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Neffy
epinephrine nasal
Adult Dosing .
Dosage forms: SPRAY: 2 mg per actuation
anaphylaxis
- [>30 kg]
- Dose: 2 mg intranasally x1; Info: may repeat dose x1 in same nostril after 5min
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: SPRAY: 1 mg per actuation, 2 mg per actuation
anaphylaxis
- [15-29 kg]
- Dose: 1 mg intranasally x1; Info: may repeat dose x1 in same nostril after 5min
- [>30 kg]
- Dose: 2 mg intranasally x1; Info: may repeat dose x1 in same nostril after 5min
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- IV use (auto-injector form)
- caution: hypersensitivity to drug or ingredient
- caution: hypersensitivity to sulfites
- caution: elderly patients
- caution: renal impairment
- caution: HTN
- caution: CAD
- caution: cardiomyopathy
- caution: arrhythmia
- caution: cerebrovascular disease
- caution: hyperthyroidism
- caution: diabetes mellitus
- caution: Parkinson disease
- caution: psychiatric disorder
- caution: nasal condition, structural (nasal use)
- caution: nasal condition, anatomical (nasal use)
Drug Interactions .
Overview
epinephrine
alpha/beta agonist
- COMT substrate
- hyperglycemic effects
- hypertensive effects
- hypokalemia
- tachycardia
- nasal epinephrine use: caution advised with nasal drugs, including subsequent nasal epinephrine doses, up to 2 wk after initial administration; nasal epinephrine may incr. systemic absorption of nasal drugs, risk of adverse effects
Contraindicated
- dihydroergotamine
- phenelzine
Avoid/Use Alternative
- amitriptyline
- amoxapine
- arsenic trioxide
- chlorpromazine
- clozapine
- cocaine
- desipramine
- dronabinol
- ephedra
- esmolol
- fluphenazine
- formoterol inhaled
- haloperidol
- imipramine
- isoproterenol
- labetalol
- linezolid
- methylergonovine
- nadolol
- nortriptyline
- ozanimod
- perphenazine
- pimozide
- pindolol
- procarbazine
- promethazine
- protriptyline
- rasagiline
- selegiline
- thioridazine
- timolol
- trifluoperazine
- yohimbe
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- acebutolol
- acetazolamide
- albuterol inhaled
- aliskiren
- almotriptan
- aloe
- alogliptin
- amiloride
- aminophylline
- amiodarone
- amlodipine
- amphetamine
- amphotericin
- angiotensin II
- aprocitentan
- arformoterol inhaled
- armodafinil
- asciminib
- asparaginase
- atenolol
- atogepant
- atomoxetine
- atropine
- atropine ophthalmic
- axitinib
- azilsartan medoxomil
- benazepril
- benzphetamine
- benztropine
- betamethasone
- betaxolol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bisoprolol
- brigatinib
- bromocriptine
- brompheniramine
- budesonide
- bumetanide
- bupropion
- cabozantinib
- caffeine
- caffeine citrate
- canagliflozin
- candesartan cilexetil
- cannabis
- captopril
- carbinoxamine
- carfilzomib
- celecoxib
- cetuximab
- chlorothiazide
- chlorpheniramine
- chlorthalidone
- cisplatin
- clemastine
- clevidipine
- clonidine
- colesevelam
- copanlisib
- corticotropin
- cortisone
- crizotinib
- cyclosporine
- cyproheptadine
- danazol
- dapagliflozin
- darbepoetin alfa
- decitabine
- deflazacort
- desflurane
- desvenlafaxine
- dexamethasone
- dexbrompheniramine
- dexchlorpheniramine
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- diclofenac
- diclofenac topical
- dicyclomine
- diethylpropion
- diflunisal
- digoxin
- diltiazem
- dimenhydrinate
- dinutuximab
- diphenhydramine
- disopyramide
- dobutamine
- dofetilide
- dopamine
- doxapram
- doxazosin
- doxylamine
- dronedarone
- droxidopa
- dulaglutide
- eletriptan
- emapalumab
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- ephedrine injection
- ephedrine oral
- eplerenone
- epoetin alfa
- eptinezumab
- erenumab
- ertugliflozin
- esketamine
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- exenatide
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fingolimod
- flecainide
- fludrocortisone
- flurbiprofen
- foscarnet
- fosfomycin injection
- fosinopril
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- galcanezumab
- glimepiride
- glipizide
- glyburide
- glycopyrrolate
- guanfacine
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydroxocobalamin IV
- hydroxyzine
- hyoscyamine
- ibrutinib
- ibuprofen
- ibutilide
- indapamide
- indomethacin
- insulin
- irbesartan
- isoflurane
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- ketamine
- ketoprofen
- ketorolac
- lanreotide
- leflunomide
- lenalidomide
- lenvatinib
- levalbuterol inhaled
- levomilnacipran
- levothyroxine
- licorice
- lidocaine
- lifileucel
- linagliptin
- liothyronine
- liraglutide
- lisdexamfetamine
- lisinopril
- lixisenatide
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- magnesium citrate
- magnesium salicylate
- mannitol
- meclizine
- meclofenamate
- mefenamic acid
- meloxicam
- metformin
- methamphetamine
- methazolamide
- methoxy polyethylene glycol-epoetin beta
- methscopolamine
- methyldopa
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- metoprolol
- mexiletine
- mifepristone
- miglitol
- milnacipran
- minoxidil
- mirabegron
- modafinil
- moexipril
- motixafortide
- nabumetone
- naproxen
- naratriptan
- nateglinide
- naxitamab
- nebivolol
- necitumumab
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- niraparib
- nisoldipine
- nitroglycerin
- nitroprusside
- norepinephrine
- obinutuzumab
- olmesartan medoxomil
- olodaterol inhaled
- opicapone
- orphenadrine
- osilodrostat
- oxaprozin
- oxymetazoline nasal
- oxytocin
- pamidronate
- panitumumab
- pazopanib
- perindopril
- pexidartinib
- phendimetrazine
- pheniramine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pioglitazone
- piroxicam
- polyethylene glycol
- ponatinib
- ponesimod
- posaconazole
- pramlintide
- prazosin
- prednisolone
- prednisone
- procainamide
- propafenone
- pseudoephedrine
- pyrilamine
- quetiapine
- quinapril
- quinidine (antiarrhythmic)
- ramipril
- regorafenib
- repaglinide
- rimegepant
- ripretinib
- rizatriptan
- ropinirole
- rosiglitazone
- rotigotine transdermal
- sacituzumab govitecan
- salmeterol inhaled
- salsalate
- saxagliptin
- selinexor
- selpercatinib
- semaglutide
- sevoflurane
- siponimod
- sirolimus albumin-bound
- sitagliptin
- sodium benzoate
- sodium phenylacetate
- sodium phenylbutyrate
- sodium polystyrene sulfonate
- sodium thiosulfate
- solriamfetol
- sorafenib
- sotalol
- spironolactone
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tafasitamab
- tagraxofusp
- telmisartan
- terazosin
- terbutaline
- teriflunomide
- testosterone
- theophylline
- thyroid
- tirzepatide
- tivozanib
- tolcapone
- tolmetin
- topiramate
- torsemide
- trametinib
- trandolapril
- triamcinolone
- triamterene
- triprolidine
- trospium
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vandetanib
- vasopressin
- venlafaxine
- verapamil
- vilanterol inhaled
- viloxazine
- voclosporin
- zavegepant
- ziv-aflibercept
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- respiratory difficulty
- pulmonary edema
- HTN
- arrhythmia
- myocardial ischemia
- stress cardiomyopathy
- cerebral hemorrhage
- renal impairment
- tissue damage, extravasation-related (IV use)
- myonecrosis (SC or IM use)
- necrotizing fasciitis (SC or IM use)
Common Reactions
- palpitations
- tachycardia
- respiratory difficulty
- nausea
- vomiting
- pallor
- diaphoresis
- dizziness
- weakness
- tremor
- headache
- apprehension
- nervousness
- anxiety
- restlessness
- nasal discomfort (nasal use)
- nasal congestion (nasal use)
- rhinorrhea (nasal use)
- paresthesia (nasal use)
- epistaxis (nasal use)
- throat irritation (nasal use)
Safety/Monitoring .
Monitoring Parameters
no routine tests recommended
Look/Sound-Alike Drug Names
EPINEPHrine confused with: ePHEDrine; Neo-Synephrine; norepinephrine; phenylephrine
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, especially during labor and delivery, though benefits outweigh risks for anaphylaxis use; possible risk of teratogenicity based on limited or conflicting human data; risk of teratogenicity and embryo-fetal death based on animal data at 3-15x MRHD; risk of decr. uterine perfusion and interference with uterine contractility based on drug's mechanism of action
Lactation
Clinical Summary
benefits outweigh risks while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; no human data available, though theoretical decr. milk production with high-dose IV use based on decr. prolactin levels
Pharmacology .
Metabolism: for epinephrine: liver, other tissues; CYP450: unknown
Excretion: for epinephrine: urine (minimally unchanged); Half-life: <5min (IV)
Subclass: Anaphylaxis
Mechanism of Action
for epinephrine: stimulates alpha and beta adrenergic receptors (sympathomimetic)
Formulary .
No Formulary Selected
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