Asthma Treatment What to Know About Asthmanefrin (Racinepinephrine) A Medication Used With a Nebulizer to Treat Asthma By Pat Bass, MD twitter linkedin Dr. Bass is a board-certified internist, pediatrician, and a Fellow of the American Academy of Pediatrics and the American College of Physicians. Learn about our editorial process Pat Bass, MD Medically reviewed by Medically reviewed by John Carew, MD on July 08, 2020 twitter linkedin John Carew, MD, is board-certified in otolaryngology-head and neck surgery. He is an adjunct assistant professor at Mount Sinai Medical Center and NYU Medical Center. Learn about our Medical Review Board John Carew, MD on July 08, 2020 Print Table of Contents View All Table of Contents Uses Before Use Dosage Side Effects Warnings and Interactions 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. Asthmanenefrin is not approved by the Food and Drug Administration (FDA) for asthma treatment. This medication should never be used as a substitute for any asthma medication prescribed by your doctor. 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. How Asthma Is Treated Before Use Asthmanefrin should never be used until you have been officially diagnosed with asthma by a physician. It should only be used in accordance with your doctor-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 itselfConcurrent 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: AnginaArrhythmia (abnormal heart rhythm)Coronary artery diseaseDiabetesEpilepsyGlaucomaHeart failureHeart valve problemsHyperthyroidismParkinson's diseasePrevious heart attack or heart injuryPsychiatric disordersTachycardia (abnormally rapid heart rate)Uncontrolled hypertension Asthmanefrin is a Pregnancy Category C drug. This means the benefits of taking it may outweigh the risks but that people who are pregnant, intend to get pregnant, or are breastfeeding should use caution when using it. With Category C drugs, there is some evidence of fetal harm in animal studies (typically at doses that far exceed those in humans), but no well-controlled human studies are available. Speak with your doctor 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 resolveMaximum of 12 inhalations every 24 hours Symptoms should improve within 20 minutes. Never exceed the maximum dose. Taking too much Asthmanefrin or using it too often may increase the risk of heart attack or stroke in people with underlying coronary artery disease. Because the drug has been understudied, the actual risk is as of yet unknown. All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you. Are OTC Inhalers Safe for My Asthma? 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: Wash your hands.Remove the plastic vial from its foil pouch.Open the vial and pour the medication into the medicine cup.Place the mouthpiece in your mouth, wrapping your lips tightly to create a seal.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.)Breathe in deeply through your mouth only. To prevent nose breathing, you can pinch your nostrils or use a nose clamp, if needed.Continue inhaling until all of the medication is delivered. Depending on your lung capacity, this can take anywhere from one to three inhalations.Turn off the machine.Wash the medicine cup and mouthpiece with water, and allow them to air dry. How to Use a Nebulizer for Asthma 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: JitterinessAnxietyTremorsDifficulty sleepingHeadacheIncreased heart ratePounding sensations in the head, neck, or earsFatigueBlurred vision Illustration by Emily Roberts, Verywell Most of these side effects tend to be mild and transient, resolving over the course of several hours. Call your doctor if side effects persist or worsen. Allergy to epinephrine is rare. When to See a Doctor Because asthma can be life-threatening if not treated appropriately, you should see a doctor if:You are not better within 20 minutes of using Asthmanefrin.Your asthma gets worse despite Asthmanefrin use.You have no relief from symptoms after 12 inhalations in 24 hours.You use Asthmanefrin three or more days per week.You have more than two asthma attacks in a week. 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 gabapentinAntihistamines 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 doxycyclineTricyclic antidepressants like Elavil (amitriptyline) or Anafranil (clomipramine)Opioid drugs like Oxycontin (oxycodone)Caffeine pillsDiet pills and appetite suppressantsNatural stimulants like kola nut or guaranaIllicit stimulant drugs like cocaine or methamphetamine To reduce the risk of interactions, tell your doctor 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 doctor 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. What to Know About Over-the-Counter Asthma Inhalers Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article 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. Mondal P, Kandala B, Ahrens R, Chesrown SE, Hendeles L. Nonprescription racemic epinephrine for asthma. J Allergy Clin Immunol Pract. 2014;2(5):575-8. doi:10.1016/j.jaip.2014.02.014 Carr JA, Tietz KJ, Asthmanefrin: Patient counseling opportunity. Pharmacy Today. 2013;2013;23. U.S. Library of Medicine. Asthmanephrine - racepinephrine hydrochloride solution. In: DailyMed. Updated October 30, 2019. Dalal R, Grujic D. Epinephrine. In: StatPearls. Updated February 10, 2020.