Epinephrine Dose for Contrast Reactions

• Intramuscular: This is the first-line treatment. Use 1:1,000 concentrated epinephrine injected in the lateral aspect of the thigh. Dose is 0.01 mg/kg body weight up to a total of 0.5 mg. Usual doses: 0.1–0.5 mg of 1:1,000 concentrated epinephrine.
• Intravenous: Must be dilute, given slowly, and titrated for effect in a monitored patient. Fatal adverse reactions, though rare, can occur. Intravenous route may have to be used for a life-threatening reaction unresponsive to intramuscular injection. Usual doses: 5 mcg to 0.5 mg of 1:10,000 concentrated epinephrine.
• Subcutaneous: Not as effective. May be no better than placebo. The 1:1,000 concentrated epinephrine is used. Usual doses: 0.1–0.5 mg of 1:1,000 concentrated epinephrine.

References

Lightfoot CB, Abraham RJ, Mammen T, Abdolell M, Kapur S, Abraham RJ. Survey of radiologists' knowledge regarding the management of severe contrast material-induced allergic reactions. Radiology. 2009 Jun;251(3):691-6.