Contraindications and precautions
The SmPC for EpiPen® (adrenaline) auto-injector notes various precautions to adrenaline, however in practice there are no known contraindications to IM adrenaline use in a life-threatening allergic reaction.
Adrenaline should be used with caution in patients with high blood pressure, and also in those using cocaine and in uncontrolled hyperthyroidism because of the sensitisation of the heart to catecholamines that occur in these individuals. Blood sugar may increase in patients with diabetes and symptoms can temporarily get worse in patients with Parkinson’s disease.
Auto-injectors should ONLY be injected into the anterolateral aspect of the thigh (not the buttock).
Auto-injectors should NOT be injected intravenously.
Since adrenaline is a strong vasoconstrictor, accidental injection into the hands or feet may result in loss of blood flow to the affected area and should be avoided. If there is an accidental injection into these areas, the patient should go immediately to the nearest casualty department for treatment.