Despite concerns regarding administration of adrenaline to patients with co-existing medical conditions it is important to remember that adrenaline is used to treat a potentially life threatening allergic reaction and these concerns should not prevent prompt treatment.

Patients with these co-existing conditions will require closer observation following administration of adrenaline.

Contra-indications €“ there are no absolute contra-indications to the use of adrenaline in the treatment of anaphylaxis.

Cautions - adrenaline should not be administered into the gluteus maximus muscle because of the risk of administration into a vein.

Adrenaline should be used with caution in patients with existing heart disease including angina, cardiac arrhythmia, cor pulmonale, obstructive cardiomyopathy or atherosclerosis.

Adverse reactions are also possible when adrenaline is administered to patients with hyperthyroidism, hypertension, phaeochromocytoma, glaucoma, severe renal impairment, prostate adenoma, hypercalcaemia, hypokalaemia and in elderly or pregnant patients. Patients with Parkinson's disease may notice a slight worsening of symptoms of rigidity and tremor when administered adrenaline.

Accidental injection of adrenaline into hands or feet can result in reduced blood flow to these areas and possible peripheral ischaemia.

Patients who have accidentally administered adrenaline should be referred to their local accident and emergency department.