Patient/caregiver was educated on how to take Epinephrine as follows:

1. Take this medication as ordered by your physician. Do not change the dose on this medication without consulting your doctor.
2. Epinephrine is mainly administered as a shot, via subcutaneous, intramuscular, and intravenous routes, for management of allergies, anaphylaxis, and cardiac stimulation. Epinephrine could be administered as a shot, directly into the heart muscle, to stimulate the heart, during emergencies situations, such as, cardiac arrest. Epinephrine could also be administered in a nebulizer, mixed with sodium chloride solution, for relief of asthma in emergencies. Administer the medication via the prescribed route only.
3. Epinephrine can be prescribed for regular use, to individuals with history of hypotension and bradycardia, as epinephrine tends to elevate the blood pressure and heart rate. For regular use, take the medication dose at the same time, every day, for the duration prescribed, to avoid forgetting the intake of medication.
4. Epinephrine could also be used in emergency situations, on an as needed basis, for management of episodes of severe exacerbation of asthma, treatment of anaphylaxis, and management of cardiac arrest. For individuals receiving epinephrine only during emergencies, training a caregiver on epinephrine administration would be of great help, as you would not able to administer the shot yourself during the emergency.
5. Before every use, make sure the solution in the medication bottle appears clear, without any discoloration or particulate matter. If you notice any cloudiness in the medication bottle or particulate matter or coloration, discard the medication appropriately and call your physician to have the medication reordered.
6. While administering epinephrine intramuscularly, avoid administering epinephrine into distal body parts, such as, fingers and toes. Epinephrine administration into fingers and toes can result in closing the blood vessels down locally, around the site of injection, thus shutting off the blood supply to the distal body parts. Over the course of time, this can result in tissue death, necrosis, and ulcers that are difficult to heal, in the distal body parts. These non-healing ulcers in the distal body parts can be an even bigger problem in individuals with history of diabetes and chronic smoking. Report to your physician regarding any accidental administration of epinephrine into the distal body parts and seek emergency intervention, to avoid any serious outcomes, such as, tissue necrosis and consequent amputation of digits and toes.
7. Epinephrine should always be administered into a bigger muscle, with reasonably good blood supply, such as, into the bulkier portion of middle of the thigh. Also, repeated epinephrine administration into the same site can result in closing the blood vessels down locally, around the site of injection, thus shutting off the blood supply in that area, which can reduce the absorption of epinephrine from the site of injection, thus compromising the therapeutic advantage. This can also result in tissue death and necrosis in the site of repeated epinephrine administration. So, change the site of epinephrine administration for each use, by alternating between the thighs. Maintaining a log on the site used can help to observe compliance with alternating the sites and avoid the complication of tissue necrosis from developing.
8. Also, avoid administering epinephrine into the limb, with a diagnosis of compromised blood circulation or peripheral vascular disease. Poor blood supply in the limb can reduce the absorption of epinephrine, thus compromising the therapeutic benefit of the medication.
9. While administering epinephrine intravenously, observe caution to avoid extravasation of epinephrine from the vein into the surrounding tissue. Check the infusion site regularly, to make sure there is extravasation of epinephrine from the vein and no blanching is noted around the site of infusion. Extravasation of epinephrine from the vein into the surrounding tissue can result in closing the blood vessels down locally, around the site of extravasation, thus shutting off the blood supply in the neighboring tissue. Over the course of time, this can result in tissue death, necrosis, and ulcers, which can be difficult to heal. If extravasation and blanching is noted, report it to your physician, so that, the site of infusion could be changed.
10. While administering epinephrine subcutaneously, observe caution to administer the shot under the skin and not into the skin. After the shot is administered, gently massage on the site of injection, to enhance blood supply to the site, which can promote quicker absorption of epinephrine, thus providing a therapeutic advantage.
11. Repeated epinephrine administration into the same subcutaneous site can result in closing the blood vessels down locally, around the site of injection, thus shutting off the blood supply in that area, which can reduce the absorption of epinephrine from the site of injection, thus compromising the therapeutic advantage. This can also result in tissue death and necrosis in the site of repeated epinephrine administration. So, change the site of subcutaneous epinephrine administration for each use, by alternating between various subcutaneous sites.
12. Administering any local anesthetics into the same site of epinephrine administration can multiply the risk for local narrowing of blood vessels, compromised local blood supply, tissue death, and necrosis. So, avoid administering any local anesthetics into the site of epinephrine administration. If you are undergoing any surgical procedure, please notify your surgeon regarding your epinephrine use and the sites you generally employ for administering the epinephrine shot.
13. As epinephrine administration can compromise blood supply in the surrounding tissues, the site of administration can present with numbness, altered sensation, coldness, and pallor. Secondary to poor oxygenated blood supply, the site of epinephrine administration and surrounding tissues can sometimes present with signs and symptoms of infection, such as, redness, pain and tenderness, and swelling. Closely observe for development of any of these findings and report them to your physician appropriately, for a change in plan of care to be considered. Avoid using sites with compromised blood supply and tissue damage for epinephrine administration, as it can complicate the condition further.
14. Epinephrine use can result in elevated blood pressure, headache, dizziness, and rapid heart rate. This can be a serious issue, especially in individuals with history of hypertension. Discuss with your physician regarding any history of blood pressure, arrhythmias, asthma, peripheral artery disease, chest pain, and myocardial infarction/heart attack and your safety with using epinephrine. Observe compliance with everyday blood pressure and heart rate recordings and log maintenance of the readings, while using epinephrine. Report to your physician regarding any poorly controlled blood pressure and grossly elevated heart rate numbers, for a possible appropriate change on dose of your medication.
15. Patients taking epinephrine on a regular basis should continue taking it as ordered, even if the symptoms of poor cardiac function and shortness of breath are under control. Abrupt discontinuation on epinephrine intake can result in episodes of extreme shortness of breath, low blood pressure and slow heart rate, with dizziness and headache. Discontinuing the medication should only be on your physician’s recommendation.
16. Your physician could change the dose of epinephrine, based on the relief obtained from symptoms or side-effects developed. So, maintain compliance with follow-up physician appointments, to update on the relief from symptoms and overall health status. Be accommodative to the plan of dose changes, until you show an optimum response.
17. If you miss a dose, try taking it at the earliest notice of noncompliance. If it is time for the next dose, skip the missed dose and take the dose scheduled. Do not take an extra dose to try making up for the missed dose, as it can lead to toxicity with the drug. Notify your doctor and other health care personnel regarding your dose noncompliance.