Download Asthmanefrin - Duquesne University

Finger Rock of the Santa Catalina Mountains – Tucson, AZ
PIC QUESTION OF THE WEEK: 10/05/12
Q:
Are there any alternatives for Primatene Mist currently available?
A: Primatene Mist inhaler contained epinephrine in a chlorofluorocarbon (CFC) propellant. It was
removed from the market in compliance with Federal law and the Montreal Protocol treaty on December 31,
2011 due to the propellant’s harmful effect on the environment. Until this year, there has been no alternative
over-the-counter bronchodilator available for sale. Asthmanefrin is a non-CFC-containing sympathomimetic
bronchodilator. The active ingredient of this product is racepinephrine, which is a racemic mixture of
epinephrine. Racepinephrine exhibits half the activity of the L-isomer of epinephrine. Asthmanefrin’s
intended use is in treating shortness of breath, chest tightness, or wheezing associated with intermittent
asthma. The product is supplied as either a starter kit, which consists of a battery operated atomizer device
and 10 unit-dose vials, or a refill kit containing 30 single use unit-dose vials. A 0.5mL vial contains the
active ingredient racepinephrine, USP 2.25%/11.25mg. Current formulations of Asthmanefrin are free of
sulfite and preservatives. The manufacturer advises consumers to protect the product from light and
excessive heat. Storage at room temperature is recommended. The patient should seek medical attention if
symptoms do not resolve within 20 minutes of use. Potential drug interactions for Asthmanefrin include cold
medications and stimulants such as products containing pseudoephedrine, phenylephrine, caffeine, and
amphetamines. Concomitant use of these products with Asthmanefrin could lead to elevated blood pressure
and increased heart rate. In addition, beta blockers may interact with Asthmanefrin, which can lead to
increased blood pressure, decreased heart rate, and epinephrine resistance. Asthmanefrin should not be taken
with an albuterol-containing product since this may lead to an increased heart rate and should only be used
when an albuterol-containing product is not available. Also, product labeling indicates that Asthmanefrin
should not be taken with a monoamine oxidase inhibitor (MAOI), or used within two weeks of stopping an
MAOI. Due to the marked bronchodilatory effects without the associated cardiac concerns, the use of inhaled
beta-2 receptor blocking agents such as albuterol are preferred over epinephrine products for treating acute
asthmatic attacks.
References:
Asthmanefrin. Nephron Pharmaceuticals Corporation. Orlando, FL 32811. http://www.asthmanefrin.com/. (Accessed
September 26, 2012).
McEvoy GK, ed in chief, Snow ED, ed. AHFS: Drug Information. Bethesda, MD: American Society of Health-System
Pharmacists; 2012:1362-1368.
Primatene Mist. Armstrong Pharmaceuticals, Inc. Canton, MA 02021. http://primatene.com/. (Accessed September 26,
2012).
Sorkness CA. Beta-adrenergic agonists. In: NF, Bochner BS, Busse WW, et al. Middleton's allergy: principles and
practice, 7th ed, Adkinson (Eds), Mosby, Philadelphia 2009. p.1485-503
Holly R. Filip and Joseph DiMatteo, Pharm.D. Candidates
The PIC Question of the Week is a publication of the Pharmaceutical Information Center, Mylan School
of Pharmacy, Duquesne University, Pittsburgh, PA 15282 (412.396.4600).