Summary
Epinephrine has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Heart Failure would be drug repurposing rather than first-in-human development. This does not mean it is approved for Heart Failure. ClinicalTrials.gov lists 8 registered trials linking Epinephrine to Heart Failure: 3 are currently recruiting; 2 have completed; 3 are terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT07281014). The largest enrolment is 5000 participants (NCT04278404). Registration activity spans 2003 to 2026. The literature layer holds 11 publications for this pair: 4 Cochrane reviews, 2 randomised controlled trial publications and 5 clinical trial publications. Publication years run from 2016 to 2026. Because at least one synthesis-level source exists (systematic review, meta-analysis or Cochrane review), this pair has been assessed beyond single studies, although the synthesis may concern a different indication.
The RepurpOS disease-intelligence file for Heart Failure ranks 616 candidate therapeutics from Open Targets, ChEMBL, DGIdb and PubMed; only a minority carry direct clinical evidence, and this page covers one of those. Spontaneous remission context recorded for the condition: Annual mortality ~22% on standard care; only 5-11% of HFrEF patients achieve normalisation of ejection fraction (HFrecEF) with GDMT; HFpEF has no disease-modifying therapy.
Evidence table
| Evidence tier | A · Strong |
|---|---|
| Evidence score | 73.0 (trials 23.0, literature 30.0, tier 15, approved bonus 5.0) |
| Registered trials | 8 total: 3 recruiting, 0 active / not yet recruiting, 2 completed, 3 other |
| Linked publications | 11 (5 clinical trial publications, 4 Cochrane reviews, 2 randomised controlled trial publications) |
| Agent type | Drug (Small molecule) |
| Development stage (any indication) | Approved |
| Mechanism / class | agonist; agonist |
| Data sources | DGIdb |
| Linked via biomarker / target | ADRB3 |
How the evidence score is calculated
- Each registered trial scores by status (recruiting / active / enrolling 3, completed 2.5, not yet recruiting 2, unknown 1, terminated / withdrawn / suspended 0.5) plus a phase bonus (phase 3-4 +2, phase 2 +1, phase 1 +0.5). The trial component is capped at 30.
- Each literature item scores by design (Cochrane review 5, meta-analysis 4, systematic review 3, RCT 3, clinical trial publication 2, curated reference 1.5, other PubMed record 1). The literature component is capped at 30.
- The existing evidence tier adds 15 (A / Strong), 10 (B / Moderate), 5 (C / Preliminary) or 0 (D / Anecdotal).
- Agents approved for any indication (max clinical phase 4) add 5, because an approved agent has an established safety profile that lowers the barrier to repurposing trials.
- The score ranks what has been studied, not what works. It does not read effect sizes or directions of effect.
Registered clinical trials
| NCT ID | Title | Status | Phase | Enrolment |
|---|---|---|---|---|
| NCT07281014 | Unmitigated Aldosterone Signaling During Standard Clinical MRA Dosing 2026 | recruiting | Phase 4 | 20 |
| NCT00446017 | The Effects of Adrenaline and Milrinone in Patients With Myocardial Dysfunction After CABG 2003 | completed | Phase 3 | 60 |
| NCT02617602 | Goal Directed Hemodynamic Management of Acute Heart Failure After Cardiac Surgery in Children 2015 | status unknown | Phase 3 | 40 |
| NCT02161445 | Systolic Time Intervals in the Diagnosis of Heart Failure in Emergency Departement 2012 | completed | Not applicable | 530 |
| NCT04278404 | Pharmacokinetics, Pharmacodynamics, and Safety Profile of Understudied Drugs Administered to Children Per Standard of Care (POPS) 2020 | recruiting | Not applicable | 5,000 |
| NCT04682483 | Cardiogenic Shock Working Group Registry 2017 | recruiting | Not applicable | 5,000 |
| NCT05202938 | eMESH Struct. 2022-23 2022 | status unknown | Not applicable | 32 |
| NCT05782075 | Biological Monitoring by a Nurse for Heart Failure Patients. 2023 | status unknown | Not applicable | 100 |
Published literature
- Cochrane review Back to the flow: a comprehensive systematic review and meta-analysis of epinephrine in the treatment of no-reflowDexheimer da Silva L, de Araújo LC, Dexheimer da Silva E et al. · Coronary artery disease · 2026 · PMID 41869818
- Cochrane review Vasoplegic syndrome after cardiovascular surgery: A review of pathophysiology and outcome-oriented therapeutic managementDatt V, Wadhhwa R, Sharma V et al. · Journal of cardiac surgery · 2021 · PMID 34251716
- Clinical trial publication Pharmacological Heart Failure Therapy in Children: Focus on Inotropic SupportSchranz D · Handbook of experimental pharmacology · 2020 · PMID 31707469
- Clinical trial publication Effects of Cognitive Behavioral Therapy for Insomnia on Sleep, Symptoms, Stress, and Autonomic Function Among Patients With Heart FailureRedeker NS, Conley S, Anderson G et al. · Behavioral sleep medicine · 2020 · PMID 30461315
- Cochrane review Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndromeUhlig K, Efremov L, Tongers J et al. · The Cochrane database of systematic reviews · 2020 · PMID 33152122
- Clinical trial publication Management of cardiogenic shock in acute decompensated chronic heart failure: The ALTSHOCK phase II clinical trialMorici N, Oliva F, Ajello S et al. · American heart journal · 2018 · PMID 30100052
- Cochrane review Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndromeSchumann J, Henrich EC, Strobl H et al. · The Cochrane database of systematic reviews · 2018 · PMID 29376560
- Clinical trial publication B-type natriuretic peptide increases cortisol and catecholamine concentrations in healthy subjectsGrimm G, Resl M, Heinisch BB et al. · Journal of applied physiology (Bethesda, Md. : 1985) · 2017 · PMID 28008098
- Clinical trial publication Exercise training effects on elderly and middle-age patients with chronic heart failure after acute decompensation: A randomized, controlled trialAcanfora D, Scicchitano P, Casucci G et al. · International journal of cardiology · 2016 · PMID 27750131
- Randomized controlled trial Post hoc analysis of the glutamics-trial: intravenous glutamate infusion and use of inotropic drugs after cabgVidlund M, Tajik B, Håkanson E et al. · BMC anesthesiology · 2016 · PMID 27484576
- Randomized controlled trial Correlates of Exercise Self-efficacy in a Randomized Trial of Mind-Body Exercise in Patients With Chronic Heart FailureYeh GY, Mu L, Davis RB et al. · Journal of cardiopulmonary rehabilitation and prevention · 2016 · PMID 26959498
Mechanism and notes
Recorded mechanism or class: agonist; agonist.
OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in DGIdb, in this case via the biomarker or target ADRB3. The tier describes how well the drug-disease link is documented, not how well the drug works.
Frequently asked questions
Is Epinephrine approved for Heart Failure?
Epinephrine has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Heart Failure would be drug repurposing rather than first-in-human development. This does not mean it is approved for Heart Failure. Approval status for the specific indication should always be confirmed with the relevant regulator and prescribing information.
Is Epinephrine in clinical trials for Heart Failure?
ClinicalTrials.gov lists 8 registered trials linking Epinephrine to Heart Failure: 3 are currently recruiting; 2 have completed; 3 are terminated, withdrawn, suspended or of unknown status. The most advanced is Phase 4 (NCT07281014). The largest enrolment is 5000 participants (NCT04278404). Registration activity spans 2003 to 2026.
What does the evidence show for Epinephrine in Heart Failure?
Epinephrine has both completed registered trials and synthesis-level publications linked to Heart Failure. That is the strongest profile in this database, but the summaries here do not extract effect sizes, so read the linked reviews for direction and magnitude of benefit. OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in DGIdb, in this case via the biomarker or target ADRB3. The tier describes how well the drug-disease link is documented, not how well the drug works.
Cite this page
Data: ClinicalTrials.gov, PubMed, Open Targets, ChEMBL, DGIdb and the OSMF therapeutic agent database. Last updated 2026-07-05. Page built 2026-10-07.