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Adrenaline, anaphylaxis and drug interactions

Authoring team

Although there is no absolute contra-indication to giving adrenaline in anaphylaxis, there are some considerations to remember regarding drug-drug interactions in such cases:

  • drugs that can antagonize the pressor effects of adrenaline include α-blockers, vasodilators such as nitrates, diuretics, and antihypertensives. These medications can reduce the vasoconstrictor effects of adrenaline, potentially diminishing its ability to raise blood pressure.
  • drugs that can potentiate the effects of adrenaline include sympathomimetics, β-blockers, tricyclic antidepressants, MAO inhibitors, COMT inhibitors, clonidine, oxytocin, levothyroxine sodium, quinidine, and certain antihistamines. These drugs may enhance the effects of adrenaline, particularly its vasoconstrictive and inotropic actions.
  • drugs that can increase the arrhythmogenic potential of adrenaline include β-blockers, cyclopropane, halogenated hydrocarbon anaesthetics, antihistamines, exogenous thyroid hormones, diuretics, and cardiac glycosides. These drugs may increase the arrhythmogenic potential of adrenaline, requiring close monitoring for the development of cardiac arrhythmias.
  • drugs that may exacerbate hypokalemia induced by adrenaline include potassium-depleting drugs such as corticosteroids, diuretics, and theophylline. These drugs may potentiate the hypokalemic effects of adrenaline, increasing the risk of significant electrolyte disturbances. Careful monitoring of vital signs is crucial, especially in patients with polypharmacy.

Note - previous guidelines recommended adrenaline dose adjustments in certain circumstances (e.g., in patients taking tricyclic antidepressants, the previous recommendation was to give half the dose). This is now considered unhelpful in the setting of an acute anaphylactic reaction.

Reference:

  1. Resuscitation Council (UK). The Emergency Medical Treatment of Anaphylactic Reactions for First Medical Responders and for Community Nurses. January 2008, annotated with links to NICE guidance July 2012, reviewed 2016

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