Q: What is the preferred route of epinephrine in anaphylaxis?
A) Intra-Venous (IV)
B) Intra-Muscular (IM)
C) Subcutaneous (SC)
IM route is the preferred, both over SC and IV routes. Obviously, over SC, it provides a quicker increase in the plasma and tissue concentrations. IM route is also preferred over IV bolus as IV bolus of "Epi" carries an inherent risk of cardiovascular complications.
1. Simons FE, Gu X, Simons KJ. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol 2001; 108:871.
2. Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract 2015; 3:76.