Dosing & Uses
Dosage Forms & Strengths
suspension for aerosol inhalation
- 0.125mg/actuation
Mild Asthma
Indicated for temporary relief of mild symptoms of intermittent asthma (eg, wheezing, chest tightness, dyspnea)
1-2 inhalations PO q4hr PRN; start with 1 inhalation, wait at least 1 minute, administer second inhalation if symptoms not relieved
Not to exceed 8 inhalations/24 hr
Dosage Forms & Strengths
suspension for aerosol inhalation
- 0.125mg/actuation
Mild Asthma
Indicated for temporary relief of mild symptoms of intermittent asthma (eg, wheezing, chest tightness, dyspnea)
<12 years: Safety and efficacy not established
≥12 years
- 1-2 inhalations PO q4hr PRN; start with 1 inhalation, wait at least 1 minute, administer second inhalation if symptoms not relieved
- Not to exceed 8 inhalations/24 hr
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (3)
- isocarboxazid
isocarboxazid and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.
- phenelzine
phenelzine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.
- tranylcypromine
tranylcypromine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Coadministration of epinephrine inhaled with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated.
Serious - Use Alternative (0)
Monitor Closely (40)
- amitriptyline
amitriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- amoxapine
amoxapine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- amphetamine
amphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- amphetamine polistirex
amphetamine polistirex, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- armodafinil
armodafinil, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- atomoxetine
atomoxetine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- benzphetamine
benzphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- caffeine
caffeine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- clomipramine
clomipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- clonidine
clonidine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- desipramine
desipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- dexmethylphenidate
dexmethylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- dextroamphetamine
dextroamphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- diethylpropion
diethylpropion, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- doxepin
doxepin and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- entacapone
entacapone will increase the level or effect of epinephrine inhaled by decreasing metabolism. Use Caution/Monitor. Entacapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- ephedrine
ephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- epinephrine
epinephrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- guanfacine
guanfacine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- imipramine
imipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- lisdexamfetamine
lisdexamfetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- lorcaserin
lorcaserin, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- methamphetamine
methamphetamine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- methylphenidate
methylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- modafinil
modafinil, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- nadolol
nadolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.
- nortriptyline
nortriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- opicapone
opicapone will increase the level or effect of epinephrine inhaled by decreasing metabolism. Use Caution/Monitor. Opicapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- penbutolol
penbutolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.
- phendimetrazine
phendimetrazine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- phentermine
phentermine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- phenylephrine
phenylephrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- propranolol
propranolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.
- protriptyline
protriptyline and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
- pseudoephedrine
pseudoephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- serdexmethylphenidate/dexmethylphenidate
serdexmethylphenidate/dexmethylphenidate, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.
- sotalol
sotalol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.
- timolol
timolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.
- tolcapone
tolcapone will increase the level or effect of epinephrine inhaled by decreasing metabolism. Use Caution/Monitor. Tolcapone is a COMT inhibitor. Caution if coadministered with drugs metabolized by COMT. If coadministered, monitor for changes in heart rate, heart rhythm, and blood pressure.
- trimipramine
trimipramine and epinephrine inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system.
Minor (0)
Adverse Effects
Frequency Not Defined
Tachycardia
Increased blood pressure
Warnings
Contraindications
Patients without a diagnosis of asthma
Coadministration with MAOIs, or within 2 weeks after discontinuing an MAOI
Cautions
Patients who have severe asthma or who have been hospitalized for asthma should seek medical attention for prescription medications to treat their asthma
Caution with preexisting conditions, including heart disease (eg, arrhythmias, coronary insufficiency, elevated blood pressure [BP]), diabetes, urinary impairment, enlarged prostate, thyroid disease, seizures, or narrow-angle glaucoma
Because asthma can be life-threatening, see healthcare professional if no improvement in 20 minutes, symptoms get worse, need 12 inhalations in any given day, use more than 9 inhalations a day for more than 3 days a week, or experience >2 asthma attacks in a week
See healthcare professional if experiencing nervousness, sleeplessness, rapid heartbeat, tremors, or experience a seizure
Do not use or store near open flame or heat above 120°F (49°C); may cause bursting
May increase heart rate or blood pressure
Not for relief of COPD symptoms
Drug interaction overview
- Coadministration with MAOIs or within 2 weeks after discontinuing an MAOI is contraindicated, owing to risk for hypertensive episode
- Tricyclic antidepressants may potentiate epinephrine effect on cardiovascular system
- Other stimulants (eg, phenylephrine, pseudoephedrine, ephedrine, caffeine) may have additive effects on HR or BP
- Caution with beta-blockers; may block bronchodilatory effects of epinephrine
- Avoid caffeine-containing foods or beverages
- Avoid dietary supplements containing ingredients reported or claimed to have stimulant effect
Pregnancy & Lactation
Pregnancy
Control of asthma during pregnancy is essential for maternal and fetal health
In women with poorly or moderately controlled asthma, there is increased risk of preeclampsia in mother and prematurity, low birth weight, and small for gestational age in neonate; pregnant women should be closely monitored and medication adjusted as necessary to maintain optimal control
Beta-agonists may interfere with uterine contractility during labor
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Lactation
Unknown if inhaled epinephrine is distributed in human milk
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Elicits beta1- and beta2-adrenergic effects, resulting in bronchial smooth muscle relaxation
Also has alpha-adrenergic effects that may increase HR and BP
Administration
Inhaled Administration
For oral inhalation only
Before first use only: Shake inhaler and spray into air; repeat both actions 4 times to assure inhaler is activated
Before subsequent doses (ie, 1-2 inhalations): Shake inhaler then spray into air once to prime
After each day of use: Wash by removing red cap and container; run water through mouthpiece for 30 seconds, then shake off excess water and let dry
Storage
Store at room temperature between 15-25°C (59-77°F)
Do not store near open flame
