Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (765 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
The active sympathomimetic hormone from the adrenal medulla. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Adrenaline; 4-(1-Hydroxy-2-(methylamino)ethyl)-1,2-benzenediol; Epitrate; Medihaler-Epi; Lyophrin; Epifrin; Epinephrine Bitartrate; Epinephrine Hydrogen Tartrate.
Where it fits in the MeSH classification
- Broader topics
- Ethanolamines; Biogenic Monoamines; Catecholamines
- Narrower topics
- Racepinephrine; Metanephrine; Deoxyepinephrine
- See also
- Receptors, Adrenergic
Related concepts
- Adrenal Medulla
- Vasoconstriction
- Heart
- Bronchi
- Asthma
- Heart Failure
- Anesthetics
Research landscape
PubMed indexes 58,520 records tagged with the MeSH heading “Epinephrine” (counts retrieved 2026-10-31). 2,704 of them (4.6%) were published from 2020 onward, and the busiest period so far is through 1999 with 44,389 records.
Reviews account for 3,024 records (5.2%) and meta-analyses for 143. Randomized controlled trials number 2,859 (4.9%) as a share of all records on the topic.
Show the data
| Period | Records |
|---|---|
| through 1999 | 44,389 |
| 2000-2009 | 6,285 |
| 2010-2019 | 5,142 |
| 2020 onward | 2,704 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 3,024 | 5.2% |
| Meta-analyses | 143 | 0.2% |
| Randomized controlled trials | 2,859 | 4.9% |
Method: PubMed query "Epinephrine"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-31.
Reading the evidence in drugs and chemicals
Studies of a chemical or drug can answer very different questions: what it is and how it behaves in cells and animals, how the body handles it, and whether it changes outcomes in people. Laboratory and animal findings often do not carry over to patients, and observational studies of exposures are confounded by who uses a substance and why. Nothing on this page is a recommendation to use, avoid, start or stop any substance or medicine; talk to a qualified clinician or pharmacist about your own situation. Check the dose, the species, the comparison group and whether a patient-relevant outcome was measured.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
| Study / authors | Year | Source label / design | Europe PMC citations | Licence / source |
|---|---|---|---|---|
| Stress-induced epinephrine enhances lactate dehydrogenase A and promotes breast cancer stem-like cells | 2019 | Research article Design not recorded in structured metadata | 228 | cc by PMID 30688660 · DOI · PMC6391112 |
| Regulation of natural killer cell activity by glucocorticoids, serotonin, dopamine, and epinephrine | 2020 | Review article Design not recorded in structured metadata | 108 | cc by PMID 32503998 · DOI · PMC7331581 |
| Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis | 2021 | Meta-analysis Design not recorded in structured metadata | 68 | cc by PMID 33862009 · DOI · PMC8588837 |
| Cystathionine β-synthase is inhibited by epinephrine and norepinephrine over-secretion via NF-κB activation in stress-induced hyperhomocysteinemia | 2026 | Research article Design not recorded in structured metadata | 0 | cc by PMID 42156447 · DOI · PMC13385765 |
Stress-induced epinephrine enhances lactate dehydrogenase A and promotes breast cancer stem-like cells [1]
Abstract reading summary — source excerpts
- Opening excerpt
- Chronic stress triggers activation of the sympathetic nervous system and drives malignancy.
- Closing excerpt
- Thus, the LDHA-lowering agent vitamin C can be a potential approach for combating stress-associated breast cancer.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (125 words)
Chronic stress triggers activation of the sympathetic nervous system and drives malignancy. Using an immunodeficient murine system, we showed that chronic stress-induced epinephrine promoted breast cancer stem-like properties via lactate dehydrogenase A-dependent (LDHA-dependent) metabolic rewiring. Chronic stress-induced epinephrine activated LDHA to generate lactate, and the adjusted pH directed USP28-mediated deubiquitination and stabilization of MYC. The SLUG promoter was then activated by MYC, which promoted development of breast cancer stem-like traits. Using a drug screen that targeted LDHA, we found that a chronic stress-induced cancer stem-like phenotype could be reversed by vitamin C. These findings demonstrated the critical importance of psychological factors in promoting stem-like properties in breast cancer cells. Thus, the LDHA-lowering agent vitamin C can be a potential approach for combating stress-associated breast cancer.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 30688660 · DOI · PMC6391112
Regulation of natural killer cell activity by glucocorticoids, serotonin, dopamine, and epinephrine [2]
Abstract reading summary — source excerpts
- Opening excerpt
- The immune system and the nervous system are highly complex organs composed of various different cells that must interact with each other for proper function of the system.
- Closing excerpt
- Understanding the effects of neuroendocrine factors on NK cell activities during physiological and pathophysiological conditions may result in novel therapeutic strategies to enhance NK cell functions against tumors.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (191 words)
The immune system and the nervous system are highly complex organs composed of various different cells that must interact with each other for proper function of the system. This communication can be mediated by soluble factors. The factors released by the nervous system (neurotransmitters) differ from those released by the immune system (cytokines). Nevertheless, the nervous and immune systems can influence each other's activity because immune cells express neurotransmitter receptors, and neurons express cytokine receptors. Moreover, immune cells can synthesize and release neurotransmitters themselves, thus using neurotransmitter-mediated pathways via autocrine and paracrine mechanisms. Natural killer (NK) cells are innate lymphocytes that are important for early and effective immune reactions against infections and cancer. Many studies have shown the strong influence of stress and the nervous system on NK cell activity. This phenomenon may be one reason why chronic stress leads to a higher incidence of infections and cancer. Here, we review the effects of neuroendocrine factors on the different activities of NK cells. Understanding the effects of neuroendocrine factors on NK cell activities during physiological and pathophysiological conditions may result in novel therapeutic strategies to enhance NK cell functions against tumors.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 32503998 · DOI · PMC7331581
Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis [3]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundRegulatory bodies recommend that all patients at risk of anaphylaxis be prescribed 2 epinephrine autoinjectors, which they should carry at all times.
- Closing excerpt
- ConclusionAround 1 in 10 anaphylaxis reactions are treated with more than 1 dose of epinephrine.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (267 words)
BackgroundRegulatory bodies recommend that all patients at risk of anaphylaxis be prescribed 2 epinephrine autoinjectors, which they should carry at all times. This is in contrast to some guidelines. The proportion of anaphylaxis reactions that are treated with multiple doses of epinephrine has not been systematically evaluated.ObjectiveOur aim was to undertake a systematic review and meta-analysis of published studies reporting epinephrine treatment for anaphylaxis in which data relating to the number of doses administered were available.MethodsWe searched the Medline, Embase, and Cochrane databases for relevant studies reporting at least 10 anaphylaxis events (due to food or venom) from 1946 until January 2020. Data were extracted in duplicate for the meta-analysis, and the risk of bias was assessed. The study was registered under the PROSPERO identifier CRD42017069109.ResultsA total of 86 studies (36,557 anaphylaxis events) met the inclusion criteria (20 of the studies [23%] were prospective studies; 64 [74%] reported reactions in the community, and 22 [26%] included food challenge data). Risk of bias was assessed as low in 50 studies. Overall, 7.7% of anaphylaxis events from any cause (95% CI = 6.4-9.1) were treated with multiple doses of epinephrine. When only epinephrine-treated reactions for which subsequent doses were administered by a health care professional were considered, 11.1% of food-induced reactions (95% CI = 9.4-13.2) and 17.1% of venom-induced reactions (95% CI = 11.3-25.0) were treated with more than 1 epinephrine dose. Heterogeneity was moderate to high in the meta-analyses, but at sensitivity analysis this estimate was not affected by study design or anaphylaxis definition.ConclusionAround 1 in 10 anaphylaxis reactions are treated with more than 1 dose of epinephrine.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 33862009 · DOI · PMC8588837
Cystathionine β-synthase is inhibited by epinephrine and norepinephrine over-secretion via NF-κB activation in stress-induced hyperhomocysteinemia [4]
Abstract reading summary — source excerpts
- Opening excerpt
- Stress can elevate plasma homocysteine (Hcy) levels, a key factor in the development of various diseases, leading to hyperhomocysteinemia (HHcy).
- Closing excerpt
- These findings suggest that E/NE contributes to stress-induced HHcy by inhibiting Cbs transcription through the upregulation of Sp3, and that the IL-6/NF-κB axis plays a critical role in the dysregulation of Hcy metabolism.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (182 words)
Stress can elevate plasma homocysteine (Hcy) levels, a key factor in the development of various diseases, leading to hyperhomocysteinemia (HHcy). The enzyme Cystathionine β-synthase (CBS) functions in the trans-sulfuration pathway, which links the methionine cycle to glutathione synthesis. This pathway is essential for the metabolism of homocysteine. However, the precise mechanism by which stress regulates hepatic CBS expression remains unclear. The present study aimed to elucidate the molecular mechanism by which CBS expression is regulated in the livers of restraint-stressed rats. Our results showed that stress-induced over-secretion of epinephrine and norepinephrine (E/NE) activated the β-adrenergic receptor, leading to elevated serum IL-6 levels. Treatment of rat primary hepatocytes with IL-6 for 1 h suppressed both CBS activity and Cbs mRNA expression, concomitant with an enhancement of Sp3-mediated transcriptional repression. Furthermore, we found that IL-6 activates NF-κB via the tyrosine phosphorylation pathway, which in turn potentiates Sp3-mediated repression of Cbs transcription. These findings suggest that E/NE contributes to stress-induced HHcy by inhibiting Cbs transcription through the upregulation of Sp3, and that the IL-6/NF-κB axis plays a critical role in the dysregulation of Hcy metabolism.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 42156447 · DOI · PMC13385765
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning [5]
- Research article Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis [6]
- Research article Emergency department diagnosis and treatment of anaphylaxis: a practice parameter [7]
- Research article Peanut allergy [8]
- Research article Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia [9]
- Research article Adrenaline in the treatment of anaphylaxis: what is the evidence? [10]
References
- Cui B, Luo Y, Tian P, Peng F, Lu J, Yang Y, et al.. Stress-induced epinephrine enhances lactate dehydrogenase A and promotes breast cancer stem-like cells. . 2019. PMID 30688660 · DOI · PMC6391112
- Capellino S, Claus M, Watzl C. Regulation of natural killer cell activity by glucocorticoids, serotonin, dopamine, and epinephrine. . 2020. PMID 32503998 · DOI · PMC7331581
- Patel N, Chong KW, Yip AYG, Ierodiakonou D, Bartra J, Boyle RJ, et al.. Use of multiple epinephrine doses in anaphylaxis: A systematic review and meta-analysis. . 2021. PMID 33862009 · DOI · PMC8588837
- Zhang L, Wu S, Xie F, Wang X, Sun Z, Zhao Y, et al.. Cystathionine β-synthase is inhibited by epinephrine and norepinephrine over-secretion via NF-κB activation in stress-induced hyperhomocysteinemia. . 2026. PMID 42156447 · DOI · PMC13385765
- Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008. PMID 18094670 · DOI
- Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, et al.. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020. PMID 32001253 · DOI
- Campbell RL, Li JT, Nicklas RA, Sadosty AT, Members of the Joint Task Force, Practice Parameter Workgroup. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014. PMID 25466802 · DOI
- Burks AW. Peanut allergy. Lancet. 2008. PMID 18456104 · DOI
- Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Surg. 2013. PMID 23908250 · DOI
- McLean-Tooke AP, Bethune CA, Fay AC, Spickett GP. Adrenaline in the treatment of anaphylaxis: what is the evidence?. BMJ. 2003. PMID 14656845 · DOI · PMC286326
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-31.
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Evidence strength
EvidenceHelix's computed view of the study designs behind this topic: how common meta-analyses, randomized trials and reviews are, how recent the literature is, and a plain-language reading. It describes the design mix of the literature. It is not a quality appraisal of any study, and it is not medical advice.