Over-The-Counter Inhalers for Asthma: What to Know

Are Primatene Mist or Asthmanefrin right for you?

With the high cost of prescription inhalers, you may wonder whether over-the-counter (OTC) asthma inhalers actually work.

There are currently two nonprescription options available in the United States called Primatene Mist (epinephrine) and Asthmanefrin (racepinephrine). These products are sometimes referred to as rescue inhalers because they are used to treat acute asthma attacks.

Primatene Mist and Asthmanefrin both have similar mechanisms of action and can provide temporary relief of asthma symptoms such as shortness of breath, chest tightness, and wheezing.

otc asthma inhaler side effects
​Illustration by Emily Roberts, Verywell

This article explores the benefits and drawbacks of OTC asthma inhalers, including their side effects and potential risks. It also wades into the controversy surrounding inhalers like Primatene Mist and Asthamanefrin and what leading public health authorities say about them.

Asthma Symptoms

Asthma is a chronic lung disease that causes your airways may react to certain triggers, such as smoke, pollen, pollution, or infections. When this happens, the airways will begin to constrict (narrow) and spasm, making it difficult to breathe.

Classic symptoms of asthma include:

  • Wheezing
  • Chest tightness
  • Cough
  • Shortness of breath

Asthma can be treated with long-acting prescription inhalers that help control the condition from day to day. There are also short-acting prescription inhalers, commonly called rescue inhalers, that are used to treat an asthma attack.

OTC asthma inhalers are uncommon choices for the treatment of asthma, but ones that some people turn to due to their convenience and price.

OTC Treatment Options

There are two OTC asthma inhalers currently sold in pharmacies and drugstores in the United States. Both are approved for use by the U.S. Food and Drug Administration (FDA) for temporary relief of symptoms of mild intermittent asthma. This is a form of asthma that occurs only occasionally and is considered the mildest form of the disease.

Primatene Mist

Primatene Mist is an OTC asthma inhaler used for the relief of acute asthma symptoms. It contains a drug called epinephrine (adrenaline) that acts on the airways, causing them to dilate (widen). Epinephrine is the same drug used in EpiPen auto-injectors that are used to treat severe allergic reactions.

Primatene Mist was removed from the U.S. market in 2011 because it was manufactured with an aerosol propellant called chlorofluorocarbon (CFC) that was harmful to the ozone layer. It was later approved by the FDA in 2018 when it was manufactured with a new propellant called hydrofluoroalkane (HFA) that is used in many other asthma inhalers.

Recommended Dose

Primatene Mist is approved for adults and children 12 and over. The recommended dose is 1 to 2 inhalations, not to exceed 8 inhalations within a 24-hour period.

Primatene Mist is not intended for long-term use. Moreover, the FDA strongly recommends that Primatene Mist not be used until asthma is diagnosed by a healthcare provider. This is because other conditions can cause asthma-like symptoms and would need to be treated differently.

Asthmanefrin

Asthmanefrin is a CFC-free inhaler that works similarly to Primatene Mist. It contains a drug called racepinephrine that has a similar action to epinephrine but tends to be potent.

Asthmanefrin was introduced in 2012 after the discontinuation of Primatene Mist as a cost-effective bronchodilator. While it appears to be useful in treating mild bronchoconstriction (narrowing of the airway), it is generally less able to treat bronchospasm (spasms of the airways).

Asthmanefrin is not delivered in a pressurized canister like Primatene Mist. Instead, it is sold in liquid form in a 30-count pack for use in a portable nebulizer machine. This is a device that turns liquid into a fine mist for inhalation.

This makes Asthmanefrin somewhat less convenient during an asthma attack than an HFA propellant like Primatene Mist.

Recommended Dose

Asthmanefrin is approved for use in adults and children 4 and over. The recommended dose is 1 to 3 inhalation every 3 hours, not to exceed 24 inhalations during a 24-hour period.

As with Primatene Mist, Asthmanefrin is not intended for long-term use and should only be used after you have been diagnosed with asthma by a healthcare provider.

Asthma Doctor Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

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Side Effects

Just like prescription medications, OTC medications like Primatene Mist and Asthmanefrin also carry a risk of side effects.

Primatene Mist
  • Bad taste

  • Cough

  • Dizziness

  • Dry mouth

  • Headache

  • Nausea

  • Nervousness

  • Sore throat

  • Stomach ache

  • Sweating

  • Tremors

  • Trouble sleeping

  • Vomiting

Asthmanefrin
  • Appetite changes

  • Dizziness

  • Headache

  • Hyperactivity (particularly in children)

  • Nausea

  • Nervousness

  • Sinus pain

  • Sore throat

  • Sweating

  • Tremors

  • Trouble sleeping

  • Vomiting

Benefits

There are certain presumed benefits to OTC inhalers like Primatene Mist and Asthmanefrin. To many people who use them, the first is cost.

Primatene Mist currently retails for around $35 a canister, while a 30-count box of Asthmanefrin retails for more or less than the same. That is considerably less than what many asthma inhalers cost, some of which can retail for $300 or more.

But, the same does not necessarily apply to rescue inhalers. While brand-name products like Proventil (albuterol) and Xopenex (levalbuterol) retail at around twice the price of Primatene Mist and Asthmanefrin, there are may low-cost generic versions available. Some cost more or less as same as Primatene Mist and Asthmanefrin.

But, of course, the cost of the drugs accounts for only a portion of the treatment of asthma. With drugs like Primatene Mist and Asthmanefrin, you don't require a prescription and don't have to pay to see a doctor if you don't have to.

But, is that truly a "benefit?"

Risks

Self-treating any medical condition poses significant risks, including misdiagnoses and overdosing or underdosing medications. With OTC inhalers, the greater concern is that the drugs may continue to be used even when they begin to lose their effectiveness.

If this happens and you experience frequent attacks, your lungs can begin to change and become stiffer and stiffer as scar tissues start to develop. Over time, this can reduce the capacity of your lungs, leaving you weak and breathless with even moderate activity.

When Rescue Inhalers Are Not Enough

If you use a rescue inhaler two or more times per week or more than two nights per month, you need to talk to a healthcare provider about starting asthma controller medications. These are inhaled, oral, or injectable drugs used regularly (sometimes daily) to help control asthma symptoms.

According to a 2017 study published in BMJ Open, people who use OTC rescue inhalers are no more likely to have uncontrolled asthma than those who use prescription rescue inhalers. However, they are 70% more likely to require urgent asthma care within a year.

Conflicting Opinions

In their approval of the "new" Primatene Mist in 2018, the FDA assured the public that, as with all approved drugs, Primatene Mist underwent "a robust scientific review to ensure it can be used safely by patients." With that said, the FDA acknowledged that only a "narrow population" of people—namely those with mild intermittent asthma—would benefit.

Many health professionals do not agree.

In fact, the American College of Asthma, Allergy & Immunology, the American Association for Respiratory Care, the American Thoracic Society, and the National Association for Medical Direction of Respiratory Care do not believe that OTC inhalers of any sort are safe for the treatment of asthma.

For its part, the National Institutes of Health do not include either Primatene Mist or Asthmanefrin in its Guidelines for the Diagnosis and Management of Asthma.

Summary

There are two over-the-counter (OTC) inhalers available for the treatment of asthma in the United States. They are Primatene Mist, which contains epinephrine, and Asthmanefrin, which contains a similar drug called racepinephrine.

While both are approved for use by the FDA, OTC inhalers are only intended for the short-term use of mild intermittent asthma. Most major health authorities, including the American Thoracic Society, advise against their use and contend that the risks of these inhalers (including an increased likelihood of a severe attack) outweigh the benefits.

A Word From Verywell

You will need to decide for yourself whether it is appropriate to use an OTC inhaler to manage your asthma. You may be attracted to the lower cost and the fact that you don't need a prescription.

But, it is important to remember that OTC inhalers do not have the same proven benefits as prescription inhalers. Moreover, they may not necessarily cost less than generic inhalers like albuterol or levalbuterol. To make an informed judgment, speak with your healthcare provider first.

Frequently Asked Questions

  • Is Primatene Mist the same as albuterol?

    No. Primatene Mist contains epinephrine, the same drug used to treat severe allergy attacks. By contrast, albuterol is a short-acting bronchodilator that works by relaxing muscles of the airways, reducing spasms and improving breathing.

  • Are over-the-counter inhalers safe?

    While they are not "unsafe," over-the-counter (OTC) inhalers like Primatene Mist and Asthmanefrin may provide inadequate control of asthma symptoms. This is evidenced by a 2017 study that reported that users of OTC inhalers are 70% more likely to require urgent asthma care than those who use prescription inhalers.

  • How much do over-the-counter inhalers cost?

    Cost is one of the major draws of over-the-counter inhalers like Primatene Mist and Asthmanefrin, both of which cost around $35. But, that may end up being a false saving given that generic versions of albuterol inhalers (considered the first-line option for acute asthma symptoms) now cost more or less the same.

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12 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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