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Rare cases of myocardial infarction have been associated with relatively small doses of epinephrine in patients at risk for coronary artery disease.Epinephrine can induce hypokalemia with resultant T wave changes on the electrocardiogram.Other local reactions have included injection site pallor, coldness and hypoesthesia or injury at the injection site resulting in bruising, bleeding, discoloration, erythema or skeletal injury.Cardiovascular side effects have included elevations in heart rate or blood pressure in up to 55% and arrhythmias in 3% to 17% (including fatal ventricular arrhythmias) when used to treat cardiac arrest.Applies to epinephrine: injection injectable, injection solution In addition to its needed effects, some unwanted effects may be caused by epinephrine.Epinephrine may be more arrhythmogenic in some patients, such as patients with congenital long QT syndrome.This has caused increased peripheral vascular resistance, which was important in patients with coronary artery disease (worsened myocardial ischemia/angina) or hypertension (risk of emergent hypertension/stroke).You should check with your doctor immediately if any of these side effects occur when taking epinephrine: Incidence not known Applies to epinephrine: compounding powder, inhalation aerosol, inhalation solution, injectable kit, injectable solution, intravenous solution, subcutaneous suspension Nervous system side effects have included fear, agitation, anxiety, tenseness, restlessness, headache, tremor, dizziness, lightheadedness, nervousness, sleeplessness, excitability, weakness, and increased parkinsonian tremors.In smaller doses, epinephrine has caused peripheral coronary arterial vasodilation, but in larger doses, epinephrine has caused diffuse vasoconstriction.Local side effects have included local tissue ischemia after repeated injections.Rare cases of cardiomyopathy have been associated with brief and chronic exposure to epinephrine (including inhaled epinephrine).

Chronic IM epinephrine injections have induced local vasoconstriction, predisposing patients to Clostridial infections.Complications associated with epidural anesthesia with epinephrine have included nerve root ischemia and clinical paralysis/plegia.In the event that any of these side effects do occur, they may require medical attention.Animal studies have shown that catecholamines can cause an influx of calcium into myocardial cells, which may cause myocardial injury, particularly during periods of epinephrine-induced coronary vasoconstriction.Angina may occur in patients with coronary artery disease.

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