Ephedrine Sulphate

Registered South African indications:

• Hypotension

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Coadministration with indirect sympathomimetic agents (e.g. phenylpropanolamine, phenylephrine, pseudoephedrine and methylphenidate)
• Coadministration with alpha sympathomimetic agents
• Coadministration with non-selective monoamine oxidase inhibitors or within 14 days of their use

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hyperthyroidism
• Cardiovascular disease or history thereof
• Ischaemic heart disease
• Arrhythmia
• Tachycardia
• Occlusive vascular disorders
• Arterioschlerosis
• Hypertension
• Aneurysms
• Angina pectoris
• Diabetes mellitus
• Closed-angle glaucoma
• Prostatic hypertrophy
• Athletes

Forms avail. in SA and covered in this monograph: inj

Hypotension
- Anaesthesia-induced 

• IV: 5-10mg, bolus given as a slow injection; Max: 50mg/24hrs
• IM/SC: 25-50mg

Repeat doses determined by blood pressure response

See additional prescribing points

Paed forms avail. in SA and covered in this monograph: inj

Hypotension
- Anaesthesia-induced 

Younger than 12 years

• IV: 0.1-0.3mg/kg/dose, bolus given as a slow injection; Max: 25mg/24hrs

Older than 12 years

• Refer to adult dosages

Repeat doses determined by blood pressure response

See additional prescribing points

Pregnancy

• Caution
• Studies in animals have shown a teratogenic effect. Clinical data from epidemiological studies on a limited number of women appear to indicate no particular effects of ephedrine with respect to malformation. Isolated cases of maternal hypertension have been described after abuse or prolonged use of vasoconstrictor amines
• Ephedrine crosses the placenta and this has been associated with an increase in fetal heart rate and beat-to-beat variability. Therefore, ephedrine should be avoided or used with caution, and only if necessary, during pregnancy

Breastfeeding

• Caution; not recommended
• Ephedrine is excreted in breast milk. Irritability and disturbed sleep patterns have been reported in breast-fed infants. There is evidence that ephedrine is eliminated within 21 to 42 hours after administration, therefore a decision needs to be made on whether to avoid ephedrine therapy or breastfeeding should be suspended for 2 days following its administration taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman

Fertility

• No information available

Renal Impairment

• Caution, no dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended
  Initiate at lower dosing range

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Prohibited - In competition

Central Nervous System Disorders

• Confusion
• Anxiety
• Depression
• Psychotic states
• Fear
• Nervousness
• Irritability
• Restlessness
• Weakness
• Insomnia
• Headache
• Sweating
• Tremor
• Cerebral haemorrhage

Cardiovascular Disorders

• Palpitations
• Hypertension
• Tachycardia
• Cardiac arrhythmias
• Angina pain
• Reflex bradycardia
• Cardiac arrest
• Hypotension

Respiratory Disorders

• Dyspnoea
• Pulmonary oedema

Gastrointestinal Disorders

• Hypersalivation
• Nausea and vomiting

Genitourinary Disorders

• Acute urinary retention

Endocrine and Metabolic Disorders

• Reduced appetite
• Hypokalaemia
• Alterations in blood glucose levels

Immune, Blood and Lymphatic System Disorders

• Alterations in primary haemostasis
• Hypersensitivity reactions

Sensory Disorders

• Angle-closure glaucoma

• Sympathomimetics
• Monoamine oxidase inhibitors
• Halogenated volatile anaesthetics
• Cyclopropane
• Halothane
• Cardiac glycosides
• Quinidine
• Tricyclic antidepressants
• Imipramine
• Antihypertensive agents
• Reserpine
• Methyldopa
• Beta-adrenoceptor blockers
• Propranolol
• Xanthines
• Aminophylline
• Theophylline
• Corticosteroids
• Dexamethasone
• Diuretics
• Ergot alkaloids
• Linezolid
• Noradrenergic-serotoninergic antidepressants
• Venlafaxine
• Minalcipran
• Guanethidine
• Sibutramine
• Antiepileptics
• Phenytoin
• Phenobarbitone
• Primidone
• Doxapram
• Oxytocin

• Blood pressure
• Pulse

Practical notes on adult dosages 

• 50mg vial: Draw up to 10ml to create a solution that is 5mg/ml
• Administer 1-2ml (5mg-10mg) every 2-3min
• Ephedrine is known to exhibit receptor tachyphylaxis, a decrease in response to a drug, once a cumulative daily dose of 50mg in adults has been reached, no further benefit will be gained from repeat administration. An alternative inotrope or vasopressor should be used

Practical notes on paediatric dosages 

• Prepare a solution of 50mg drawn up to 50ml with saline to yield a 1mg/ml solution
• Administer a dose of 0.2mg/kg as a push dose pressor
• Ephedrine is known to exhibit receptor tachyphylaxis, a decrease in response to a drug, once a cumulative daily dose of 25mg in children has been reached, no further benefit will be gained from repeat administration. An alternative inotrope or vasopressor should be used

Ephedrine is a sympathomimetic amine that acts directly on alpha and beta receptors and indirectly by increasing the release of noradrenaline at the sympathetic nerve endings. It stimulates the central nervous system, the cardiovascular system, the respiratory system, and the sphincters of the digestive and urinary systems.

Injection (per ml) 50mg

• Ephedrine Sulphate (Pfizer) originator