epinephrine racemic

Epinephrine racemic is an inhaled medication available over-the-counter and used for temporary relief of symptoms associated with bronchial asthma in adults and children, and to treat pediatric croup, an upper respiratory tract viral infection that obstructs the airway.

Racemic epinephrine eases breathing by relaxing the bronchial smooth muscles and dilating the airway.

Racemic epinephrine belongs to a class of medications known as alpha/beta agonists, which work by enhancing the activity of both alpha and beta receptors. Racemic epinephrine is a synthetic form of epinephrine, a natural hormone produced by the adrenal gland. Epinephrine has many functions in the body, including as a neurotransmitter that helps nerve cells communicate.

Epinephrine exerts its effects by stimulating specific receptors on cell membranes including alpha-1, alpha-2, beta-1 and beta-2 receptors, and the degree of stimulation of each type of receptor is dose-dependent.

The main therapeutic effect of racemic epinephrine in asthma is from stimulation of beta-2 receptors, which relaxes the bronchial smooth muscles, relieving bronchial asthma symptoms such as wheezing, shortness of breath, and chest tightness.

The effects of epinephrine include:

• Relaxation of smooth muscles in various tissues including the bronchial tissue
• Cardiac stimulation, increasing heart rate and cardiac output
• Dilation of blood vessels and increased blood flow in skeletal muscles
• Constriction of blood vessels and increase in blood pressure, with higher doses
• Stimulation of glycogen breakdown (glycogenolysis) in the liver and release of glucose into the bloodstream

• Do not use racemic epinephrine in patients with epiglottitis, an inflammation and swelling of the epiglottis, the tissue in the throat that prevents food from entering the airway.
• Do not take simultaneously with monoamine oxidase inhibitors (MAOIs), a type of antidepressant medication, or within 2 weeks after discontinuing MAOI.
• Check with your doctor before using racemic epinephrine if you have any of the following conditions:
  • Heart disease or high blood pressure (hypertension)
  • Diabetes mellitus
  • High intraocular pressure or glaucoma
  • Prostate enlargement and/or urinary obstruction
  • Thyroid disease
  • History of seizure disorder
  • Psychiatric or emotional conditions
  • Previous hospitalization for asthma
• Racemic epinephrine should be used only after being diagnosed with asthma by a healthcare provider.

Common side effects of epinephrine racemic include:

• Headache
• Nausea
• Sweating
• Restlessness
• Tremor
• Rebound airway swelling (edema)
• Pulmonary edema
• Overreaction of the autonomic nervous system (autonomic hyperreflexia)

Serious side effects of epinephrine racemic include:

• Chest pain (angina)
• Rapid heart rate (tachycardia)
• Irregular heart rhythms (cardiac arrhythmia)
• Rapid life-threatening arrhythmia in the ventricles (ventricular fibrillation)
• Cerebral hemorrhage

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Solution for Nebulization

• 11.25mg/0.5mL (2.25% as 1.125% dextro-epinephrine and 1.125% levo-epinephrine)

Adult:

Bronchial Asthma

• Indicated for temporary relief of symptoms associated with bronchial asthma (e.g., shortness of breath, chest tightening, wheezing)
• S2: 0.5 mL of 2.25% solution diluted in 3 mL normal saline (NS) via jet nebulizer every 3 to 4 hours as needed
• Asthmanefrin: 1-3 inhalations of 0.5 mL of 2.25% solution via EZ Breathe Atomizer

Pediatric:

Bronchial Asthma

Indicated for temporary relief of symptoms associated with bronchial asthma (e.g., shortness of breath, chest tightening, wheezing)

Asthmanefrin

• Children younger than 4 years: Safety and efficacy not established
• Children 4 years and older: 1-3 inhalations of 0.5 mL of 2.25% solution via EZ Breathe Atomizer

S2

• Children younger than 4 years: 0.05 mL/kg via jet nebulizer (diluted to 3 mL with NS) over 15 minutes; no more than every 12 hours; not to exceed 0.5 mL/dose
• Children 4 years and older: 0.5 mL of 2.25% solution via jet nebulizer (diluted to 3 mL with NS) over 15 minutes every 3 to 4 hours as needed
• Use low end of dosing range for younger infants
• Should observe rapid response, can be repeated every 2 hours in older children but monitor heart rate with repeated dosing

Croup

• Children younger than 4 years: 0.05 mL/kg of 2.25% solution (S2) via jet nebulizer (diluted to 3 mL with NS) over 15 minutes every 3 to 4 hours as needed; not to exceed 0.5 mL/dose
• Children 4 years and older: 0.5 mL of 2.25% solution (S2) via jet nebulizer (diluted to 3 mL with NS) over 15 minutes every 3 to 4 hours as needed

• Epinephrine racemic overdose can increase arterial blood pressure leading to cerebrovascular events, and can also disturb heart rhythm.
• Epinephrine effects may be countered by alpha and beta blocking agents, and treatment may include respiratory support if required.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Severe interactions of epinephrine racemic include:
  • arsenic trioxide
  • disopyramide
  • ibutilide
  • indapamide
  • iobenguane I 123
  • pentamidine
  • pimozide
  • procainamide
  • quinidine
  • sotalol
• Epinephrine racemic has serious interactions with at least 57 different drugs.
• Epinephrine racemic has moderate interactions with at least 251 different drugs.
• Mild interactions of epinephrine racemic include:
  • bendroflumethiazide
  • bumetanide
  • chlorothiazide
  • chlorthalidone
  • cyclopenthiazide
  • ethacrynic acid
  • eucalyptus
  • furosemide
  • hydrochlorothiazide
  • indapamide
  • methyclothiazide
  • metolazone
  • noni juice
  • sage
  • thiothixene
  • torsemide
  • vasopressin

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information.

Check with your doctor or health care provider if you have any questions about the medication.

• Uncontrolled asthma during pregnancy is associated with greater maternal and fetal risk than appropriate use of asthma medications. There are no well-controlled studies of racemic epinephrine use during pregnancy, and animal studies show evidence of fetal harm. Use with caution in pregnant women if benefits outweigh risks.
• Systemic epinephrine is excreted in breast milk, however, there is no information if inhaled racemic epinephrine is present in breast milk. Use with caution in nursing mothers.

• Racemic epinephrine should be used only for oral inhalation.
• Use exactly as per label instructions, do not use higher than recommended doses or more often.
• Do not use the inhalation solution if it is brown in color or cloudy, pinkish or darker than slightly yellow, or has any particulate matter.
• Asthma attacks may be life-threatening. When self-medicating with OTC racemic epinephrine, stop use and seek medical help if:
  • Symptoms are not relieved within 20 minutes
  • You feel worse after treatment
  • You need more inhalations than recommended for 24 hours
  • You have more than 2 asthma attacks in a week
  • You have difficulty sleeping
  • You have a rapid heartbeat
  • You have tremors, nervousness, or seizure
• Store safely out of reach of children.
• In case of overdose, immediately seek medical help or contact Poison Control.