Racepinephrine

• Acute Bronchospasm:
• Relief of bronchospasm associated with bronchial asthma and reversible bronchospasm in chronic bronchitis and emphysema.
• Croup (Acute Laryngotracheobronchitis):
• Nebulized racepinephrine is used for temporary relief of airway obstruction caused by inflammation and edema in croup.
• Upper Airway Obstruction:
• Used as adjunctive therapy for swelling or inflammation causing airway narrowing.
• Off-label Uses:
• Emergency treatment of anaphylaxis-related bronchospasm when other agents are unavailable.

• Adults and Children (Nebulization):
• 0.25 to 0.5 mL of 2.25% racepinephrine solution diluted in 2 to 3 mL normal saline every 3 to 6 hours as needed.
• Intramuscular Injection:
• 0.1 to 0.5 mg IM for emergency use, administered with caution.
• Route:
• Nebulization is preferred for bronchospasm.
• IM route reserved for emergency situations.
• Special Populations:
• Pediatrics: Dose adjusted by weight and clinical status.
• Elderly: Use cautiously with cardiovascular monitoring.
• Duration:
• As clinically indicated; continuous monitoring required.

Racepinephrine is a non-selective adrenergic agonist stimulating alpha and beta receptors. Beta-2 receptor activation in bronchial smooth muscle causes relaxation and bronchodilation, easing airflow obstruction. Alpha receptor stimulation induces vasoconstriction, reducing mucosal edema in the upper airway, improving patency. These combined effects rapidly relieve bronchospasm and airway swelling.

• Absorption: Rapid following inhalation or IM injection.
• Distribution: Extensive; crosses placenta.
• Metabolism: Metabolized by COMT and MAO enzymes.
• Elimination: Renal excretion of metabolites.
• Half-life: Approximately 2–3 minutes systemically.
• Onset: Minutes after administration.
• Duration: 1–3 hours depending on dose and route.

• Pregnancy: Category C — animal studies show adverse effects; use only if benefits justify risk.
• Lactation: Unknown excretion in human milk; use with caution.

• Sympathomimetic agent
• Non-selective adrenergic agonist
• Bronchodilator

• Hypersensitivity to racepinephrine or components.
• Narrow-angle glaucoma.
• Cardiovascular disorders (use with caution).
• Concomitant use with MAO inhibitors or within 14 days of discontinuation.

• Monitor cardiovascular status for tachycardia, hypertension, arrhythmias.
• Risk of paradoxical bronchospasm; discontinue if occurs.
• Avoid excessive dosing.
• Use caution in hyperthyroidism, diabetes, seizure disorders.

Common:

• Nervousness, tremor
• Headache
• Tachycardia, palpitations
• Dizziness
• Nausea

Serious (rare):

• Hypertensive crisis
• Cardiac arrhythmias
• Anaphylaxis
• Paradoxical bronchospasm

• MAO inhibitors: risk of hypertensive crisis.
• Tricyclic antidepressants: enhanced adrenergic effects.
• Beta-blockers: antagonize bronchodilator action.
• Other sympathomimetics: additive effects.
• Digoxin: increased arrhythmia risk.

• Recommended as a second-line agent for acute bronchospasm and croup.
• Emphasized cautious use in patients with cardiovascular risks.
• Improved aerosol formulations have enhanced safety.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from light and heat.
• Keep tightly closed.
• Do not freeze.
• Shake well before use.