EPINEPHrine (Oral Inhalation)

• It is used to open the airways in lung diseases where spasm may cause breathing problems.

• If you have an allergy to epinephrine or any other part of EPINEPHrine (oral inhalation).
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• If you have taken certain drugs used for low mood (depression) like isocarboxazid, phenelzine, or tranylcypromine or drugs used for Parkinson's disease like selegiline or rasagiline in the last 14 days. Taking this medicine within 14 days of those drugs can cause very bad high blood pressure.

This is not a list of all drugs or health problems that interact with EPINEPHrine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

Use EPINEPHrine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• For breathing in only as a liquid (solution) by a special machine (nebulizer) into the lungs.
• Follow how to use as you have been told by the doctor or read the package insert.
• Do not use if the solution is cloudy, leaking, or has particles.
• Do not use if solution changes color.

What do I do if I miss a dose?

• If you take this medicine on a regular basis, take a missed dose as soon as you think about it.
• If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
• Do not take 2 doses at the same time or extra doses.
• Many times EPINEPHrine is taken on an as needed basis. Do not take more often than told by the doctor.

(ep i NEF rin)

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Nebulization Solution, Inhalation:

Asthmanefrin Refill: 2.25% (1 ea) [contains edetate disodium]

Asthmanefrin Starter Kit: 2.25% (1 ea [DSC]) [contains edetate disodium]

Micronefrin: 2.25% (15 mL [DSC])

Nebulization Solution, Inhalation [preservative free]:

S2: 2.25% (1 ea) [sulfite free; contains edetate disodium]

• Alpha/Beta Agonist

Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation (increasing myocardial oxygen consumption), and dilation of skeletal muscle vasculature; small doses can cause vasodilation via beta2-vascular receptors; large doses may produce constriction of skeletal and vascular smooth muscle

Distribution

Does not cross blood-brain barrier

Metabolism

Taken up into the adrenergic neuron and metabolized by monoamine oxidase and catechol-o-methyltransferase; circulating drug hepatically metabolized

Excretion

Urine (as inactive metabolites, metanephrine, and sulfate and hydroxy derivatives of mandelic acid; small amounts as unchanged drug)

Croup (laryngotracheobronchitis)

Based on recommendations from the American Academy of Pediatrics epinephrine may be used for the emergency treatment of croup in pediatric patients [AAP [Hegenbarth 2008]].

Bronchospasm, relief of mild asthma symptoms: Children ≥4 years and Adolescents: Nebulization: Racemic epinephrine (2.25% solution): OTC labeling: Hand-bulb nebulizer: Add 0.5 mL to nebulizer; 1 to 3 inhalations; may repeat dose after at least 3 hours if needed. Do not exceed 12 inhalations in 24 hours. Note: Not recommended for routine management and treatment of asthma (GINA 2015; NAEPP 2007)

Croup (laryngotracheobronchitis), airway edema (off-label use): Infants, Children, and Adolescents: Nebulization: Note: Typically relief of symptoms occurs within 10 to 30 minutes and lasts 2 to 3 hours; patients should be observed for rapid symptom recurrence and possible repeat treatment.

Racemic epinephrine (2.25% solution): 0.05 to 0.1 mL/kg (maximum dose: 0.5 mL) diluted in 2 mL NS, may repeat dose every 20 minutes; others have reported use of 0.5 mL as a fixed dose for all patients; use lower end of dosing range for younger infants (Hegenbarth 2008; Rosekrans 1998; Rotta 2003; Wright 2002)

L-epinephrine (using parenteral 1 mg/mL solution): 0.5 mL/kg of 1 mg/mL solution (maximum dose: 5 mL) diluted in NS, may repeat dose every 20 minutes; Note: Racemic epinephrine 10 mg = 5 mg L-epinephrine (Hegenbarth 2008)