The Basics
What is Epinephrine?
Used to treat a number of conditions, including anaphylaxis, cardiac arrest, asthma, and superficial bleeding.
Brand names for Epinephrine
Adrenalin
How Epinephrine is classified
Adrenergic Agonists, Adrenergic alpha-Agonists, Adrenergic beta-Agonists, Antiglaucoma Agents, Bronchodilator Agents, Catecholamines, Mydriatics, Sympathomimetics, Vasoconstrictor Agents
Epinephrine During Pregnancy
Epinephrine pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Epinephrine while pregnant
There is no study on the acute effect of epinephrine on pregnancy. Epinephrine has been shown to have developmental effects when administered subcutaneously in rabbits at a dose of 1.2 mg/kg daily for two to three days (approximately 30 times the maximum recommended daily subcutaneous or intramuscular dose on a mg/m2 basis), in mice at a subcutaneous dose of 1 mg/kg daily for 10 days (approximately 7 times the maximum daily subcutaneous or intramuscular dose on a mg/m2 basis) and in hamsters at a subcutaneous dose of 0.5 mg/kg daily for 4 days (approximately 5 times the maximum recommended daily subcutaneous or intramuscular dose on a mg/m2 basis). These effects were not seen in mice at a subcutaneous dose of 0.5 mg/kg daily for 10 days (approximately 3 times the maximum recommended daily subcutaneous or intramuscular dose on a mg/m2 basis). Although, there are no adequate and well-controlled studies in pregnant women, epinephrine should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus.
Taking Epinephrine While Breastfeeding
What are recommendations for lactation if you're taking Epinephrine?
No information is available on the use of epinephrine during breastfeeding. Because of its poor oral bioavailability and short half-life, any epinephrine in milk is unlikely to affect the infant. High intravenous doses of epinephrine might reduce milk production or milk letdown. Low-dose intramuscular (such as Epi-Pen), epidural, topical, inhaled or ophthalmic epinephrine are unlikely to interfere with breastfeeding. To substantially diminish the effect of the drug after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
Maternal / infant drug levels
No information is available on the use of epinephrine during breastfeeding. Because of its poor oral bioavailability and short half-life, any epinephrine in milk is unlikely to affect the infant. High intravenous doses of epinephrine might reduce milk production or milk letdown. Low-dose intramuscular (such as Epi-Pen), epidural, topical, inhaled or ophthalmic epinephrine are unlikely to interfere with breastfeeding. To substantially diminish the effect of the drug after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.
Possible effects of Epinephrine on milk supply
Relevant published information in nursing mothers was not found as of the revision date. Intravenous epinephrine infusion in nonnursing subjects and in women with hyperprolactinemia decreases serum prolactin concentrations.[1] Animal data indicate that intraarterial epinephrine can decrease serum oxytocin and inhibit milk ejection.[2][3] However, low-dose infusion of epinephrine as part of epidural analgesia does not impair breastfeeding in nursing mothers.[4][5] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.
An Egyptian study compared lidocaine 2% (n = 75) to lidocaine 2% plus epinephrine 1:200,000 (n = 70) as a wound infiltration following cesarean section. Patients who received epinephrine in combination with lidocaine began breastfeeding at 89 minutes following surgery compared to 132 minutes for those receiving lidocaine alone. The difference was statistically significant.[6]
Possible alternatives to Epinephrine
None listed
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Nicoletti I, Filipponi P, Sfrappini M et al. Catecholamines and pituitary function. I. Effects of catecholamine synthesis inhibition and subsequent catecholamine infusion on gonadotropin and prolactin serum levels in normal cycling women and in women with hyperprolactinemic amenorrhea. Horm Res. 1984;19:158-70. PMID: 6425187
2. Gorewit RC, Aromando MC. Mechanisms involved in the adrenalin-induced blockade of milk ejection in dairy cattle. Proc Soc Exp Biol Med. 1985;180:340-7. PMID: 4048172
3. Song SL, Crowley WR, Grosvenor CE. Evidence for involvement of an adrenal catecholamine in the beta-adrenergic inhibition of oxytocin release in lactating rats. Brain Res. 1988;457:303-9. PMID: 2851365
4. Radzyminski S. The effect of ultra low dose epidural analgesia on newborn breastfeeding behaviors. J Obstet Gynecol Neonatal Nurs. 2003;32:322-31. PMID: 12774874
5. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. 2005;21:305-14. PMID: 16113019
6. Tharwat AA, Yehia AH, Wahba KA et al. Efficacy and safety of post-cesarean section incisional infiltration with lidocaine and epinephrine versus lidocaine alone in reducing postoperative pain: A randomized controlled double-blinded clinical trial. J Turk Ger Gynecol Assoc. 2016;17:1-5. PMID: 27026771
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
