What epinephrine dosing is recommended if intravenous administration is used in anaphylaxis?

• A. 0.05-0.1 mg slow IVP or 0.01-0.2 mcg/kg/min titrated
• B. 0.5-1 mg IVP
• C. 0.3-0.5 mg IVP
• D. 2-3 mg/min IV infusion

Answer: (A)

When epinephrine is given intravenously for anaphylaxis, the approach is to use a dilute, small, carefully titrated dose rather than large boluses. A slow IV push of 0.05–0.1 mg (50–100 mcg) can provide rapid improvement, and if needed you can start a continuous IV infusion at 0.01–0.2 mcg/kg/min, titrating to the patient’s response. This strategy minimizes the risk of abrupt hypertension, tachyarrhythmias, and ischemia that come with larger bolus doses or very high infusion rates. In contrast, larger boluses (0.3–0.5 mg, or 0.5–1 mg IV) or infusions of 2–3 mg/min carry substantial risk and are not appropriate. The dilute, titratable IV approach also takes advantage of epinephrine’s combined alpha-mediated vasoconstriction (raising blood pressure and reducing edema) and beta-mediated bronchodilation, providing targeted control in rapidly evolving anaphylaxis.