EPHEDRINE

Sympathomimetic vasoconstrictor. Constricts the peripheral blood vessels and accelerates the heart rate by action on α and β receptors respectively

Dosage forms

Injection

3 mg/ml
30 mg/ml

Nasal drops

1%
0.5%

Uses

  • Prevention of hypotension from spinal or epidural anaesthesia
  • Relief of nasal congestion

Dose and duration

Prevention of hypotension from spinal or epidural anaesthesia
Adult and child over 12 years: by slow IV infusion, 3–6 mg (max 9 mg) repeated every 3–4 minutes as required to a maximum cumulative dose of 30 mg
Child 1–12 years: 0.5–0.75 mg/kg or 17–25 mg/m² every 3–4 minutes according to response (max 30 mg during each episode)
Relief of nasal congestion
Adult: Instil 1–2 drops of 1% strength as required in each nostril up to a maximum of 4 times a day
Child 12–18 years: instill 1–2 drops of 0.5% strength into each nostril up to 3 or 4 times daily when required

Do not use for more than 7 days

Contra-indications

  • Known sensitivity to ephedrine
  • Ischaemic heart disease
  • Hypertension
  • Thyrotoxicosis
  • Prostatic hypertrophy

Side effects

  • Anorexia
  • Arrhythmias, angina pain, palpitations, hypertension, tachycardia
  • Confusion, anxiety, depression, nervousness, irritability
  • Weakness, insomnia, dizziness, headache
  • Flushing, sweating
  • Dyspnoea
  • Nausea, vomiting
  • Local irritation
  • Rebound congestion
  • Excessive use leads to tolerance

Interactions

  • Reserpine (hypotensive effect of reserpine antagonised)
  • MAOIs (risk of hypertensive crisis-avoid for at least 2 weeks after stopping MAOIs)

Pregnancy

  • Can be used

Breast-feeding

  • Do not use

⚠️ Caution

  • Ephedrine is excreted in breast milk. The breast-fed child may experience irritability and disturbed sleep
  • Ephedrine readily crosses the placental barrier. Increased foetal heart rate reported with parenteral ephedrine
  • Avoid use in severe renal impairment due to increased CNS toxicity
  • Use cautiously in hyperthyroidism, diabetes mellitus, ischaemic heart disease, hypertension and angle-closure glaucoma