G-Ephedrine

• Hypotension following spinal anesthesia: Used to reverse hypotension induced by spinal or epidural anaesthesia.

Ephedrine is a stimulant drug, belonging to a group of medicines known as sympathomimetics. Specifically it is both an alpha and beta adrenergic agonist. In addition, Ephedrine enhances the release of norepinephrine, a strong endogenous alpha agonist. When administered, Ephedrine will notably increase the activity of the central nervous system, as well as have a stimulatory effect on other target cells.

Adult Dose:

• Oral (Acute bronchospasm): 15-60 mg tid; Max: 150 mg/day.
• Oral (Diabetic neuropathic oedema): 30-60 mg 3 times/day.
• Parenteral (Spinal/epidural anaesthesia-induced hypotension): 3-6 mg by slow IV inj every 3-4 min; Max total dose: 30 mg.
• Elderly Oral: Initial: 50% of adult dose.

Child Dose:

• Oral (Acute bronchospasm): 1-5 yr: 15 mg tid; 6-12 yr: 30 mg tid; >12 yr: Same as adult dose.
• Parenteral: 0.5 mg/kg or 16.7 mg/m2 4-6 hrly (SC/IM) or 0.75 mg/kg or 25 mg/m2 4 times daily (SC/IV).

Common Side Effects:

• Systemic hypertension (high blood pressure)
• Insomnia (difficulty in sleeping)

Other Side Effects:

• Nausea, vomiting, anorexia
• Tachycardia (sometimes bradycardia), arrhythmias, anginal pain
• Vasoconstriction with hypertension, vasodilation with hypotension
• Dizziness, flushing
• Dyspnoea, headache, anxiety, restlessness
• Confusion, psychoses, insomnia, tremor
• Difficulty in micturition, urine retention
• Sweating, hypersalivation
• Changes in blood-glucose concentration
• Angle-closure glaucoma (very rare)

Use in Pregnancy: Category C. Animal studies have shown adverse effects on the fetus and there are no controlled studies in women. Should be given only if potential benefit justifies potential risk to the fetus.

Precautions:

• Ephedrine Hydrochloride does not usually affect your ability to drive.
• It is usually given as a slow injection into your veins by a doctor or healthcare professional.
• Use with caution in patients with hyperthyroidism, diabetes mellitus, ischemic heart disease, hypertension, renal impairment, or angle-close glaucoma.
• In patients with prostatic enlargement, Ephedrine may increase difficulty with micturition.
• Increased fetal heart rate reported with parenteral Ephedrine during pregnancy.
• Irritability and disturbed sleep have been reported in breast-fed infants.

Overdose: When given in sufficiently large doses, Ephedrine gives rise to minor reactions such as giddiness, headache, nausea, vomiting, sweating, palpitations, difficulty in micturition, tremors, anxiety, restlessness and insomnia. Some patients may exhibit these symptoms even with the usual therapeutic dosage.

Storage: Store in a cool, dry place, protected from light. Keep all medicines out of reach of children.