EPINEPHRINE ASCORBATE

US Approved OTC

First marketed in 1901

Details

Stereochemistry	ABSOLUTE
Molecular Formula	C9H13NO3.C6H8O6
Molecular Weight	359.3285
Optical Activity	UNSPECIFIED
Defined Stereocenters	3 / 3
E/Z Centers	0
Charge	0

SHOW SMILES / InChI

Structure Search

SMILES

[H][C@@]1(OC(=O)C(O)=C1O)[C@@H](O)CO.CNC[C@H](O)C2=CC=C(O)C(O)=C2

InChI

InChIKey=KOUXVSUXTJGEEM-GJZRPOMESA-N

InChI=1S/C9H13NO3.C6H8O6/c1-10-5-9(13)6-2-3-7(11)8(12)4-6;7-1-2(8)5-3(9)4(10)6(11)12-5/h2-4,9-13H,5H2,1H3;2,5,7-10H,1H2/t9-;2-,5+/m00/s1

HIDE SMILES / InChI

Molecular Formula	C9H13NO3
Molecular Weight	183.2044
Charge	0
Count

Stereochemistry	ABSOLUTE
Additional Stereochemistry	No
Defined Stereocenters	1 / 1
E/Z Centers	0
Optical Activity	UNSPECIFIED

Molecular Formula	C6H8O6
Molecular Weight	176.1241
Charge	0
Count

Stereochemistry	ABSOLUTE
Additional Stereochemistry	No
Defined Stereocenters	2 / 2
E/Z Centers	0
Optical Activity	UNSPECIFIED

Description
Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/204200s000lbl.pdf | https://www.ncbi.nlm.nih.gov/pubmed/8401205

Epinephrine is a sympathomimetic catecholamine. It acts as a naturally occurring agonist at both alpha and beta-adrenergic receptors. Three pharmacologic types have been identified: alpha 1-, alpha 2-, and beta-adrenergic receptors. Each of these has three subtypes, characterized by both structural and functional differences. The alpha 2 and beta receptors are coupled negatively and positively, respectively, to adenylyl cyclase via Gi or Gs regulatory proteins, and the alpha 1 receptors modulate phospholipase C via the Go protein. Subtype expression is regulated at the level of the gene, the mRNA, and the protein through various transcriptional and postsynthetic mechanisms. Through its action on alpha-adrenergic receptors, epinephrine lessens the vasodilation and increased vascular permeability that occurs during anaphylaxis, which can lead to loss of intravascular fluid volume and hypotension. Through its action on beta-adrenergic receptors, epinephrine causes bronchial smooth muscle relaxation and helps alleviate bronchospasm, wheezing and dyspnea that may occur during anaphylaxis. Epinephrine also alleviates pruritus, urticaria, and angioedema and may relieve gastrointestinal and genitourinary symptoms associated with anaphylaxis because of its relaxer effects on the smooth muscle of the stomach, intestine, uterus and urinary bladder. Epinephrine increases glycogenolysis, reduces glucose up take by tissues, and inhibits insulin release in the pancreas, resulting in hyperglycemia and increased blood lactic acid.

CNS Activity

Originator

Approval Year

Targets

Primary Target	Pharmacology	Condition	Potency
Adrenergic receptor 35 Target ID: CHEMBL2331074 Sources: https://www.ncbi.nlm.nih.gov/books/NBK28138/ \| https://www.ncbi.nlm.nih.gov/pubmed/8401205	Agonist 2678
Dopamine D4 receptor 71 Target ID: CHEMBL219 Sources: https://www.ncbi.nlm.nih.gov/pubmed/9003072	Agonist 2678		33.0 nM [Ki]

Conditions

Condition	Modality	Targets	Highest Phase	Product
Anaphylaxis 46 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/204200s000lbl.pdf	Primary		Approved 8429	ADRENALIN Approved Use Adrenalin® is a non-selective alpha and beta adrenergic agonist indicated for:  Emergency treatment of allergic reactions (Type 1), including anaphylaxis  Induction and maintenance of mydriasis during intraocular surgery
Miosis 6 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/204200s000lbl.pdf	Preventing		Approved 8429	ADRENALIN Approved Use Adrenalin® is a non-selective alpha and beta adrenergic agonist indicated for:  Emergency treatment of allergic reactions (Type 1), including anaphylaxis  Induction and maintenance of mydriasis during intraocular surgery

C_max

Value	Dose	Analyte	Population
309 pg/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/26994624	0.3 mg single, intramuscular dose: 0.3 mg route of administration: Intramuscular experiment type: SINGLE co-administered:	EPINEPHRINE plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
386 pg/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/26994624	5 mg multiple, nasal dose: 5 mg route of administration: Nasal experiment type: MULTIPLE co-administered:	EPINEPHRINE plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
0.486 ng/mL EXPERIMENT https://www.jacionline.org/article/S0091-6749(11)02197-X/pdf	0.3 mg single, intramuscular dose: 0.3 mg route of administration: Intramuscular experiment type: SINGLE co-administered:	EPINEPHRINE unknown	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN

AUC

Value	Dose	Analyte	Population
18.3 ng × min/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/26994624	0.3 mg single, intramuscular dose: 0.3 mg route of administration: Intramuscular experiment type: SINGLE co-administered:	EPINEPHRINE plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
19.4 ng × min/mL EXPERIMENT https://www.ncbi.nlm.nih.gov/pubmed/26994624	5 mg multiple, nasal dose: 5 mg route of administration: Nasal experiment type: MULTIPLE co-administered:	EPINEPHRINE plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
0.724 ng × h/mL EXPERIMENT https://www.jacionline.org/article/S0091-6749(11)02197-X/pdf	0.3 mg single, intramuscular dose: 0.3 mg route of administration: Intramuscular experiment type: SINGLE co-administered:	EPINEPHRINE unknown	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN

Doses

Dose	Population	Adverse events
0.3 mg 1 times / day single, intramuscular Recommended Dose: 0.3 mg, 1 times / day Route: intramuscular Route: single Dose: 0.3 mg, 1 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/201739Orig1s000MedR.pdf Page: nda/2012/201739Orig1s000MedR.pdf - p.55	healthy, 18 to 45 years old n = 66 Health Status: healthy Age Group: 18 to 45 years old Sex: M+F Population Size: 66 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/201739Orig1s000MedR.pdf Page: nda/2012/201739Orig1s000MedR.pdf - p.55	Disc. AE: Ventricular extrasystoles... AEs leading to discontinuation/dose reduction: Ventricular extrasystoles (grade 1, 1.5%) Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/201739Orig1s000MedR.pdf Page: nda/2012/201739Orig1s000MedR.pdf - p.55

AEs

AE	Significance	Dose	Population
Ventricular extrasystoles	grade 1, 1.5% Disc. AE	0.3 mg 1 times / day single, intramuscular Recommended Dose: 0.3 mg, 1 times / day Route: intramuscular Route: single Dose: 0.3 mg, 1 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/201739Orig1s000MedR.pdf Page: nda/2012/201739Orig1s000MedR.pdf - p.55	healthy, 18 to 45 years old n = 66 Health Status: healthy Age Group: 18 to 45 years old Sex: M+F Population Size: 66 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/201739Orig1s000MedR.pdf Page: nda/2012/201739Orig1s000MedR.pdf - p.55

Overview

CYP3A4	CYP2C9	CYP2D6	hERG
inducer 781	inhibitor 1767	inhibitor 1852

OverviewOther

Other Inhibitor	Other Substrate	Other Inducer
CYP3A 214	OCT2 355 OCT3 80	CYP2B6 547 OCT1 35

Drug as perpetrator

Target	Modality	Activity
CYP2C9 1819	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/19356039/ Page: 2.0	yes [Ki 156 uM]
CYP3A 298	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/19356039/ Page: 2.0	yes [Ki 42.3 uM]
CYP2D6 1891	inhibitor 3277 Sources: https://pubmed.ncbi.nlm.nih.gov/19356039/ Page: 2.0	yes [Ki 707 uM]
CYP2B6 1001	inducer 1573 Sources: https://www.tandfonline.com/doi/abs/10.3109/00498254.2014.955831 Page: 8.0	yes
CYP3A4 1925	inducer 1573 Sources: https://www.tandfonline.com/doi/abs/10.3109/00498254.2014.955831 Page: 8.0	yes
OCT1 543	inducer 1573 Sources: https://www.tandfonline.com/doi/abs/10.3109/00498254.2014.955831 Page: 8.0	yes

Drug as victim

Target	Modality	Activity	Metabolite	Clinical evidence
OCT2 355	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/16581093/	yes
OCT3 80	substrate 3367 Sources: https://pubmed.ncbi.nlm.nih.gov/16581093/	yes

PubMed

Title	Date	PubMed
Effects of succinylcholine and d-tubocurarine on epinephrine-induced arrhythmias during halothane anesthesia in dogs.	1975 Jan	1111370
[Experimental anti-arrhythmic effects of a new beta-adrenergic receptor blocking agent, dl-l-(tert. butylamino)-3-[(2-propinyloxy)phenoxy]2-propanol hydrochloride (dl Kö 1400-Cl)].	1976 Jul	11153
More Horner's than meets the eye.	2000	10886715
Central retinal artery occlusion after a local anesthetic with adrenaline on nasal mucosa.	2000 Dec	11130745
Low catecholamine concentrations protect adult rat ventricular myocytes against apoptosis through cAMP-dependent extracellular signal-regulated kinase activation.	2000 Dec	11093795
Effects of ubiquinone-10 on energy metabolism and lipid peroxidation in rats with myocardial ischemia.	2000 Jul	11140574
[Lactic acidosis: a complication of spinal cord injury in multiple trauma].	2000 Jun	10925653
Cardiovascular studies on different classes of soft drugs.	2000 Mar	10756546
[Acute toxic accident following lumbar plexus block with bupivacaine].	2000 May	10874433
Beta-adrenergic modulation of NNK-induced lung carcinogenesis in hamsters.	2000 Nov	11079726
Influence of antioxidants on blood-brain barrier permeability during adrenaline-induced hypertension.	2000 Nov	11069044
Enabling sutureless vascular bypass grafting with the exovascular sleeve anastomosis.	2000 Sep	10957659
The effects of epidural block on the distribution of lymphocyte subsets and natural-killer cell activity in patients with and without pain.	2001 Feb	11159252
[(123)I]metaiodobenzylguanidine and [(111)In]octreotide uptake in begnign and malignant pheochromocytomas.	2001 Feb	11158032
Plasma catecholamine and cardiovascular responses to physostigmine in Alzheimer's disease and aging.	2001 Feb	11087961
Key role of the P2Y(1) receptor in tissue factor-induced thrombin-dependent acute thromboembolism: studies in P2Y(1)-knockout mice and mice treated with a P2Y(1) antagonist.	2001 Feb 6	11156884
Early neurohormonal effects of trandolapril in patients with left ventricular dysfunction and a recent acute myocardial infarction: a double-blind, randomized, placebo-controlled multicentre study.	2001 Jan	11163738
Contrasting clinical properties and exercise responses in obese and lean hypertensive patients.	2001 Jan	11153733
Guanabenz, an antihypertensive centrally acting alpha2-agonist, suppresses morning elevations in aggregation of human platelets.	2001 Jan	11152378
Regulation of endothelin-1 production in cultured rat vascular smooth muscle cells.	2001 Jan	11152371
Plasma concentrations and pharmacokinetics of bupivacaine with and without adrenaline following caudal anaesthesia in infants.	2001 Jan	11152032
The PlA polymorphism of glycoprotein IIIa functions as a modifier for the effect of estrogen on platelet aggregation.	2001 Jan	11151063
Reversal of Haemorrhagic Shock in Rats by Tetrahydroaminoacridine.	2001 Jan	11150921
Hormonal responses to exercise in chronic fatigue syndrome.	2001 Jan	11150897
Genitourinary injuries in the newborn.	2001 Jan	11150473
Fatalities due to anaphylactic reactions to foods.	2001 Jan	11150011
Viral croup.	2001 Jan	11139641
Effects of high extracellular [K+] and adrenaline on force development, relaxation and membrane potential in cardiac muscle from freshwater turtle and rainbow trout.	2001 Jan	11136612
Effects of human pregnancy on cardiac autonomic function above and below the ventilatory threshold.	2001 Jan	11133925
Catecholamine responses to alpha-adrenergic blockade during exercise in women acutely exposed to altitude.	2001 Jan	11133901
Adrenergic receptor activated ion transport in human fetal retinal pigment epithelium.	2001 Jan	11133877
Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes.	2001 Jan	11133627
Dexamethasone facilitates discharge after outpatient anorectal surgery.	2001 Jan	11133606
Cardiac resuscitation after incremental overdosage with lidocaine, bupivacaine, levobupivacaine, and ropivacaine in anesthetized dogs.	2001 Jan	11133597
Neurotransmitter release from bovine adrenal chromaffin cells is modulated by capacitative Ca(2+)entry driven by depleted internal Ca(2+)stores.	2001 Jan	11133355
Neonatal catecholamine levels and neurodevelopmental outcome: a cohort study.	2001 Jan	11124926
Hypoxic vasoconstriction of cyclostome systemic vessels: the antecedent of hypoxic pulmonary vasoconstriction?	2001 Jan	11124152
A single bout of exercise induces beta-adrenergic desensitization in human adipose tissue.	2001 Jan	11124148
An accidental ringblock of the great toe?	2001 Jan	11123745
Chromaffin-adrenocortical cell interactions: effects of chromaffin cell activation in adrenal cell cocultures.	2001 Jan	11121377
Lack of effect of incretin hormones on insulin release from pancreatic islets in the bile duct-ligated rats.	2001 Jan	11120659
Reference intervals for glucose, beta-cell polypeptides, and counterregulatory factors during prolonged fasting.	2001 Jan	11120658
Cardiovascular effects of hypercarbia in rainbow trout (Oncorhynchus mykiss): a role for externally oriented chemoreceptors.	2001 Jan	11104715
Neuroendocrine responses to experimentally-induced psychological stress in healthy humans.	2001 Jan	11070337
Development of glaucoma after phacoemulsification for removal of cataracts in dogs: 22 cases (1987-1997).	2001 Jan 1	11149718
Synthesis and characterization of an immobilized phenylethanolamine N-methyltransferase liquid chromatographic stationary phase.	2001 Jan 1	11141309
Embryonic epinephrine synthesis in the rat heart before innervation: association with pacemaking and conduction tissue development.	2001 Jan 19	11139483
The role of nitric oxide in bradycardia of rats with obstructive cholestasis.	2001 Jan 5	11137868
Mice with a deletion in the gene for CCAAT/enhancer-binding protein beta have an attenuated response to cAMP and impaired carbohydrate metabolism.	2001 Jan 5	11024029
Effect of amlodipine on cardiopulmonary performance in volunteers.	2001 Jan-Feb	11153533

Patents

Sample Use Guides

In Vivo Use Guide

Anaphylaxis: o Adults and Children 30 kg (66 lbs) or more: 0.3 to 0.5 mg (0.3 to 0.5 mL) intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary o Children 30 kg (66 lbs) or less: 0.01 mg/kg (0.01 mL/kg), up to 0.3 mg (0.3 mL), intramuscularly or subcutaneously into anterolateral aspect of the thigh every 5 to 10 minutes as necessary (2.1) Intraocular surgery: Dilute 1 mL with 100 to 1000 mL of an ophthalmic irrigation fluid, for ophthalmic irrigation or intracameral injection

Route of Administration: Other

In Vitro Use Guide

Treatment of primary human hepatocytes with 10μM epinephrine for 24h repressed mRNA expression of various transporters, such as the sinusoidal influx transporters NTCP, OATP1B1, OATP2B1, OAT2, OAT7 and OCT1 and the efflux transporters MRP2, MRP3 and BSEP, whereas it induced that of MDR1, but failed to alter that of BCRP.

Substance Class	Chemical Created by `admin` on `Sat Dec 16 10:58:30 GMT 2023` Edited by `admin` on `Sat Dec 16 10:58:30 GMT 2023`
Record UNII	QH0PJV94AX
Record Status	`Validated (UNII)`
Record Version

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Name

Type

Language

EPINEPHRINE ASCORBATE

Common Name

English

L-ASCORBIC ACID, COMPD. WITH (R)-4-(1-HYDROXY-2-(METHYLAMINO)ETHYL)-1,2-BENZENEDIOL (1:1)

Systematic Name

English

TONHORMON

Brand Name

English

Epinephrine ascorbate [WHO-DD]

Common Name

English

1,2-BENZENEDIOL, 4-(1-HYDROXY-2-(METHYLAMINO)ETHYL)-, COMPD. WITH L-ASCORBIC ACID (1:1)

Common Name

English

Code System Code Type Description

PUBCHEM

69652297