Ephedrine sulfate

dr.joan

Ephedrine sulfate
Trade name: Nasal decongestant: Pretz-D

Drug classes

· Sympathomimetic drug
· Vasopressor
· Bronchodilator drug
· Nasal decongestant
Pregnancy: (Category C)

Therapeutic actions

Peripheral effects are mediated by receptors in target organs and are due in part to the release of norepinephrine from nerve terminals. Effects mediated by these receptors include vasoconstriction (increased BP, decreased nasal congestion α receptors); cardiac stimulation (β1), and bronchodilation (β2). Longer acting but less potent than epinephrine; also has CNS stimulant properties.

Indications

• Treatment of hypotensive states, especially those associated with spinal anesthesia; Stokes-Adams syndrome with complete heart block; CNS stimulant in narcolepsy and depressive states; acute bronchospasm (parenteral)
• Pressor agent in hypotensive states following sympathectomy, over dosage with ganglionic-blocking agents, antiadrenergic agents, or other drugs used for lowering BP (parenteral)
• Relief of acute bronchospasm (parenteral; epinephrine is the preferred drug)
• Treatment of allergic disorders, such as bronchial asthma, and local treatment of nasal congestion in acute coryza, vasomotor rhinitis, acute sinusitis, hay fever (oral)
• Symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other respiratory allergies (topical)
• Adjunctive therapy of middle ear infections by decreasing congestion around the eustachian ostia (topical)

Contraindications/cautions

• Contraindications: allergy to ephedrine, angle-closure glaucoma, anesthesia with cyclopropane or halothane, thyrotoxicosis, diabetes, hypertension, CV disorders, women in labor whose BP < 130/80.
• Use cautiously with angina, arrhythmias, prostatic hypertrophy, unstable vasomotor syndrome, lactation.

Dosage

Adult

Hypotensive episodes, allergic disorders, asthma:

25---50 mg IM (fast absorption), SC (slower absorption), or IV (emergency administration).

Labor:

Titrate parenteral doses to maintain BP at or below 130/80.

Acute asthma:

Administer the smallest effective dose (0.25---0.5 mL or 12.5---25 mg).

Maintenance dosage--allergic disorders, asthma:

25---50 mg PO q3---4h as necessary.

Topical nasal decongestant:

Instill solution in each nostril q4h. Do not use longer than 3---4 consecutive days.

Pediatric:

25---100 mg/m2 IM or SC divided into 4 to 6 doses; 3 mg/kg per day or 100 mg/m2 per day divided into 4 to 6 doses, PO, SC, or IV for bronchodilation.

Topical nasal decongestant (> 6 y):

Instill solution in each nostril q4h. Do not use for longer than 3---4 consecutive d. Do not use in children <6 y unless directed by physician.

Geriatric:

More likely to experience adverse reactions; use with caution.

Adverse effects

Systemic effects are less likely with topical administration, but can take place, and should be considered.

• CNS: Fear, anxiety, tenseness, restlessness, headache, light-headedness, dizziness, drowsiness, tremor, insomnia, hallucinations, psychological disturbances, convulsions, CNS depression, weakness, blurred vision, ocular irritation, tearing, photophobia, symptoms of paranoid schizophrenia
• GI: Nausea, vomiting, anorexia
• CV: Arrhythmias, hypertension resulting in intracranial hemorrhage, CV collapse with hypotension, palpitations, tachycardia, precordial pain in patients with ischemic heart disease
• GU: Constriction of renal blood vessels and decreased urine formation (initial parenteral administration), dysuria, vesical sphincter spasm resulting in difficult and painful urination, urinary retention in males with prostatism
• Local: Rebound congestion with topical nasal application
• Other: Pallor, respiratory difficulty, orofacial dystonia, sweating

Clinically important interactions

• Drug-drug
  • Severe hypertension with MAO-inhibitors, TCAs, furazolidone
  • Additive effects and increased risk of toxicity with urinary alkalinizers
  • Decreased vasopressor response with reserpine, methyldopa, urinary acidifiers
  • Decreased hypotensive action of guanethidine with ephedrine

Nursing Considerations

• Protect solution from light; give only if clear; discard any unused portion.
• Monitor urine output with parenteral administration; initially renal blood vessels may be constricted and urine formation decreased.
• Do not use nasal decongestant for longer than 3---5 d.
• Avoid prolonged use of systemic ephedrine (a syndrome resembling an anxiety effect may occur); temporary cessation of the drug usually reverses this syndrome.
• Monitor CV effects carefully; patients with hypertension may experience changes in BP because of the additional vasoconstriction. If a nasal decongestant is needed, give pseudoephedrine.