It is applied to cope with hypotension, concomitant spinal anesthesia; as a pressor agent in hypotonic states after sympathectomy or in overdosage with ganglionblockers and antiadrenergics, applied in arterial hypertension.
Dosage and administration:
The drug may be applied subcutaneously, intramuscularly and intravenously. It should be known that even the lowest therapeutic doses in normotensive patients may lead to elevation of arterial pressure by 15-20 mm Hg. In patients with severe hypotension Ephedrinum hydrochloricum should be applied with caution and to use maximum the highest therapeutic doses for a short period of time, when it is necessary to take extra measures to correct the arterial pressure like infusion of volume-substitution solutions. As a pressor drug, Ephedrinum hydrochloricum is applied usually subcutaneously or intramuscularly in a dose of 25-50 mg at dosage limits of 10-50 mg. If necessary, an extra intramuscular dose of 50 mg or 25 mg intravenously may be applied. The intravenous application is carried out always slowly and it is recommended even to apply it as a drip infusion for a period of 5-10 min approximately. The maximum parenteral daily dose for adults should not exceed 150 mg. In children it is applied at a daily dose of 3 mg/kg or 100 mg/m2 skin surface subcutaneously or intravenously, divided in 4-6 applications.
Hypersensitivity to sympatomimetic amines, atherosclerosis, severe organic heart diseases, hypertension, closed angle glaucoma, patients who have received prior anesthesia with halothane or cyclopropane (increases sensitivity of myocardium to arrhythmogenic effect of sympatomimetics), thyrotoxicosis, diabetes.
It is antagonist of ganglion-blocking and antiadrenergic medicinal products. Ephedrinum hydrochloricum reduces antihypertensive effect of guanethidine. Alphaadrenergic blockers reduce vasopressor activity of Ephedrinum hydrochloricum, provoking vasodilatation. The combined therapy of reserpine or methyldopa with Ephedrinum hydrochloricum may reduce the pressor effect of the latter. Similar effect may be observed also in the combination of the medicinal product with diuretics. In combination of Ephedrinum hydrochloricum with MAO inhibitors, a sharp increase of blood pressure is possible while in combination with beta-blockers its broncholytic effect is reduced. Ephedrinum hydrochloricum is antagonist of nonnarcotic analgesics and of medicines, inhibiting the central nervous system. Ephedrinum hydrochloricum should be applied with caution in combination with medicines, inhibiting myocardium sensitivity to sympatomimetics – i.e. patients on anesthesia with halothane or cyclopropane or treated with digitalis glycosides. Ephedrinum hydrochloricum should not be combined with other sympatomimeticsdue to danger of additive effect and increasing of toxicity.
The acute toxic effects are resulting normally from the prolonged therapeutic effect of the medicinal product or more often they are due to overdosage. The most serious adverse reaction, caused by excessive doses of Ephedrinum hydrochloricum, is the extreme hypertension with vasoconstriction, related to stimulation of alpha-adrenoreceptors. It may lead to brain hemorrhage. In other cases vasodilatation with hypotension may be observed. At the normal doses, some patients react with short whitening, difficult breathing, tremor, sense of anxiety and disturbance, perplexity and strain, lassitude, palpitation, vertigo, headache, perspiration. Nausea, vomiting and hallucinations are possible. The repeated injection may cause contraction of the sphincter of urinary bladder and impossibility for volitional urination. The danger of difficult urination should be in mind especially in case of elderly men.