleting diuretics, aminophylline and theophylline.
Hyperglycaemia:
Adrenaline-induced hyperglycaemia may lead to loss of blood-sugar control in diabetic patients treated with insulin or oral hypoglycaemic agents.
top
4.6 Pregnancy and lactation
Pregnancy:
Adrenaline crosses the placenta. There is some evidence of a slightly increased incidence of congenital abnormalities.
Injection of adrenaline may cause anoxia, foetal tachycardia, cardiac irregularities, extra systoles and louder heart sounds.
Adrenaline usually inhibits spontaneous or oxytocin induced contractions of the pregnant human uterus and may delay the second stage of labour. In dosage sufficient to reduce uterine contractions, the drug may cause a prolonged period of uterine atony with haemorrhage.
Parenteral Adrenaline should not be used during the second stage of labour.
Lactation:
Adrenaline is distributed into breast milk. Breast-feeding should be avoided in mothers receiving Adrenaline injection.
Adrenaline should not be used in pregnancy unless clearly necessary.
top
4.7 Effects on ability to drive and use machines
The patients' ability to drive and use machines may be affected by the anaphylactic reaction, as well as by possible adverse reactions to adrenaline.
top
4.8 Undesirable effects
The adverse events of adrenaline mainly relate to the stimulation of both alpha- and beta-adrenergic receptors. The occurrence of undesirable effects depends on the sensitivity of the indiv
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