Dosing and uses of AsthmaNefrin, S2 (epinephrine racemic)
Adult dosage forms and strengths
solution for nebulization
- 11.25mg/0.5mL (2.25% as 1.125% dextro-epinephrine and 1.125% levo-epinephrine)
Bronchial Asthma
Indicated for temporary relieve of symptoms associated with bronchial asthma (eg, shortness of breath, chest tightening, wheezing)
S2: 0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer q3-4hr PRn
Asthmanefrin: 1-3 inhalations of 0.5 mL of 2.25% solution via EZ Breathe Atomizer
Pediatric dosage forms and strengths
solution for nebulization
- 11.25mg/0.5mL (2.25% as 1.125% dextro-epinephrine and 1.125% levo-epinephrine)
Bronchial Asthma
Indicated for temporary relieve of symptoms associated with bronchial asthma (eg, shortness of breath, chest tightening, wheezing)
Asthmanefrin
- <4 years: Safety and efficacy not established
- ≥4 years: 1-3 inhalations of 0.5 mL of 2.25% solution via EZ Breathe Atomizer
S2
- <4 years old: 0.05 mL/kg via jet nebulizer (diluted to 3 mL with NS) over 15 minutes; no more than q12hr; not to exceed 0.5 mL/dose
- ≥4 years old: 0.5 mL of 2.25% solution via jet nebulizer (diluted to 3 mL with NS) over 15 minutes q3-4 hr PRN
Use low end of dosing range for younger infants
Should observe rapid response, can be repeated q2hr in older children but monitor HR with repeated dosing
Croup
<4 years: 0.05 mL/kg of 2.25% solution (S2) via jet nebulizer (diluted to 3 mL with NS) over 15 minutes q3-4 hr PRN; not to exceed 0.5 mL/dose
≥4 years old: 0.5 mL of 2.25% solution (S2) via jet nebulizer (diluted to 3 mL with NS) over 15 minutes q3-4 hr PRn
AsthmaNefrin, S2 (epinephrine racemic) adverse (side) effects
Frequency not defined
Tachycardia
Arrhythmias
Headache
Nausea
Sweating
Tremor
Restlessness
Rebound airway edema may occur
Angina
Autonomic hyperreflexia
Cardiac dysrhythmia
Ventricular fibrillation
Cerebral hemorrhage
Pulmonary edema
Warnings
Contraindications
Epiglottitis
Coadministration with MAOIs, or within 2 weeks after discontinuing an MAOI
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
Pregnancy category: C
Lactation: Excreted in breast milk
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.
Pharmacology of AsthmaNefrin, S2 (epinephrine racemic)
Mechanism of action
Elicits agonistic action on alpha, beta-2, and beta-2 receptors resulting in bronchial smooth muscle relaxation, cardiac stimulation, vasodilation in skeletal muscle, and stimulation of glycogenolysis in the liver
Pharmacokinetics
Onset: 1-5 min
Duration: 1-3 hr
Metabolism: liver
Metabolites: metanephrine & 3-methoxy-4-hydroxymandelic acid (vanillylmandelic acid, VMA)
Excretion: unknown
