Racemic Epinephrine: Uses, Dosage, and Side Effects Guide

Summary of Key Points

Racemic Epinephrine is a medication used to manage breathing difficulties caused by conditions such as croup, asthma, and bronchospasm. It works by relaxing the muscles in the airways, making it easier to breathe. This medication is typically administered through a nebulizer. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist with any questions or concerns.

Names of Medication

US Brand Name: Asthmanefrin (Racemic Epinephrine)

The generic name is the official medical name of the drug, while the brand name is assigned by the manufacturer. In this article, the generic name is listed in parentheses.

Pharmacologic Category

Adrenergic Agonist

Bronchodilator

Vasopressor

Dosing for Racemic Epinephrine

Racemic Epinephrine is used to treat various conditions related to breathing difficulties. Below are the recommended doses for adults. Always consult your healthcare provider before making any changes to your medication. If you need assistance, our telemedicine providers are available to help.

Croup Treatment: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.
Asthma: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 3-4 hours as needed.
Bronchospasm: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 3-4 hours as needed.
Anaphylaxis: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.
Allergic Reactions: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.
Respiratory Distress: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.
Laryngeal Edema: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.
Vocal Cord Dysfunction: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.
Post-Extubation Stridor: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.
Acute Airway Obstruction: 0.5 mL of racemic epinephrine (2.25%) via nebulizer, diluted in 3 mL of normal saline. May repeat every 20 minutes as needed.

Dosage Forms and Strengths

Solution for Nebulization: 2.25% (11.25 mg/mL)

How to Use Racemic Epinephrine

Racemic Epinephrine is typically administered using a nebulizer, a device that converts liquid medication into a mist for inhalation directly into the lungs. Follow these steps for proper administration:

Use the prescribed dose of racemic epinephrine and dilute it with normal saline as directed by your healthcare provider.
Place the solution into the nebulizer chamber.
Attach the nebulizer to the mouthpiece or mask and start the machine.
Breathe in the mist slowly and deeply until the medication is fully inhaled, usually within 5-10 minutes.
Clean the nebulizer after each use according to the manufacturer’s instructions.

Always follow the instructions provided by your healthcare provider or pharmacist. If you have any questions about using your nebulizer or medication, our telemedicine providers are available to assist you.

Racemic Epinephrine Side Effects

Like all medications, racemic epinephrine may cause side effects. While not everyone will experience them, it’s important to be aware of potential risks. If you experience severe side effects, seek medical attention immediately.

Common Side Effects

These side effects occur in more than 1 in 10 people.

Increased heart rate (tachycardia): You may feel your heart beating faster than usual.
Tremors: You may notice shaking in your hands or body.
Nervousness: Some people may feel anxious or jittery after using this medication.

Less Common Side Effects

These occur in fewer than 1 in 10 people.

Headache: You may experience mild to moderate headaches.
Dizziness: Some people may feel lightheaded or dizzy.
Insomnia: Difficulty sleeping may occur, especially if the medication is used later in the day.

Rare but Serious Side Effects

These serious side effects occur in fewer than 1 in 100 people.

Severe allergic reactions: Symptoms may include rash, itching, swelling, or difficulty breathing.
Chest pain: If you experience chest pain, seek medical help immediately.
High blood pressure: This medication can cause a temporary increase in blood pressure.

Contraindications for Racemic Epinephrine

A contraindication is a specific situation or condition where a medication should not be used because it may cause harm. It’s important to know if you have any contraindications before starting a new medication. Below are the contraindications for taking Racemic Epinephrine:

Allergy to Epinephrine: If you are allergic to epinephrine or any of the ingredients in racemic epinephrine, taking this medication could cause a severe allergic reaction, which can be life-threatening.
Heart Disease: Racemic epinephrine can increase heart rate and blood pressure. If you have a history of heart disease, such as coronary artery disease or arrhythmias, this medication could worsen your condition.
High Blood Pressure (Hypertension): Since racemic epinephrine can elevate blood pressure, it is not recommended for individuals with uncontrolled high blood pressure, as it may increase the risk of complications like stroke or heart attack.
Thyroid Disorders (Hyperthyroidism): People with an overactive thyroid may experience increased sensitivity to the effects of epinephrine, which could lead to dangerous side effects such as rapid heart rate and high blood pressure.
Glaucoma: Racemic epinephrine can increase intraocular pressure, which may worsen glaucoma, a condition that affects the eyes.

Drug to Drug Interactions

Racemic epinephrine can interact with other medications, potentially altering its effectiveness or increasing the risk of side effects. It’s important to inform your healthcare provider about all the medications you are currently taking. Below are some common drug interactions to be aware of:

Beta-blockers (e.g., Metoprolol, Atenolol): These medications, often prescribed for high blood pressure and heart conditions, can reduce the effectiveness of racemic epinephrine and may lead to a dangerous increase in blood pressure.

Monoamine Oxidase Inhibitors (MAOIs) (e.g., Phenelzine, Tranylcypromine): These antidepressants can intensify the effects of epinephrine, potentially causing dangerously high blood pressure or other severe side effects.

Tricyclic Antidepressants (e.g., Amitriptyline, Nortriptyline): These medications may also enhance the effects of epinephrine, which could result in an increased heart rate and elevated blood pressure.

General Anesthetics (e.g., Halothane): When used in combination with racemic epinephrine, these medications can raise the risk of heart arrhythmias.

Racemic Epinephrine in Pregnancy

Is it safe to take racemic epinephrine during pregnancy?

Racemic epinephrine is classified as a Category C medication by the FDA for use during pregnancy. This means that while no well-controlled studies have been conducted in pregnant women, animal studies have shown some potential risk to the fetus. The medication should only be used if the potential benefits outweigh the risks. If you are pregnant or planning to become pregnant, it’s essential to consult your healthcare provider before using racemic epinephrine. Our telemedicine providers are available to help you make an informed decision.

Racemic Epinephrine while Breastfeeding

Is it safe to take racemic epinephrine while breastfeeding?

There is limited information available regarding the use of racemic epinephrine during breastfeeding. While epinephrine is known to pass into breast milk in small amounts, the effects on a nursing infant are not well studied. If you are breastfeeding, it’s important to consult your healthcare provider before using this medication. Our telemedicine providers can assist you in weighing the potential risks and benefits.

Estimated Cost of Racemic Epinephrine

The cost of a 30-day supply of racemic epinephrine without insurance can vary depending on the pharmacy and location. With a GoodRx coupon, the estimated cost typically ranges from $20 to $40. For the most accurate pricing, check with your local pharmacy.

Possible Alternatives to Racemic Epinephrine

Depending on the condition being treated, alternative treatments or lifestyle changes may help manage your symptoms. Always discuss any changes to your treatment plan with your healthcare provider. Our telemedicine providers are available to help you explore these options.

Croup: In mild cases, humidified air and proper hydration may provide relief. Corticosteroids like dexamethasone can also help reduce inflammation.
Asthma: Inhaled corticosteroids (e.g., Fluticasone) and bronchodilators (e.g., Albuterol) are common alternatives. Lifestyle changes, such as avoiding allergens and quitting smoking, can also help manage asthma symptoms.
Bronchospasm: Short-acting bronchodilators like Albuterol or long-acting bronchodilators like Salmeterol may be used. Avoiding triggers such as smoke or allergens can also help reduce symptoms.
Anaphylaxis: Epinephrine auto-injectors (e.g., EpiPen) are the first-line treatment. Avoiding known allergens is crucial to preventing future episodes.
Allergic Reactions: Antihistamines (e.g., Diphenhydramine) or corticosteroids may be used to manage symptoms. Avoiding triggers is also important.
Respiratory Distress: Depending on the cause, oxygen therapy or bronchodilators may be used. In severe cases, mechanical ventilation may be necessary.
Laryngeal Edema: Corticosteroids and antihistamines can help reduce swelling. Avoiding allergens or irritants may prevent future episodes.
Vocal Cord Dysfunction: Speech therapy and breathing exercises are often recommended. Identifying and avoiding triggers can also help manage symptoms.
Post-extubation Stridor: Corticosteroids and humidified air may help reduce swelling and ease breathing.
Acute Airway Obstruction: Depending on the cause, treatments may include bronchodilators, corticosteroids, or, in severe cases, surgery.

Recent Updates on Racemic Epinephrine Research

Recent studies have focused on the use of racemic epinephrine in treating croup and other respiratory conditions. A 2022 study published in the Journal of Pediatrics found that racemic epinephrine, when combined with corticosteroids, significantly reduced the need for hospitalization in children with moderate to severe croup. Ongoing research is also exploring the use of racemic epinephrine in managing post-extubation stridor and vocal cord dysfunction, with early results showing promise in reducing symptoms and improving patient outcomes.

As more research becomes available, staying informed is important. Our telemedicine providers can help you understand the latest findings and how they may impact your treatment plan.

James Kingsley

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