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Weight-based intramuscular epinephrine dosing and administration for anaphylaxis in health care settings

In patients with severe symptoms or who are rapidly deteriorating, use an autoinjector if drawing up the dose will cause a significant delay. There are three available autoinjector strengths: 0.1 mg (Auvi-q), 0.15 mg (EpiPen Jr, others), 0.3 mg (EpiPen, others)
Weight	Preferred	Alternative
<10 kg (infants)	Draw up 0.01 mg/kg (0.01 mL/kg of epinephrine 1 mg/mL)	0.1 mg autoinjector If not available, 0.15 mg autoinjector may be given OR draw up 0.1 mg (0.1 mL of epinephrine 1 mg/mL)
10 to 25 kg (infants and children)	0.15 mg autoinjector	Draw up 0.15 mg (0.15 mL of epinephrine 1 mg/mL)
>25 to 50 kg	0.3 mg autoinjector	Draw up 0.3 mg (0.3 mL of epinephrine 1 mg/mL)
>50 kg	Draw up 0.5 mg (0.5 mL of epinephrine 1 mg/mL)	0.3 mg autoinjector

If the dose is to be drawn up, confirm that the 1 mg/mL epinephrine solution is being used. Draw up into a 1 mL syringe. The intramuscular injection is given into the mid-outer thigh.
If using an autoinjector, it should be held in place for three seconds after the injection, which is sufficient to deliver the dose.
Most patients respond to a single dose of intramuscular epinephrine. However, if there is no response or an inadequate response, then intramuscular epinephrine may be repeated at 5- to 15-minute intervals or sooner, if clinically indicated.

Data From:

Sicherer SH, Simons FER. Epinephrine for first-aid management of anaphylaxis. Pediatrics 2017; 139:e20164006.

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