Adrenergic amines are drugs that stimulate the sympathetic nervous system (also called the adrenergic nervous

system).
These compounds are also called sympathomimetic drugs. The sympathetic nervous system is the part of the autonomic
nervous system that originates in the thoracic (chest) and lumbar (lower back) regions of the spinal cord and regulates
involuntary reactions to stress. It stimulates the heartbeat, sweating, breathing rate, and other stress-related body processes.

Purpose
Adrenergic drugs have many uses. They are used to increase the output of the heart, to raise blood pressure, and to increase
urine flow as part of the treatment of shock. Adrenergics are also used as heart stimulants. They may be given to a patient to
reverse the drop in blood pressure that is sometimes caused by general anesthesia. They may be used to stop bleeding by
causing the blood vessels to constrict, and to keep local anesthetics in a small area of the body by closing off the nearby blood
vessels that would otherwise spread the anesthetic to other parts of the body. This ability to make blood vessels constrict
makes adrenergics useful in reducing nasal stuffiness associated with colds and allergies. They may also be given to open the
bronchi (the tubes leading to the lungs) for treatment of asthma and chronic obstructive pulmonary disease (COPD).

Description
There are several types of adrenergic receptors in the human body. Although all types of adrenergic receptors (nerve
endings) respond to the same drugs, the effects depend on which specific receptors are stimulated. The alpha receptors make
the heart beat faster, the pupils of the eyes dilate, and the muscles contract. The beta receptors have similar effects and also
cause the bronchi in the lungs to open up. Both alpha and beta receptors are divided into subgroups—alpha-1, alpha-2, beta-
1, and beta-2—each with its own specific effects. A hormone called norepinephrine that is secreted in the body affects all
types of adrenergic receptors; the drugs used in medicine and surgery, however, have been developed to affect only specific
types of receptors.

There are several adrenergic amines in common use:

 Albuterol (Alupent, Ventolin, others): given by mouth or as a nasal spray to improve breathing.
 Dobutamine (Dobutrex and generic forms): used to stimulate the heart during surgery or after a heart attack or
cardiac arrest.
 Dopamine (Intropin): used to increase cardiac output, blood pressure, and urine flow in treating patients with
shock.
 Epinephrine (Adrenalin): used locally to control bleeding from arterioles and capillaries during surgery. It is used
to treat shock, as a heart stimulant, and as a decongestant. Epinephrine may be added to local anesthetics to keep
the anesthetic in the area where it is applied. Epinephrine may also be applied to the eye to reduce the symptoms of
conjunctivitis (red eye).
 Isoproteranol: most widely used to ease breathing problems in asthma and COPD, but also used to control several
types of irregular heartbeat until a pacemaker can be implanted.
 Phenylephrine (Neo-Synephrine): used to treat shock and low blood pressure; also used in the form of nose drops
or spray to relieve nasal congestion from colds and allergies.
 Metaraminol (Aramine): used to raise the blood pressure and stimulate the heart in treating patients with shock.
  Norepinephrine (Levophed): used to increase the output of the heart and raise blood pressure as part of the
treatment of shock.

Recommended dosage
The recommended dosage of an adrenergic drug depends on the specific compound, the purpose for which it is given, and
the route of administration (oral or intravenous).

People who use adrenergic amines to treat breathing problems or conjunctivitis (red eye) should not use over-the-counter
preparations of these drugs as an alternative to seeking professional care. These medications may temporarily relieve the
symptoms of some disorders but will not cure the underlying problems, which may be serious.

Precautions
When adrenergic amines are given during surgery, they will be administered by an anesthesiologist or other health care
professional skilled in their use. It is the anesthesiologist's responsibility to exercise appropriate care when these drugs are
used during an operation.

The following are some of the hazards associated with the use of adrenergic amines. Patients under anesthesia may not be
aware of these side effects:

 nervousness
 rapid heart beat
 high blood pressure
 irregular heart beat
 rapid heartbeat
 chest pain
 dizziness
 dry mouth
 headache
 flushing
 nausea
 vomiting
 weakness

Before undergoing procedures that may involve the use of an adrenergic amine, people with any of these medical problems
should make sure their physicians know about them:

 narrow-angle glaucoma
 liver disease
 enlarged heart
 disorders affecting the arteries and veins
 diseases and disorders affecting the blood supply to the brain
Side effects
The most common side effects of adrenergic amines are nervousness, agitation, and wakefulness. These side effects do not
usually cause problems when the drugs are given during surgery or in combination with local anesthetics.

The following side effects sometimes occur when adrenergic amines are used to treat nasal congestion due to allergies or
infections:

 rapid heartbeat
 increased sweating
 nervousness
 hallucinations
 sleep disturbances
 paleness

Other rare side effects may occur. Anyone who has unusual symptoms after taking adrenergic amines should contact his or
her physician right away.

Interactions
Adrenergic amines may interact with many different types of drugs. People should discuss the use of these drugs with their
pharmacist or physician before using over-the-counter preparations that contain them for colds or allergies. Patients
scheduled for surgery should be sure to give the surgeon and anesthesiologist a list of all the drugs they take, including
nonprescription, herbal, and alternative preparations. Some drugs that interact with adrenergic amines should be
discontinued several days before surgery, since they last for a long time after the last dose.

Drugs that may interact with adrenergic amines include:

 furazolidone (Furoxone)
 tricyclic antidepressants (Adapin, Asendin, Aventyl, Elavil, Endep, Norpramin, Pamelor, Sinequan, Surmontil,
Tofranil, Vivactil)
 guanethidine (Ismelin)
 methyldopa (Aldomet)

Herbs that have been reported to interact with adrenergic amines include ephedra (ma huang), often sold in over-the-
counter weight loss formulas; St. John's wort, a popular remedy for anxiety or depression; alfalfa; hibiscus; ginseng; angelica
(dong quai); and yohimbe.

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