epinephrine inhaled (OTC)

Brand and Other Names:Primatene Mist
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

suspension for aerosol inhalation

  • 0.125mg/actuation

Mild Asthma

Indicated for temporary relief of mild symptoms of intermittent asthma (eg, wheezing, chest tightness, dyspnea)

1-2 inhalations PO q4hr PRN; start with 1 inhalation, wait at least 1 minute, administer second inhalation if symptoms not relieved

Not to exceed 8 inhalations/24 hr

Dosage Forms & Strengths

suspension for aerosol inhalation

  • 0.125mg/actuation

Mild Asthma

Indicated for temporary relief of mild symptoms of intermittent asthma (eg, wheezing, chest tightness, dyspnea)

<12 years: Safety and efficacy not established

≥12 years

  • 1-2 inhalations PO q4hr PRN; start with 1 inhalation, wait at least 1 minute, administer second inhalation if symptoms not relieved
  • Not to exceed 8 inhalations/24 hr
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Interactions

Interaction Checker

and epinephrine inhaled

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (3)

            • isocarboxazid

              isocarboxazid and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.

            • phenelzine

              phenelzine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.

            • tranylcypromine

              tranylcypromine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.

            Serious - Use Alternative (0)

              Monitor Closely (39)

              • amitriptyline

                amitriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • amoxapine

                amoxapine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • amphetamine

                amphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • amphetamine polistirex

                amphetamine polistirex, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • armodafinil

                armodafinil, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • atomoxetine

                atomoxetine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • benzphetamine

                benzphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • caffeine

                caffeine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • clomipramine

                clomipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • clonidine

                clonidine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • desipramine

                desipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • dexmethylphenidate

                dexmethylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • dextroamphetamine

                dextroamphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • diethylpropion

                diethylpropion, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • doxepin

                doxepin and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • entacapone

                entacapone will increase the level or effect of epinephrine inhaled by decreasing metabolism. Use Caution/Monitor. Entacapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.

              • ephedrine

                ephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • epinephrine

                epinephrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • guanfacine

                guanfacine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • imipramine

                imipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • lisdexamfetamine

                lisdexamfetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • lorcaserin

                lorcaserin, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • methamphetamine

                methamphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • methylphenidate

                methylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • modafinil

                modafinil, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • nadolol

                nadolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

              • nortriptyline

                nortriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • opicapone

                opicapone will increase the level or effect of epinephrine inhaled by decreasing metabolism. Use Caution/Monitor. Opicapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.

              • penbutolol

                penbutolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

              • phendimetrazine

                phendimetrazine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • phentermine

                phentermine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • phenylephrine

                phenylephrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • propranolol

                propranolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

              • protriptyline

                protriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              • pseudoephedrine

                pseudoephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • sotalol

                sotalol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

              • timolol

                timolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

              • tolcapone

                tolcapone will increase the level or effect of epinephrine inhaled by decreasing metabolism. Use Caution/Monitor. Tolcapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.

              • trimipramine

                trimipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.

              Minor (0)

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                Adverse Effects

                Frequency Not Defined

                Tachycardia

                Increased blood pressure

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                Warnings

                Contraindications

                Undiagnosed pulmonary symptoms

                Coadministration with MAOIs, or within 2 weeks after discontinuing an MAOI

                Cautions

                Patients who have severe asthma or who have been hospitalized for asthma should seek medical attention for prescription medications to treat their asthma

                Caution with preexisting conditions, including heart disease (eg, arrhythmias, coronary insufficiency, elevated blood pressure [BP]), diabetes, urinary impairment, enlarged prostate, thyroid disease, seizures, or narrow-angle glaucoma

                May increase heart rate (HR) or BP

                Not for relief of COPD symptoms

                Drug interaction overview

                • Coadministration with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated, owing to risk for hypertensive episode
                • Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system
                • Other stimulants (eg, phenylephrine, pseudoephedrine, ephedrine, caffeine) may have additive effects on HR or BP
                • Caution with beta-blockers; may block bronchodilatory effects of epinephrine
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                Pregnancy & Lactation

                Pregnancy

                Control of asthma during pregnancy is essential for maternal and fetal health

                In women with poorly or moderately controlled asthma, there is increased risk of preeclampsia in mother and prematurity, low birth weight, and small for gestational age in neonate; pregnant women should be closely monitored and medication adjusted as necessary to maintain optimal control

                Beta-agonists may interfere with uterine contractility during labor

                Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

                Lactation

                Unknown if inhaled epinephrine is distributed in human milk

                Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Elicits beta1- and beta2-adrenergic effects, resulting in bronchial smooth muscle relaxation

                Also has alpha-adrenergic effects that may increase HR and BP

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                Administration

                Inhaled Administration

                For oral inhalation only

                Before first use only: Shake inhaler and spray into air; repeat both actions 4 times to assure inhaler is activated

                Before subsequent doses (ie, 1-2 inhalations): Shake inhaler then spray into air once to prime

                After each day of use: Wash by removing red cap and container; run water through mouthpiece for 30 seconds, then shake off excess water and let dry

                Storage

                Store at room temperature between 15-25°C (59-77°F)

                Do not store near open flame

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                Images

                No images available for this drug.
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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.