What is the recommended route for initial epinephrine administration in anaphylaxis?

• A. Intramuscular
• B. Subcutaneous
• C. Intravenous
• D. Inhaled

Answer: (A)

When treating suspected anaphylaxis, delivering epinephrine quickly through a route that provides fast and reliable systemic absorption is essential. The intramuscular route, especially into the mid-outer thigh, achieves rapid peak levels and more consistent absorption than other routes, which is crucial when airway compromise and shock can progress rapidly.

Subcutaneous injections can have slower and less predictable uptake, particularly in the setting of poor perfusion during anaphylaxis, making them less reliable as the initial treatment. Intravenous administration is reserved for special cases in a monitored setting because it carries a higher risk of dangerous rapid changes in blood pressure and heart rhythm. Inhaled epinephrine does not address the systemic circulation effectively and is not appropriate for life-threatening anaphylaxis.

Typical initial dosing is 0.3–0.5 mg of 1:1000 epinephrine given intramuscularly in adults (a similar weight-based approach applies to children, usually 0.01 mg/kg up to 0.3 mg). Repeat every 5–15 minutes as needed while monitoring and obtaining emergency care. The key idea is to achieve quick, reliable systemic response to reverse the airway and circulatory symptoms of anaphylaxis.