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Systemic absorption of adrenaline after aerosol, eye‐drop and subcutaneous administration to healthy volunteers
Author(s) -
Dahlöf C.,
Mellstrand T.,
Svedmyr N.
Publication year - 1987
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/j.1398-9995.1987.tb02202.x
Subject(s) - eye drop , medicine , absorption (acoustics) , anesthesia , aerosol , pharmacology , chemistry , materials science , organic chemistry , composite material
Adrenaline is the drug of choice for management of the anaphylactic reaction. The objective of this study was to compare systemic absorption of adrenaline after administration by different routes to healthy volunteers. Ten puffs (1.5 mg as adrenaline base) with 10–15 s intervals between them followed 2 h later by 20 puffs (3 mg) of adrenaline from a pressurized aerosol (Medihaler‐Epi, 3M Riker, 14.0 mg/ml adrenaline acid tartrate) were sprayed into the cheek pouch or inhaled through the mouth or the nostrils. Adrenaline was also administered to the eyes by giving 2 drops (1 mg) of Isopto‐Epinal (Alcon, 10 mg × ml −1 ). Finally, 0.5 ml (0.5 mg) of adrenaline was given subcutaneously in the upper arm of the same individuals. The systemic absorption was determined by measuring plasma adrenaline levels and effects on blood pressure, heart rate and finger tremor before and 5, 15, 30, 60, 90, and 120 min after adrenaline administration. Adrenaline given as eye‐drops did not have any significant effect on these parameters. Subcutaneously administered adrenaline caused within 5 min a significant increase of plasma adrenaline level (from 1.0 ± 0.2 to a peak of 6.5 ± 1.2 nM) which gradually decreased during 2 h. This mode of adrenaline administration increased the systolic blood pressure by a maximum of 11 ± 3.5 mmHg, heart rate by 9 ± 2.2 beats × min −1 , tremor ratio by 4 ± 0.6 and reduced the diastolic blood pressure by 18 ± 4.7 mmHg. The cardiovascular effects were approximately maximum 15 min after administration and lasted almost 90 min. After 10 inhalations through the mouth no significant effects were seen, whereas after 20 inhalations the plasma adrenaline level increased significantly (from 1.1 ± 0.2 to a peak of 2.4 ± 0.6 nM). The effects on blood pressure, heart rate and finger tremor ratio were more short‐lived than those caused by subcutaneously administered adrenaline. The effects of nasal inhalation of adrenaline were similar but more long‐lasting when compared to oral inhalation. Conclusion. Inhaled adrenaline gives rapid systemic absorption but this is less pronounced and more short‐lasting than with subcutaneous adrenaline. Apart from being easier for the patient to use, the inhaled route of adrenaline administration also appears to be cardiovascularly safe within a wide dose range. It is therefore suggested that patients known to be hypersensitive should be equipped with Medihaler Adrenaline for emergencies as a complement to subcutaneous adrenaline. Further, the recommended dose of this inhaler in the treatment of acute upper airway hyperreactive conditions should be increased to 10–20 inhalations, which can be repeated if necessary.