Name

racemic epinephrine (micronefrin, vaponefrin)

Class

Sympathomimetic

Description/Mechanism

A racemic mixture of the dextrorotary & levorotary (right and left 'handed') forms of epinephrine. Since the levorotary form is active and the dextrorotary form in inactive, the racemic mixture decreases the overall potency of the preparation. The net effect is achievement of the desired bronchodilation with minimized increases in heart rate and blood pressure.

Onset

Within 5 minutes

Duration

1-3 hours

Indications

Croup (laryngotracheobronchitis)

Laryngeal edema

Contraindications

Hypertension

Underlying cardiovascular disease

Epiglottitis

Adverse Reactions

Tachycardia

Dysrhythmias

Drug Interactions

MAO inhibitors and bretylium may potentiate the effect of epinephrine

Beta adrenergic antagonists may blunt inotropic response.

Sympathomimetics and phosphodiesterase inhibitors may exacerbate dysrhythmia response.

Supplied

MDI: 0.16 – 0.25 mg/spray

Solution: 7.5, 15, 30 ml in 1%, 2.25% solution

Dose/Administration

Adult

Dilute 5 ml (1%) in 5ml saline, administer over 15 minutes

Pediatric

< 20 kg:

• Dilute 0.25 ml (0.1%) in 2.5 ml saline and administer via neb.

20-40 kg:

• Dilute 0.5 ml (0.1%) in 2.5 ml saline and administer via neb.

>40 kg

• 0.75 ml in 2.5 ml saline and administer via neb.

Special Consideration

Pregnancy Safety: Category C

May produce tachycardia and other dysrhythmias

Monitor vital signs

Excessive use may cause bronchospasm