Epinephrine Racemic

Epinephrine racemic is used for temporary relief of symptoms associated with bronchial asthma (e.g., shortness of breath, chest tightening, wheezing) and to treat croup in children.

Epinephrine racemic is available under the following different brand names: AsthmaNefrin and S2.

Dosages of Epinephrine Racemic:

Adult and Pediatric Dosage Forms and Strengths

Solution for Nebulization

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

Dosage Considerations – Should be Given as Follows:

Bronchial Asthma

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

S2

• Adults: 0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer every 3-4 hours as needed
• 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 3-4 hours as needed
• Children under 4 years old: 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
• Use the 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

Asthmanefrin

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

Croup

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

Side effects of epinephrine racemic include:

• Fast heart rate
• Irregular/abnormal heartbeats
• Headache
• Nausea
• Sweating
• Tremor
• Restlessness
• Rebound airway swelling may occur
• Chest pain (angina)
• Autonomic hyperreflexia
• Ventricular fibrillation
• Cerebral hemorrhage
• Pulmonary edema

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe interactions of epinephrine racemic include:

• arsenic trioxide
• cisapride
• disopyramide
• ibutilide
• indapamide
• iobenguane I 123
• pentamidine
• pimozide
• procainamide
• quinidine
• sotalol

Epinephrine racemic has serious interactions with at least 56 different drugs.

Epinephrine racemic has moderate interactions with at least 252 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

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

This medication contains epinephrine racemic. Do not take AsthmaNefrin or S2 if you are allergic to epinephrine racemic or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Epiglottitis
• Coadministration with monoamine oxidase inhibitors (MAOIs), or within 2 weeks after discontinuing an MAOI

Effects of Drug Abuse
No information available

Short-Term Effects

See "What Are Side Effects Associated with Using Epinephrine Racemic?”

Long-Term Effects

See "What Are Side Effects Associated with Using Epinephrine Racemic?”

Cautions

• For oral inhalation only
• Caution with heart disease, hypertension, thyroid disease, diabetes, or urinary retention caused by prostate enlargement
• Instruct patient to seek immediate medical attention if symptoms not relieved within 20 minutes or become worse following administration
• Do not use if product is brown in color or cloudy
• Do not use if product is pinkish or darker than slightly yellow, or if it contains a precipitate

Pregnancy and Lactation

Use epinephrine racemic with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.

Epinephrine racemic is excreted in breast milk. Consult your doctor before breastfeeding.