Asthmanefrin (Racepinephrine) - Inhalation

What Is Asthmanefrin?

Asthmanefrin (racepinephrine) is an inhaled bronchodilator (a type of medication used to make breathing easier) used to relieve symptoms of intermittent asthma in adults and children 4 and older.

Asthmanefrin is classified as a non-selective beta agonist (a group of drugs that lower artery and vein pressure) and is further categorized as a short-acting bronchodilator that can temporarily relieve mild symptoms of intermittent asthma.

Asthmanefrin works by stimulating the beta receptors found in the respiratory tract's smooth muscles, resulting in the opening of airways which can subsequently lessen wheezing, shortness of breath, and Angina (chest tightness) as a result of an asthma diagnosis.

Asthmanefrin, a brand-name drug, contains the active ingredient racepinephrine. However, racepinephrine is not available as a generic product.

Instead, Asthmanefrin is available without a prescription as an over-the-counter (OTC) solution for inhalation.

This medication requires the use of the short-acting racepinephrine inhalation solution bronchodilator, categorized as a handheld nebulizer. For context, the nebulizer turns the liquid medication into a fine mist that you breathe into your lungs.

Drug Facts

Generic Name: Racepinephrine

Brand Name(s): Asthmanefrin

Drug Availability: OTC

Therapeutic Classification: Bronchodilator

Available Generically: No

Controlled Substance: N/A

Administration Route: Inhalation

Active Ingredient: Racepinephrine

Dosage Form(s): Inhalation solution

What Is Asthmanefrin Used For?

The Food and Drug Administration (FDA) has approved Asthmanefrin to treat the symptoms associated with intermittent asthma in adults and children 4 and older. Mild intermittent asthma symptoms include wheezing, angina, and shortness of breath.

Asthmanefrin is not the same as short-acting beta-agonists (SABAs), such as albuterol, an oral drug that provides rapid relief from asthma attacks.

For context, intermittent asthma is the occurrence of asthma symptoms that occur a maximum of two days per week, alongside nighttime symptoms that occur twice a month at most.

However, it should be noted that the FDA does not approve this drug for asthma treatment.

How to Take Asthmanefrin

Inhale Asthmanefrin using a nebulizer. Don't use more than 12 inhalations in 24 hours. Do not use more Asthmanefrin than directed.

An adult should supervise the use of this product by children.

When using the handheld rubber bulb nebulizer, add 0.5 milliliters (contents of one vial) of the solution to the nebulizer.

To use the handheld nebulizer:

  1. Wash your hands.
  2. Remove the plastic vial from its foil pouch.
  3. Open the vial and pour the medication into the medicine cup.
  4. Place the mouthpiece in your mouth, wrapping your lips tightly to create a seal.
  5. Turn on the nebulizer (if you use a bulb nebulizer, you would instead squeeze the rubber bulb to pump the atomized medication into the lungs).
  6. Breathe in through your mouth only.
  7. Inhale until all of the medication is delivered.
  8. Turn off the machine.
  9. Wash the medicine cup and mouthpiece with water, and allow them to air dry.

Storage

Store Asthmanefrin vials in their protective foil pouches in the refrigerator or at room temperature (36 F to 77 F).

Moreover, keep away from excessive heat, direct light, or freezing temperatures, and be sure to keep out of reach of children and pets, if applicable.

How Long Does Asthmanefrin Take to Work?

Asthmanefrin should begin to relieve asthma symptoms within minutes. If there is no relief within 20 minutes, seek care from a healthcare provider.

What Are the Side Effects of Asthmanefrin?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

The most common side effects experienced when taking Asthmanefrin include:

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms associated with the use of Asthmanefrin may include the following:

  • Angina
  • Increased blood pressure or tachycardia (a fast heartbeat), side effects that could increase your risk of heart attack or stroke and potentially death.
  • Numbness or weakness in the arm or leg or on one side of your body
  • Allergic reactions, such as rash, fever, flushing, or tachycardia

Because asthma may be life-threatening, see a healthcare provider if you:

  • Are not better in 20 minutes
  • Get worse or need more than 12 inhalations in 24 hours
  • Use more than nine inhalations in 24 hours for three or more days a week
  • Have more than two asthma attacks in a week

Report Side Effects

Asthmanefrin may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Asthmanefrin Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For inhalation dosage form:
    • For relief of asthma symptoms:
      • Adults and children 4 years of age and older—1 to 3 inhalations for each dose. Wait at least 3 hours between doses. Do not use more than 12 inhalations in 24 hours.
      • Children younger than 4 years of age—Use and dose must be determined by your doctor.

Modifications

The following factors may affect whether you take Asthmanefrin or how you take it:

Pregnancy: The safe use of Asthmanefrin in pregnancy has not been established; therefore, the decision to use it during pregnancy must consider the benefits and potential risks to the pregnant person and fetus. Consult with a healthcare provider before using this medication during pregnancy.

Breastfeeding: It is not known if Asthmanefrin is present in human breast milk. However, most experts agree that inhaled bronchodilators, including epinephrine, are compatible with breastfeeding, as they are poorly absorbed via ingestion and have low maternal serum levels after use.

Children: The safety and efficacy of Asthmenefrin have not been established in children under 4 years old.

Missed Dose

If you miss a dose of Asthmanefrin, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and take the next dose at the regularly scheduled time.

Do not take an extra dose to make up for the missed dose. 

Because this medication should be used only when needed in response to asthma symptoms, missed doses are typically not an issue.

Overdose: What Happens If I Take Too Much Asthmanefrin?

The symptoms associated with an overdose of Asthmanefrin may include tachycardia, high or low blood pressure, nervousness, tremor, heart palpitations (abnormal heart rhythms), hyperglycemia (high blood sugar), nausea, or vomiting.

Also, injecting this medication intravenously (into the vein) may result in serious heart problems, including heart attack and death.

Treatment of overdose should be symptomatic and supportive. Cardiac monitoring is recommended for those experiencing cardiac symptoms. Medications may be needed to treat severely high blood pressure.

What Happens if I Overdose on Asthmanefrin?

If you think you or someone else may have overdosed on Asthmanefrin, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Asthmanefrin, call 911 immediately.

Precautions

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It is very important that your doctor check your or your child's progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

Check with your doctor if your symptoms do not improve or if they get worse. Your asthma may be getting worse if:

  • You are not better in 20 minutes.
  • You need more than 12 inhalations in 24 hours.
  • You use more than 9 inhalations in 24 hours for 3 or more days a week.
  • You have more than 2 asthma attacks in a week.

Check with your doctor right away if you have trouble sleeping, fast heartbeat, tremors, nervousness, or seizures.

Do not use this medicine if you are using or have used an MAO inhibitor (MAOI) such as isocarboxazid [Marplan®], linezolid [Zyvox®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]) within the past 14 days.

This medicine may cause high blood pressure, which may increase your risk for heart attack or stroke. Check with your doctor right away if you are having chest pain or discomfort, nausea or vomiting, pain or discomfort in the arms, jaw, back, or neck, slurred speech, or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Use Asthmanefrin?

You should not take this medication if the following applies:

  • You have not been diagnosed with asthma by a healthcare provider
  • You are currently or have recently taken a prescription monoamine oxidase inhibitor (MAOI) within the last two weeks (drugs used to treat depression, psychiatric conditions, or Parkinson's disease)
  • If the product is brown in color or cloudy

Additionally, you should speak to a healthcare provider before starting treatment with Asthmanefrin if the following applies:

  • You have been hospitalized for asthma
  • You have a history of heart disease
  • You have a history of high blood pressure
  • You carry a diabetes diagnosis
  • You carry a thyroid disease diagnosis
  • You currently or in the past have suffered from seizures
  • You carry a narrow-angle glaucoma diagnosis
  • You have trouble urinating due to an enlarged prostate gland

What Other Medications Interact With Asthmanefrin?

Some medications should not be taken along with Asthmanefrin. Be sure your healthcare provider has an updated list of all medicines you take, including prescription and over-the-counter (OTC) drugs, vitamins, and herbal supplements.

Medications that may interact with Asthmanefrin include:

Also, diet pills, stimulants (e.g., caffeine), and decongestants, such as Sudafed 12 Hour (pseudoephedrine), may increase the risk of side effects when used with Asthmanefrin.

What Medications Are Similar?

Asthmanefrin belongs to a family of inhaled drugs known as short-acting bronchodilators, commonly used to treat asthma.

Other medications in this family include:

People with asthma should only use one short-acting bronchodilator at a time.

The prescription bronchodilator, albuterol, is available both as a multi-dose inhaler and as a solution for a nebulizer.

Frequently Asked Questions

  • What side effects can I expect while using Asthmanefrin?

    The most common side effects associated with the use of Asthmanefrin include palpitations, anxiety, tremor, restlessness, nausea, and vomiting.

  • How does racepinephrine differ from epinephrine?

    Racepinephrine is a mixture containing dextro-epinephrine and Levo-epinephrine, while epinephrine consists of Levo-epinephrine, the more potent form.

  • How do OTC inhaled medications like Asthmanefrin compare to prescription inhalers like albuterol?

    There are limited data comparing racepinephrine to albuterol, but one small study showed that albuterol was more effective in protecting against bronchospasm.

    Some people believe having some asthma medications available without a prescription is convenient for people without access to regular healthcare or insurance. However, there are safety concerns with self-diagnosing and self-treating breathing problems.

    It may seem like seeing a healthcare provider who then prescribes medications for asthma would be more costly than purchasing medication over the counter.

    However, many programs provide free or reduced-cost asthma medications for people who qualify based on finances.

How Can I Stay Healthy While Taking Asthmanefrin?

Do not exceed the recommended dose of Asthmanefrin. Excessive use of Asthmanefrin does not lead to increased therapeutic effects and can result in serious side effects, including cardiac emergencies and potential death.  

Don’t use caffeine or other stimulants, as these can increase the likelihood of side effects. 

If your Asthmanefrin treatment becomes less effective or requires more frequent use, meaning more than nine inhalations a day for three days a week, speak to your healthcare provider promptly.

These signs may indicate that your asthma is not well-controlled, and you may need other medications to improve your lung function.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. American Academy of Allergy Asthma & Immunology. Short-acting beta-agonists (SABAs).

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By Carrie Yuan, PharmD
Carrie Yuan PharmD is a clinical pharmacist with expertise in chronic disease medication management for conditions encountered in primary care.