Catecholamines: Uses, common brands, and safety info

Catecholamines are natural neurotransmitters released by the body in response to both physical and emotional stress. They include adrenaline, noradrenaline, and dopamine. They are a component of the sympathetic nervous system and central nervous system, and each affects the alpha and beta-adrenergic receptors in the body. These receptors control the pace and force of your heartbeat as well as the dilation of blood vessels. In general, catecholamines work to increase the heart’s function in order to allow the body to respond to stressful situations. 

Catecholamine drugs may be considered vasopressors or inotropes. Vasopressors are used in the treatment of hypotension (low blood pressure) and the hemodynamic instability related to a patient going into shock. Inotropes are medications that increase cardiac output. There are four catecholamine drugs that come in various dosage forms: dobutamine, dopamine, epinephrine, and isoproterenol. Drug choice depends on the purpose of use.

Other catecholamines:

• Medihaler-Iso (isoproterenol)

• Twinject (epinephrine)

• Medihaler-Epi (epinephrine)

• Isuprel (isoproterenol)

• Dobutrex (dobutamine)

• Adrenaclick (epinephrine)

What are catecholamines?

The catecholamine class of medications are a group of synthetic catecholamines designed to mimic the actions of your body’s natural catecholamine neurotransmitters which increase during times of stress. Naturally occurring adrenaline was first extracted from the adrenal gland in the earliest endocrinology studies of the late 1800s. A physician named George Oliver began giving the extract from the adrenal gland to his own son and discovered that his brachial artery narrowed upon receiving the extract. It was subsequently discovered that the extract raised blood pressure. From this point, neuroendocrine research on the effects of catecholamines continued. It was discovered that noradrenaline is the precursor to adrenaline in 1946, and 12 years later, dopamine was discovered. 

These catecholamines are produced in the brain, nerve tissues, and the adrenal glands located just above the kidneys. They each serve different functions in your body’s response. Adrenaline, also known as epinephrine, is released during times of stress primarily from the adrenal medulla (adrenal gland), a part of your endocrine system. This release in response to stress is also referred to as the “fight or flight” syndrome. The release of adrenaline causes increased blood flow to the muscles, heart, and lungs. 

Noradrenaline, also referred to as norepinephrine, is primarily produced in the nerves. 

Dopamine is found throughout the nervous system and plays a role in emotions, memory, and movement. Synthetically produced catecholamine drugs work to mimic the desired effects of these catecholamine neurotransmitters when the body needs them, such as in anaphylactic shock and hypotensive emergencies. Only a health care provider can determine if catecholamine treatment is safe for you.

How do catecholamines work?

Catecholamine drugs are active on the body’s alpha and beta-adrenergic receptors. Alpha receptors primarily play a role in the constriction of smooth muscle and blood vessels. Stimulation of beta receptors of the heart, also known as beta-1 receptors, causes the heart to beat faster and more forcefully. In contrast, beta-2 receptors, located in the lungs and throughout the body, cause relaxation and dilation of the smooth muscle located in your veins and airways. 

The affinity of catecholamine drugs for these receptors is dose-dependent. For instance, epinephrine has a high affinity for beta-1 receptors and moderate affinity for beta-2 receptors at low doses but has a high affinity for alpha receptors and moderate affinity for beta-1 and beta-2 receptors at high doses. This explains why epinephrine, at relatively low doses such as that in Primatene Mist, is effective in asthma because it leads to a relaxation of the smooth muscle of the airways, making it easier to move air to the lungs to provide oxygen to the blood. At high doses, epinephrine, in the form of a subcutaneous injection like EpiPen, is used in conditions such as anaphylactic shock. Anaphylactic shock is an extreme allergic reaction to the body. It causes a drastic drop in blood pressure and a constriction of the airways. Because epinephrine at high doses affects both alpha and beta receptors, it works to constrict blood vessels to keep blood pressure up as well as relax airways to allow easier breathing.

Prior to beginning catecholamine therapy, your health care provider may request urinary or blood samples to run a catecholamine test to determine baseline levels and rule out other

What are catecholamines used for?

• Asthma

• Cardiogenic shock

• Heart failure

• Septic shock

• Anaphylactic shock/ anaphylaxis

• Hypotension

• Cardiac arrest

• Croup

• Bradycardia (low heart rate)

• Surgical bleeding

• Open-angle glaucoma

Who can take catecholamines?

Adults

Adult men and women can take catecholamine medications for a variety of indications including anaphylaxis, cardiac arrest (heart attack), and acute asthma exacerbations. If a patient has a known sensitivity to a catecholamine, then catecholamines should be avoided. There are no contraindications to the use of parenteral epinephrine in life-threatening situations.

Seniors

Seniors may use catecholamines, though they may be more sensitive to the effects of catecholamines. Seniors may be more prone to renal disease, Catecholamines can constrict renal blood vessels and decrease urine output. Catecholamines can raise blood pressure, and this can be dangerous in patients who already suffer from hypertension. Use catecholamines cautiously in patients who already have high blood pressure.

Children

Catecholamine drugs are used in infants, children, and adolescents for some approved indications. They are approved in the treatment of anaphylaxis, cardiac arrest, and other life-threatening indications. They are not approved in indications such as glaucoma. Your healthcare professional will decide if a catecholamine is appropriate for your child.

Are catecholamines safe?

Catecholamine recalls

• Mylan Pharmaceuticals: EpiPen and EpiPen Jr devices failure to deactivate, February 2018

• KRS Global Biotechnology, Inc.: Lack of assurance of sterility, September 2019

• Fagron Inc: Microbial contamination of LETS GEL KIT, November 2019

Catecholamine restrictions

Patients with a known sensitivity to catecholamines should avoid their use unless they are in a life-threatening emergency with no other treatment options. 

Patients with pre-existing cardiac disease such as hypertension or coronary artery disease may be at an increased risk of developing cardiac arrhythmias, myocardial ischemia, and angina pectoris. 

Some dosage forms may contain a sulfur ingredient which could trigger a hypersensitivity reaction in a patient allergic to sulfur. Use in sulfa-allergic patients should be limited to life-saving measures only.

Catecholamines are used in the treatment of open-angle glaucoma but can exacerbate and worsen closed-angle glaucoma. Do not treat your glaucoma condition without your doctor’s guidance.

Vasoconstricting catecholamines should never be injected in the extremities such as fingers, toes, nose, and genitalia. The vasoconstriction can completely cut off blood flow to these extremities causing tissue necrosis. 

Catecholamines can cause increases in blood sugar, and therefore diabetic patients should monitor their glucose levels closely. 

Certain classes of drugs can increase the accumulation of your body’s natural catecholamines. One such example are monoamine oxidase inhibitors which can increase catecholamine levels in the brain. Make sure to tell your physician all of the medications you are taking.

Catecholamines will increase blood pressure, and this can be dangerous in patients with uncontrolled hypertension. For patients with naturally high levels of catecholamines, it may be necessary to take alpha receptor blockers, such as clonidine, to help inhibit some of the negative cardiac effects.

Certain tumors and atypical cells will cause an increase in the body’s catecholamine levels. A pheochromocytoma is a tumor that can develop in certain cells, known as chromaffin cells, inside the adrenal gland. This tumor causes the secretion of too much adrenaline and noradrenaline, even when you are not in a stressful situation. This can cause an unwarranted increase in blood pressure, heart rate, heavy sweating, tremors, weight loss, or panic attack symptoms. 

Paragangliomas are another similar type of tumor that happens in chromaffin cells in other parts of the body and have similar effects on your body. Neuroblastomas are a type of cancer that also causes the release of too many catecholamines. Your body breaks down catecholamines into metabolites, and the two most common metabolites are homovanillic acid (HVA) and vanillylmandelic acid (VMA). 

These diagnoses of these disorders include a urine test or blood test to look at the levels of catecholamines and their metabolites in your body. These test results are only one component of the diagnosis. Catecholamine drugs will exacerbate the symptoms of these rare tumors and cancer due to the high levels of catecholamines already present, and their use in these patients could be life-threatening.

Can you take catecholamines while pregnant or breastfeeding?

Catecholamines can be used in life-saving situations such as the mother going into anaphylactic shock or septic shock. However, it can cause decreased blood flow to the uterus and fetal anoxia (lack of oxygen to the fetus). The Food and Drug Administration (FDA) has not assigned the catecholamines a pregnancy category. There is no scientific information on the presence of drugs such as epinephrine in breast milk. Exposure through breast milk is thought to be very low.

Are catecholamines controlled substances?

No, catecholamines are not controlled substances.

Common catecholamines side effects

• Anxiety

• Restlessness

• Tremor

• Weakness

• Dizziness

• Sweating

• Palpitations

• Pallor

• Nausea

• Vomiting

• Headache

• Respiratory difficulties

• Arrhythmias

• Rapid rise in blood pressure

• Angina

• Tissue necrosis

• Tachycardia

• Coldness

How much do catecholamines cost?

One of the most common types of prescribed catecholamines are autoinjectors which contain epinephrine. Without coverage, these autoinjectors can cost close to $1000 for two doses. Insurance coverage may vary, and some manufacturers may offer some type of coupon or savings, but they can still be very expensive. Most autoinjectors have a shelf-life of one year or less, meaning that if you don’t have a need for the medication in the next year, you may have potentially spent a large amount of money on a medication you will not use. Singlecare does offer free coupons to help you find the best possible price on your prescribed medication, and this can help you feel confident you have gotten the best price on your potentially life-saving medication.