What to Know About Asthmanefrin (Racepinephrine)

Asthmanefrin (racepinephrine) is an over-the-counter (OTC) inhaled medicine that helps open (dilate) constricted airways and provides temporary relief of shortness of breath, wheezing, tightness of chest, and wheezing due to asthma. It is a liquid solution made with two types of epinephrine (adrenaline) that is added to a handheld device called a nebulizer, which turns the liquid into a fine mist that you breathe in.

Uses

People use Asthmanefrin for the short-term relief of acute asthma symptoms. The two different forms of epinephrine in racepinephrine (also known as racemic epinephrine) work together to relax smooth muscles in the airways, allowing them to open and for breathing to ease. Levo-epinephrine is the active agent; dextro-epinephrine has relatively weak action.

Although some people describe Asthmanefrin as a rescue inhaler, it is not the same as short-acting beta-agonists (SABAs) like albuterol that provide rapid and effective relief of asthma attacks.

A 2014 study the Journal of Clinical of Allergy and Clinical Immunology: In Practice concluded that racepinephrine was far less effective in relieving bronchial spasms compared to albuterol—even at more than four times the dose.

Next to Primatene Mist, Asthmanefrin is one of the few over-the-counter medications that may provide relief of asthma symptoms when prescription medications cannot be obtained. Common reasons for opting for OTC inhalers like Asthmanefrin include convenience and a lack of health insurance.

Still, it should be noted that although Asthmanefrin is generally regarded as safe, there is little evidence of its long-term effectiveness. Albuterol is the gold standard for the quick relief of asthma symptoms.

Before Use

Asthmanefrin should never be used until you have been officially diagnosed with asthma by a healthcare provider. It should only be used in accordance with your healthcare provider-approved management plan.

Precautions and Contraindications

There are no absolute contraindications for the use of racepinephrine (or any other form of epinephrine) other than:

• An allergy to the compound itself
• Concurrent use of an monoamine oxidase inhibitor (MAOI) to treat depression or Parkinson's disease

MAOIs work by preventing the breakdown of certain neurotransmitters, including epinephrine. Taking an MAOI with Asthmanefrin can potentiate the action of racepinephrine and trigger severe side effects.

As a bioactive hormone and neurotransmitter, epinephrine acts upon multiple organ systems, including the central nervous system, cardiovascular system, endocrine system, respiratory tract, gastrointestinal tract, and kidneys. Racepinephrine should, therefore, be used with caution by people with:

• Angina
• Arrhythmia (abnormal heart rhythm)
• Coronary artery disease
• Diabetes
• Epilepsy
• Glaucoma
• Heart failure
• Heart valve problems
• Hyperthyroidism
• Parkinson's disease
• Previous heart attack or heart injury
• Psychiatric disorders
• Tachycardia (abnormally rapid heart rate)
• Uncontrolled hypertension

Asthmanefrin should be used with caution in people who are pregnant, intend to get pregnant, or are breastfeeding, as there is some evidence of fetal harm in animal studies (typically at doses that far exceed those in humans)—although no well-controlled human studies are available. However, the benefits of taking it may outweigh the risks.

Speak with your healthcare provider to fully understand the benefits and risks of Asthmanefrin and whether there are other drug options for you if you are pregnant or hope to be. It is unknown if inhaled racepinephrine can be passed through breast milk.

Dosage

Asthmanefrin is sold in individual 0.5-milliliter (mL) vials for use with a portable nebulizer. Each dose contains 11.25 milligrams (mg) of racepinephrine.

Asthmanefrin can be used by adults and children 4 and over. Dosage recommendations are the same for both groups:

• One to three inhalations no more than every three hours until asthma symptoms resolve
• Maximum of 12 inhalations every 24 hours

Symptoms should improve within 20 minutes.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.

How to Take and Store

Asthmanefrin is delivered to the lungs in a handheld nebulizer (also known as an atomizer). This is a portable device that turns the liquid solution into an inhalable mist.

Because each dose contains only 0.5 mL of fluid, Asthmanefrin should not be used in larger units designed for prescription nebulized medications.

To use a 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 deeply through your mouth only. To prevent nose breathing, you can pinch your nostrils or use a nose clamp, if needed.
7. Continue inhaling until all of the medication is delivered. Depending on your lung capacity, this can take anywhere from one to three inhalations.
8. Turn off the machine.
9. Wash the medicine cup and mouthpiece with water, and allow them to air dry.

Do not consume caffeine while using Asthmanefrin as caffeine combined with Asthmanefrin can increase blood pressure and may trigger rapid heartbeats in people with pre-existing tachycardia.

Asthmanefrin can be stored at room temperature and is stable at temperatures between 36 degrees F and 77 degrees F. Keep the vial in its foil pouch until needed, and out of reach of children and pets.

Do not use the medicine if it looks cloudy, discolored, or gritty; it should be clear. Discard any unused solution. Never use Asthmanefrin past its expiration date.

Side Effects

As with any medication, Asthmanefrin may cause side effects for some. Side effects tend to increase if the drug is overused. Common side effects include:

• Jitteriness
• Anxiety
• Tremors
• Difficulty sleeping
• Headache
• Increased heart rate
• Pounding sensations in the head, neck, or ears
• Fatigue
• Blurred vision

Most of these side effects tend to be mild and transient, resolving over the course of several hours. Call your healthcare provider if side effects persist or worsen. Allergy to epinephrine is rare.

Warnings and Interactions

Asthmanefrin may interact with certain drugs, particularly stimulants and other drugs that influence neurotransmitters like epinephrine. Other medications may directly interfere with the action of Asthmanefrin, among them:

• Anticonvulsives like gabapentin
• Antihistamines like Allegra (fexofenadine) or Zyrtec (cetirizine)
• Beta-blockers like Tenormin (atenolol) 
• Decongestants like Afrin (oxymetazoline) or Sudafed (pseudoephedrine)
• Heartburn medications like Prilosec (omeprazole)
• Tetracycline antibiotics like doxycycline
• Tricyclic antidepressants like Elavil (amitriptyline) or Anafranil (clomipramine)
• Opioid drugs like Oxycontin (oxycodone)
• Caffeine pills
• Diet pills and appetite suppressants
• Natural stimulants like kola nut or guarana
• Illicit stimulant drugs like cocaine or methamphetamine

To reduce the risk of interactions, tell your healthcare provider about any drugs you are taking, including prescription, non-prescription, and recreational drugs.

If you decide to use Asthmanefrin and are taking an MAOI antidepressant, you will need to stop the MAOI at least two weeks beforehand to avoid interactions.

A Word From Verywell

Asthmanefrin is not the ideal treatment for asthma, but one that some turn to if they can't afford to see a healthcare provider or are unwilling to. At roughly one dollar per dose, Asthmanefrin may seem like a good option—until you find yourself using it regularly. If asthma is not properly controlled, it will almost invariably progress and worsen.

Don't assume that prescription asthma drugs are unaffordable. There are numerous patient assistance programs offered by manufacturers that cover some, if not all of the cost of certain asthma drugs if you are unable to afford them. Speak with your health provider to see if you qualify.