After an adrenaline injection, transient and minor adverse effects occur in most patients. They include anxiety, fear, restlessness, headache, dizziness, palpitations, tremor and pallor. Studies have shown minimal cardiovascular effects in children.2 Serious adverse effects are rare.
Intramuscular adrenaline (1:1000) in doses of 0.01 mg/kg is not associated with clinically significant cardiotoxicity, even if given inadvertently in the absence of acute anaphylaxis.3 The reluctance to give adrenaline due to fear of adverse cardiac effects should be countered by the awareness that coronary artery spasm, myocardial ischaemia and infarction, and dysrhythmias can occur in untreated anaphylaxis.4,5 However, patients on non-selective beta-blocking drugs may experience severe hypertension6 and bradycardia when they are given adrenaline.
Precautions are relative as adrenaline autoinjectors are intended for use in life-threatening anaphylaxis. There are no absolute contraindications to the administration of adrenaline for anaphylaxis.7
Patients should be monitored by a health professional for a minimum of four hours after the last dose of adrenaline. This is in case further doses are needed.