Posology : מינונים

4.2 Posology and method of administration

Adrenaline Teva 1mg/ml Solution for Injection can be administered by intramuscular (I.M.), subcutaneous (S.C.) and intravenous (I.V.) injection, and in extremely serious cases and if the intravenous route is not practicable, via the intracardiac route.

The intravenous and intracardiac routes must be used in the hospital setting, after dilution of the solution in 0.9% sodium chloride solution and under cardiac monitoring. Adrenaline Teva will be administered by healthcare personnel. Adrenaline Teva 1mg/ml (1:1,000) must be 
diluted in 0.9% sodium chloride solution to 1:10,000 before I.V. or intracardiac administration.
To prevent degradation by light or oxidation, it is recommended that the product be used immediately after dilution. The dosage and route of administration depend on the diagnosis and the clinical condition of patients. In an emergency situation, a rapid route of absorption should be used.

Acute asthma attacks, allergic reactions and anaphylactic shock
The usual dose for the treatment of acute asthma attacks and allergic reactions in adults is 0.3-0.5 mg (0.3-0.5 ml) by I.M. or subcutaneous injection, with the I.M. route being the quickest and most effective. In the case of anaphylactic shock, the I.M. route or, in very serious cases and in the hospital setting, the I.V. route must be used. If necessary, the administration can be repeated after 15-20 minutes and then at intervals of 4 hours. In serious conditions, the dose can be increased up to 1 mg (1 ml).

In elderly patients, the recommended doses are the same as for adults, but special caution is needed.

The usual dose for children is 0.01 mg (0.01 ml) per kg of body weight either by intramuscular or subcutaneous injection up to a maximum dose of 0.5 mg (0.5 ml). If necessary, the administration can be repeated after 15-20 minutes and then at intervals of 4 hours.

Cardiac arrest and cardiopulmonary resuscitation
For the treatment of cardiac arrest and cardiopulmonary resuscitation, the recommended dose of epinephrine (adrenaline) is 1 mg by intravenous injection (1:1,000) which must be administered after dilution in 0.9% sodium chloride solution to 1:10,000 and can be repeated every 3-5 minutes as many times as necessary.

In children, the standard dose is 0.01 mg/kg by intravenous injection, which can be repeated every 5 minutes if necessary.

When the intravenous route is not practicable, the intracardiac route can be used (using the same diluted solution). However, it should be borne in mind that this route presents serious risks and should only be used if the intravenous route is persistently inaccessible.

The lowest dose that produces relief should be used. For acute asthma attacks, low doses administered at the outset are more effective than higher doses administered later. Patients who frequently receive adrenaline (and other sympathomimetics), such as asthmatic patients, may develop tolerance and therefore require increased doses to achieve the same therapeutic effect. In advanced cases, this may lead to resistance or refractoriness to the clinical effects of this medicinal product.