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2026-03-22T09:14:32Z

Strip excess bold

← Older revision		Revision as of 09:14, 22 March 2026
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	==Adult Dosing==		==Adult Dosing==
	*~~'''~~Asthma/Bronchospasm:~~'''~~		*Asthma/Bronchospasm:
	**S2: 0.5 mL of 2.25% solution diluted in 3 mL normal saline (NS) via jet nebulizer every 3-4 hours as needed		**S2: 0.5 mL of 2.25% solution diluted in 3 mL normal saline (NS) via jet nebulizer every 3-4 hours as needed
	**AsthmaNefrin: 1-3 inhalations of 0.5 mL of 2.25% solution via EZ Breathe Atomizer; max 12 inhalations/24 hours		**AsthmaNefrin: 1-3 inhalations of 0.5 mL of 2.25% solution via EZ Breathe Atomizer; max 12 inhalations/24 hours
	*~~'''~~Croup/Stridor/Laryngeal edema:~~'''~~		*Croup/Stridor/Laryngeal edema:
	**0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer over 15 minutes; may repeat every 20 minutes as needed		**0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer over 15 minutes; may repeat every 20 minutes as needed
	*~~'''~~Post-extubation stridor:~~'''~~		*Post-extubation stridor:
	**0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer; may repeat every 20 minutes as needed		**0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer; may repeat every 20 minutes as needed
	*~~'''~~Alternative if racemic epi unavailable:~~'''~~ L-epinephrine 1 mg/mL (1:1000): 5 mL undiluted via nebulizer		*Alternative if racemic epi unavailable: L-epinephrine 1 mg/mL (1:1000): 5 mL undiluted via nebulizer

	==Pediatric Dosing==		==Pediatric Dosing==
	*~~'''~~<4 years:~~'''~~		*<4 years:
	**0.05 mL/kg of 2.25% solution via jet nebulizer diluted in 3 mL NS over 15 minutes; max 0.5 mL/dose		**0.05 mL/kg of 2.25% solution via jet nebulizer diluted in 3 mL NS over 15 minutes; max 0.5 mL/dose
	**Croup: every 2 hours (with heart rate monitoring); asthma: no more often than every 12 hours		**Croup: every 2 hours (with heart rate monitoring); asthma: no more often than every 12 hours
	**Use low end of dosing range for younger infants		**Use low end of dosing range for younger infants
	*~~'''~~≥4 years:~~'''~~		*≥4 years:
	**0.5 mL of 2.25% solution via jet nebulizer diluted in 3 mL NS over 15 minutes every 3-4 hours as needed		**0.5 mL of 2.25% solution via jet nebulizer diluted in 3 mL NS over 15 minutes every 3-4 hours as needed
	*~~'''~~Alternative if racemic epi unavailable:~~'''~~ L-epinephrine 1 mg/mL: 3 mL for <10 kg; 5 mL for ≥10 kg (undiluted)		*Alternative if racemic epi unavailable: L-epinephrine 1 mg/mL: 3 mL for <10 kg; 5 mL for ≥10 kg (undiluted)

	==Special Populations==		==Special Populations==
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	*Racemic epinephrine is a 1:1 mixture of the d- (S+) and l- (R−) isomers of epinephrine		*Racemic epinephrine is a 1:1 mixture of the d- (S+) and l- (R−) isomers of epinephrine
	*Nonselective agonist at alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors (all G-protein-coupled receptors)		*Nonselective agonist at alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors (all G-protein-coupled receptors)
	*~~'''~~Alpha-1 mediated vasoconstriction:~~'''~~ constricts submucosal arterioles → reduces mucosal edema and capillary leakage (primary effect in croup/stridor; onset within 10-15 minutes)		*Alpha-1 mediated vasoconstriction: constricts submucosal arterioles → reduces mucosal edema and capillary leakage (primary effect in croup/stridor; onset within 10-15 minutes)
	*~~'''~~Beta-2 mediated bronchodilation:~~'''~~ relaxes bronchial smooth muscle → relieves bronchospasm, wheezing, chest tightness (primary therapeutic effect in asthma)		*Beta-2 mediated bronchodilation: relaxes bronchial smooth muscle → relieves bronchospasm, wheezing, chest tightness (primary therapeutic effect in asthma)
	*Beta-2 agonism activates adenylyl cyclase → increases intracellular cyclic AMP		*Beta-2 agonism activates adenylyl cyclase → increases intracellular cyclic AMP

Ostermayer: Created page with "==Administration== Type: Sympathomimetic (nonselective alpha- and beta-adrenergic agonist) Dosage Forms: Inhalation solution 2.25% (racepinephrine HCl); available as 0.5 mL unit-dose vials Routes of Administration: Nebulization (oral inhalation only) Common Trade Names: AsthmaNefrin, S2 ==Adult Dosing== *'''Asthma/Bronchospasm:''' S2: 0.5 mL of 2.25% solution diluted in 3 mL normal saline (NS) via jet nebulizer every 3-4 hours as needed AsthmaNefrin: 1-3 inhalat..."

2026-03-17T22:38:57Z

Created page with "==Administration== *Type: Sympathomimetic (nonselective alpha- and beta-adrenergic agonist) *Dosage Forms: Inhalation solution 2.25% (racepinephrine HCl); available as 0.5 mL unit-dose vials *Routes of Administration: Nebulization (oral inhalation only) *Common Trade Names: AsthmaNefrin, S2 ==Adult Dosing== *'''Asthma/Bronchospasm:''' **S2: 0.5 mL of 2.25% solution diluted in 3 mL normal saline (NS) via jet nebulizer every 3-4 hours as needed **AsthmaNefrin: 1-3 inhalat..."

New page

==Administration==
*Type: Sympathomimetic (nonselective alpha- and beta-adrenergic agonist)
*Dosage Forms: Inhalation solution 2.25% (racepinephrine HCl); available as 0.5 mL unit-dose vials
*Routes of Administration: Nebulization (oral inhalation only)
*Common Trade Names: AsthmaNefrin, S2

==Adult Dosing==
*'''Asthma/Bronchospasm:'''
**S2: 0.5 mL of 2.25% solution diluted in 3 mL normal saline (NS) via jet nebulizer every 3-4 hours as needed
**AsthmaNefrin: 1-3 inhalations of 0.5 mL of 2.25% solution via EZ Breathe Atomizer; max 12 inhalations/24 hours
*'''Croup/Stridor/Laryngeal edema:'''
**0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer over 15 minutes; may repeat every 20 minutes as needed
*'''Post-extubation stridor:'''
**0.5 mL of 2.25% solution diluted in 3 mL NS via jet nebulizer; may repeat every 20 minutes as needed
*'''Alternative if racemic epi unavailable:''' L-epinephrine 1 mg/mL (1:1000): 5 mL undiluted via nebulizer

==Pediatric Dosing==
*'''<4 years:'''
**0.05 mL/kg of 2.25% solution via jet nebulizer diluted in 3 mL NS over 15 minutes; max 0.5 mL/dose
**Croup: every 2 hours (with heart rate monitoring); asthma: no more often than every 12 hours
**Use low end of dosing range for younger infants
*'''≥4 years:'''
**0.5 mL of 2.25% solution via jet nebulizer diluted in 3 mL NS over 15 minutes every 3-4 hours as needed
*'''Alternative if racemic epi unavailable:''' L-epinephrine 1 mg/mL: 3 mL for <10 kg; 5 mL for ≥10 kg (undiluted)

==Special Populations==
===[[Drug pregnancy categories|Pregnancy Rating]]===
*Category C (former FDA system); FDA has not assigned a category under the current labeling rule
*No well-controlled studies in humans; animal studies show evidence of fetal harm
*Epinephrine crosses the placenta; use only if benefits outweigh risks

===Lactation risk===
*Systemic epinephrine is excreted in breast milk
*No data on whether inhaled racemic epinephrine is present in breast milk
*Due to poor oral bioavailability and short half-life, unlikely to significantly affect the nursing infant
*Use with caution

===Renal Dosing===
*Adult: No specific dosage adjustments recommended; use with caution and monitor
*Pediatric: No specific dosage adjustments recommended

===Hepatic Dosing===
*Adult: No specific dosage adjustments recommended
*Pediatric: No specific dosage adjustments recommended

==Contraindications==
*Allergy to class/drug
*Epiglottitis
*Concurrent use of MAOIs or within 2 weeks of discontinuing an MAOI
*Use caution with:
**Heart disease
**Hypertension
**Thyroid disease (hyperthyroidism)
**Diabetes
**Urinary retention caused by prostatic hypertrophy
**Closed-angle glaucoma
**Ventricular outflow tract obstruction (e.g., tetralogy of Fallot)
**Geriatric or cardiac patients

==Adverse Reactions==
===Serious===
*Cardiac arrhythmias (tachyarrhythmias)
*Severe hypertension
*Pulmonary edema
*Cerebrovascular hemorrhage (in overdose)
*Rebound/re-emergence of airway edema (typically 1-3 hours post-dose)
*Anginal pain
*Subarachnoid hemorrhage

===Common===
*Tachycardia
*Hypertension
*Headache
*Tremor
*Restlessness/agitation
*Nausea and vomiting
*Sweating
*Pallor
*Dizziness
*Hyperglycemia

==Pharmacology==
*Half-life: <5 minutes (plasma)
*Metabolism: Hepatic (and other extraneuronal tissues) via catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO); primary metabolites include metanephrine and vanillylmandelic acid (VMA)
*Excretion: Renal (primarily as inactive metabolites; negligible unchanged drug in urine)
*Onset of action: 1-5 minutes
*Duration of action: 1-3 hours
*Systemic bioavailability via inhalation: <10%

==Mechanism of Action==
*Racemic epinephrine is a 1:1 mixture of the d- (S+) and l- (R−) isomers of epinephrine
*Nonselective agonist at alpha-1, alpha-2, beta-1, and beta-2 adrenergic receptors (all G-protein-coupled receptors)
*'''Alpha-1 mediated vasoconstriction:''' constricts submucosal arterioles → reduces mucosal edema and capillary leakage (primary effect in croup/stridor; onset within 10-15 minutes)
*'''Beta-2 mediated bronchodilation:''' relaxes bronchial smooth muscle → relieves bronchospasm, wheezing, chest tightness (primary therapeutic effect in asthma)
*Beta-2 agonism activates adenylyl cyclase → increases intracellular cyclic AMP

==Comments==
*Observe patients for at least 4-6 hours after administration due to risk of rebound worsening of airway edema
*Rebound phenomenon is likely a re-emergence of symptoms as medication wears off, rather than true rebound
*Monitor cardiac rate and rhythm with continuous ECG during administration
*Co-administration of corticosteroids (e.g., dexamethasone) reduces likelihood of symptom recurrence
*L-epinephrine alone is considered equally efficacious as racemic epinephrine for croup and post-extubation stridor
*Not indicated as first-line therapy for routine asthma management
*Discard solution if brown, cloudy, pinkish, or darker than slightly yellow

==See Also==
*[[Croup]]
*[[Stridor]]
*[[Post-extubation stridor]]
*[[Epinephrine]]
*[[Asthma]]

==References==
<references/>
[[Category:Pharmacology]]

Racemic epinephrine - Revision history

Danbot: Strip excess bold