Pronunciation:

ep-i-NEF-rin

Brand Names:

• Adrenalin
• Primatene Mist
• Bronkaid Mistometer

Dosage Forms:

• Aerosol Liquid

Classifications:

Therapeutic—

Bronchodilator

Pharmacologic—

Sympathomimetic

Chemical—

Alkylarylamine

Uses of This Medicine:

Epinephrine inhalation is used as temporary relief for mild symptoms of a weak type of asthma, called intermittent asthma (eg, chest tightness, troubled breathing).

This medicine is available with your doctor's prescription and over the counter.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of epinephrine inhalation in children younger 12 years of age. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of epinephrine inhalation in the elderly.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Dihydroergotamine
• Isocarboxazid
• Linezolid
• Phenelzine
• Tranylcypromine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Amineptine
• Amitriptyline
• Amitriptylinoxide
• Amoxapine
• Benperidol
• Bromperidol
• Bucindolol
• Carteolol
• Carvedilol
• Clomipramine
• Desipramine
• Dibenzepin
• Digoxin
• Dilevalol
• Dixyrazine
• Doxepin
• Droperidol
• Entacapone
• Ergonovine
• Fexofenadine
• Fluphenazine
• Furazolidone
• Haloperidol
• Halothane
• Imipramine
• Iobenguane I 123
• Iproniazid
• Levalbuterol
• Levobunolol
• Lofepramine
• Loxapine
• Melitracen
• Melperone
• Methdilazine
• Methotrimeprazine
• Methylene Blue
• Methylergonovine
• Metipranolol
• Metopimazine
• Milnacipran
• Moperone
• Nadolol
• Nialamide
• Nortriptyline
• Opicapone
• Opipramol
• Oxprenolol
• Penbutolol
• Perazine
• Periciazine
• Perphenazine
• Pindolol
• Pipamperone
• Piperazine
• Pipotiazine
• Practolol
• Procarbazine
• Prochlorperazine
• Promazine
• Promethazine
• Propiomazine
• Propranolol
• Protriptyline
• Rasagiline
• Rocuronium
• Safinamide
• Selegiline
• Sotalol
• Terfenadine
• Tertatolol
• Thiethylperazine
• Thioproperazine
• Thioridazine
• Tianeptine
• Timolol
• Trifluoperazine
• Trifluperidol
• Triflupromazine
• Trimipramine
• Zavegepant

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Labetalol

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Diabetes or
• Enlarged prostate or
• Glaucoma, narrow-angle or
• Heart disease or history of or
• Hypertension (high blood pressure), or
• Seizures or
• Thyroid problems or
• Trouble urinating—Use with caution. May make these conditions worse.

Proper Use of This Medicine:

Follow the instructions on the medicine label if you are using this medicine without a prescription.

This medicine should come with patient instructions. Read and follow these instructions carefully. Ask your pharmacist if you have any questions.

To use the inhaler:

• Before using the inhaler, activate it first by shaking then test spraying into the air away from your face 4 separate times.
• Shake and spray into the air once each time you take a dose.
• Remove the cap and look at the mouthpiece to make sure it is clean.
• To inhale this medicine, breathe out fully and try to get as much air out of your lungs as possible. Put the mouthpiece just in front of your mouth with the canister upright.
• Open your mouth and breathe in slowly and deeply (like yawning), and at the same time firmly press down on the top of the canister once.
• Hold your breath for as long as you can.
• Release your finger and remove the inhaler from your mouth, then exhale slowly.
• If your symptoms are still not relieved after at least 1 minute, take a second inhalation.
• Wash your inhaler by removing the red cap and container. Run water through both ends of the mouthpiece for 30 seconds. Shake off as much water as you can. Air dry overnight. If you need to use the inhaler but it is still wet, shake off the excess water before using.
• The container of the inhaler contains a spray indicator. This will tell you how much medicine you have left. The spray indicator changes every after 20 sprays. Replace your inhaler as soon as the display reads "20".
• Do not use this medicine to treat other breathing problems, without first checking with your doctor.
• Avoid food or drinks that contain caffeine.
• Avoid supplements that contain, or claim to have, stimulant effects.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For inhalation dosage form (aerosol):
  • For relief of asthma symptoms:
    • Adults and children 12 years of age and older—1 to 2 inhalations for each dose. Wait at least 1 minute between each inhalation. Wait at least 4 hours between doses. Do not use more than 8 inhalations in 24 hours.
    • Children younger than 12 years of age—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the canister at room temperature, away from heat and direct light. Do not freeze. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold. Do not poke holes in the canister or throw it into a fire, even if the canister is empty.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Throw the inhaler away if the spray indicator displays "0" or if it has expired.

Precautions While Using This Medicine:

It is very important that your doctor check your or your child's progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

Check with your doctor if your symptoms do not improve or if they get worse. Your asthma may be getting worse if:

• You are not better in 20 minutes.
• You need more than 8 inhalations in 24 hours.
• You have more than 2 asthma attacks in a week.

Do not use this medicine if you are using or have used an MAO inhibitor (MAOI) such as isocarboxazid [Marplan®], linezolid [Zyvox®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]) within the past 14 days.

This medicine may cause high blood pressure, which may increase your risk for heart attack or stroke. Check with your doctor right away if you are having chest pain or discomfort, nausea or vomiting, pain or discomfort in the arms, jaw, back, or neck, slurred speech, or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

Blurred vision

chest pain or discomfort

confusion

difficulty in speaking

dizziness

double vision

headache

inability to move the arms, legs, or facial muscles

inability to speak

nausea

nervousness

pain or discomfort in the arms, jaw, back, or neck

pounding in the ears

seizures

slow or fast heartbeat

slow speech

sweating

tremors

vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

Difficulty sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.