WHO Model Prescribing Information: Drugs Used in Anaesthesia
(1989; 60 pages) [French] View the PDF document
Table of Contents
View the documentPreface
View the documentIntroduction
Open this folder and view contentsPremedication
Open this folder and view contentsGeneral anaesthetics and oxygen
Close this folderLocal anaesthetics
View the documentBupivacaine
View the documentLidocaine
View the documentTetracaine
View the documentEpinephrine (for use with local anaesthetics)
Open this folder and view contentsNon-opioid analgesics
Open this folder and view contentsOpioid analgesics and antagonists
Open this folder and view contentsMuscle relaxants and cholinesterase inhibitors
Open this folder and view contentsBlood substitutes
Open this folder and view contentsSolutions for correcting water and electrolyte imbalance
Open this folder and view contentsAntacid for use in obstetric practice
View the documentAnaesthesia at the District Hospital
View the documentSelected WHO publications of related interest
View the documentBack cover

Epinephrine (for use with local anaesthetics)

Group: additive to local anaesthetic agents
Injection: 1 mg (as hydrochloride) in 1-ml ampoule

General information

Epinephrine is a sympathomimetic agent that activates both α- and β-adrenoceptors. It is secreted together with norepinephrine by the adrenal medulla in response to stress. Epinephrine is transient in its effect when administered parenterally because it is rapidly metabolized.

Clinical information


To retard systemic absorption of infiltrated local anaesthetics.

Dosage and administration

The addition of epinephrine 5 micrograms/ml (1:200 000) as a vasoconstrictor to local anaesthetic solutions slows systemic absorption and prolongs the anaesthetic effect. In dental surgery, in which small volumes are injected, concentrations of 12.5 micrograms/ml (1:80 000) are commonly used.

Epinephrine should not be used in ring block of digits or the penis or in other situations where there is a danger of local ischaemia.


Solutions containing epinephrine should be used with particular caution in patients with hypertension, atherosclerotic heart disease, cerebral vascular insufficiency, heart block, thyrotoxicosis or diabetes since severe and sustained variations in blood pressure may occur.

Drug interactions

The risk of cardiac dysrhythmias is increased when epinephrine is administered to patients receiving halogenated hydrocarbon anaesthetic agents (such as halo-thane and trichloroethylene), digitalis glycosides, quinidine, tricyclicantidepressants or thyroid hormones.


An abrupt rise in blood pressure and dysrhythmias may be counteracted by propranolol or other β-adrenoceptor-blocking agents.


Epinephrine injection should be stored protected from light.

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