Racemic Epinephrine

Racemic epinephrine is an inhaled bronchodilator that is made from both a bronchodilator and epinephrine mixed together. It is most often used for respiratory conditions that cause the lungs to become tight and closed up.

They use the word racemic because they mix two medications together to help reduce the inflammation in the airways. The bronchodilator opens up the airways and the epinephrine helps to keep them open. The epinephrine is also a powerful anti-histamine that helps reduce reactions to certain chemicals in the body that produce the inflammation in the lungs.

Racemic epinephrine is used for the following conditions:

• Croup in children (moderate to severe cases)

• Asthma in both adults and children

• Respiratory Syncyctial Virus (RSV)

• After extubation of a ventilator tube to reduce irritation and stridor

Racemic epinephrine is found in two forms both prescription and over-the-counter.

Prescription Form Racemic Epinephrine

This form is the safest way to use racemic epinephrine. It comes in a ½ ml vial that you place into a nebulizer machine and breathe the vapor in slowly. The effects usually take place within the first 30 minutes after the treatment. This is usually given in an emergency room or urgent care center for the first dose. If you are stable, the doctor may have you take treatments of this medication at home.

Over-The-Counter Racemic Epinephrine

There is a form of racemic epinephrine available over-the-counter called, Asthmanefrin. This was introduced to replace another over-the-counter asthma medication that was not safe to use and taken off the shelf.

This form is nebulized racemic epinephrine. You must purchase a separate device, place the liquid racemic epinephrine in and it becomes a mist that you breathe in. This medication is only intended for adult use and should be monitored by your physician, even if it is over-the-counter.

In studies, over-the-counter racemic epinephrine was shown to help protect the lungs against bronchospasms, but found to be less effective that prescription albuterol. This is partly because over-the-counter racemic epinephrine is less milligrams than the prescription form.

Racemic epinephrine works right away to lower histamines in the body and constrict blood vessels. This eases the blood in an out of the lungs and sends oxygenated blood to the heart and body. It also relaxes the bronchial tubes, opening them up to help the air move through the lungs.

Adults

• 2.25% Solution (available by prescription only): Use 0.5ml of solution and 3ml Normal Saline via nebulizer every 3 to 4 hours as needed.

• Asthmanefrin (Available over-the-counter): 2.25% solution, take 0.5ml one to three inhalations via the EZ Breathe Atomizer (purchase separately) every 3 to 4 hours, but not sooner than 3 hours between doses.

Children

For bronchial asthma:

• 2.25% Solution (available by prescription only):

Less than 4 years of age: Take 0.05ml/kg diluted with 3ml Normal Saline via nebulizer over 15 minutes time every 12 hours.

Four years and older: Take 0.5ml diluted with 2ml Normal Saline via nebulizer over 15 minutes time every 3 to 4 hours as needed.

• Asthmanefrin (over-the-counter)

Less than 4 years of age: Not recommended for children this age. The safety and efficacy of the drug is unknown for this age group.

Four years and older: Check with your doctor. Usual recommendation is 2.25% solution, take 0.5ml for one to three inhalations with the EZ Breathe Atomizer every 3 to 4 hours.

Note

• Children should respond quickly to this medication. If no response is observed, contact medical help right away.

• Racemic epinephrine can be repeated every two hours in older children with doctor’s okay.

• Monitor heart rate when using this medication more than one time in succession.

Nebulized racemic epinephrine can have the following side-effects:

• Nervousness, shakiness, tremors

• Headache

• Reduced appetite

• Insomnia

• Nausea

• Nervous feelings

• Dizziness

• Anxiety

• Muscle tension

These side-effects are very common and normal with this medication. Contact your doctor if they are bothersome. Usually, if you use this medication less often or smaller dosages the side-effects resolve on their own.

The following are severe side-effects and need IMMEDIATE medical attention:

• Signs of allergic reaction – hives, rash, trouble breathing, swelling of face or lips

• Chest pain

• Increased heart rate (over 120)

• Increased wheezing

• Increased blood pressure (over 140/90)

• Mental changes – Hallucinations, agitation, disorientation, or aggressive behavior

• Complications of these side-effects include cardiac arrhythmia, brain hemorrhage, stroke, and heart attack.

A few notes of caution for this medication are:

• Use care when giving to children less than 12 years old

• Be careful in people that are sensitive to bronchodilators

• Use caution with people who are hypertensive or have cardiac disease

• Do not use if you are taking an MAO inhibitor

• Do not use with other bronchodilators or space them 4 hours apart

• Do not take more than the recommended dosage

• Get medical help right away if breathing issues persist!

• Do not use if the solution does not look right (discoloration)

There have been instances that people have a reverse effect from this medication and experience worsened symptoms. Also, if the medication is used too often, airways may become more inflamed.

If reverse effects or symptoms worsen, discontinue use of the medication and seek medical attention right away. The excessive use of any bronchodilator and adverse effects have caused respiratory failure, cardiac arrest and death in some cases.