to epinephrine, which may result in severe hypotension and tachycardia.Serious - Use Alternative (1)epinephrine racemic and promazine both increase QTc interval. Avoid or Use Alternate Drug.promethazineMonitor Closely (2)promethazine decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. promethazine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine racemic and promethazine both increase QTc interval. Avoid or Use Alternate Drug.propofolSerious - Use Alternative (1)propofol increases levels of epinephrine racemic by unknown mechanism. Avoid or Use Alternate Drug.propranololMonitor Closely (2)propranolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. propranolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)propranolol increases effects of epinephrine racemic by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).propylhexedrineMonitor Closely (2)epinephrine racemic and propylhexedrine both decrease sedation. Use Caution/Monitor. epinephrine racemic and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.protriptylineMonitor Closely (2)protriptyline increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor. protriptyline increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and protriptyline both increase QTc interval. Avoid or Use Alternate Drug. protriptyline, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.pseudoephedrineMonitor Closely (1)epinephrine racemic and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.quazepamMonitor Closely (1)quazepam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.quetiapineMonitor Closely (1)quetiapine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.quinidineContraindicated (1)epinephrine racemic and quinidine both increase QTc interval. Contraindicated.ranolazineMonitor Closely (1)epinephrine racemic and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.risperidoneMonitor Closely (2)epinephrine racemic and risperidone both increase QTc interval. Modify Therapy/Monitor Closely. risperidone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.romidepsinMonitor Closely (1)epinephrine racemic and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.sacubitril/valsartanMonitor Closely (1)sacubitril/valsartan increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sageMinor (1)sage increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.salicylates (non-asa)Monitor Closely (1)salicylates (non-asa) increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.salmeterolMonitor Closely (3)epinephrine racemic and salmeterol both decrease serum potassium. Use Caution/Monitor. epinephrine racemic and salmeterol both decrease sedation. Use Caution/Monitor. epinephrine racemic and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.salsalateMonitor Closely (1)salsalate increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.scullcapMonitor Closely (1)scullcap increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidateMonitor Closely (1)epinephrine racemic and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sevofluraneSerious - Use Alternative (1)sevoflurane increases levels of epinephrine racemic by unknown mechanism. Avoid or Use Alternate Drug.shepherd's purseMonitor Closely (1)shepherd's purse increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)epinephrine racemic and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.solriamfetolMonitor Closely (1)epinephrine racemic and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sotalolContraindicated (1)epinephrine racemic and sotalol both increase QTc interval. Contraindicated.Monitor Closely (2)sotalol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. sotalol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.spironolactoneMonitor Closely (1)spironolactone increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.succinylcholineMonitor Closely (1)succinylcholine increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulfamethoxazoleMonitor Closely (1)epinephrine racemic and sulfamethoxazole both increase QTc interval. Modify Therapy/Monitor Closely.sulfasalazineMonitor Closely (1)sulfasalazine increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulindacMonitor Closely (1)sulindac increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.telavancinMonitor Closely (1)epinephrine racemic and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.temazepamMonitor Closely (1)temazepam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.terbutalineMonitor Closely (3)epinephrine racemic and terbutaline both decrease serum potassium. Use Caution/Monitor. epinephrine racemic and terbutaline both decrease sedation. Use Caution/Monitor. epinephrine racemic and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.thioridazineMonitor Closely (2)thioridazine decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. thioridazine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine racemic and thioridazine both increase QTc interval. Avoid or Use Alternate Drug.thiothixeneMonitor Closely (1)thiothixene increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)thiothixene decreases effects of epinephrine racemic by pharmacodynamic antagonism. Minor/Significance Unknown.timololMonitor Closely (2)timolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. timolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)timolol increases effects of epinephrine racemic by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).tolcaponeMonitor Closely (1)tolcapone will increase the level or effect of epinephrine racemic 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.tolfenamic acidMonitor Closely (1)tolfenamic acid increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolmetinMonitor Closely (1)tolmetin increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolvaptanMonitor Closely (1)tolvaptan increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.topiramateMonitor Closely (1)topiramate increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.torsemideMonitor Closely (1)epinephrine racemic and torsemide both decrease serum potassium. Use Caution/Monitor.Minor (1)epinephrine racemic, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.tramadolMonitor Closely (1)tramadol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tranylcypromineSerious - Use Alternative (1)tranylcypromine increases effects of epinephrine racemic by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.trazodoneMonitor Closely (2)trazodone increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor. trazodone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and trazodone both increase QTc interval. Avoid or Use Alternate Drug. trazodone, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triamtereneMonitor Closely (1)triamterene increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.triazolamMonitor Closely (1)triazolam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.trifluoperazineMonitor Closely (2)trifluoperazine decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. Block pressor response to epinephrine, which may result in severe hypotension and tachycardia. trifluoperazine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine racemic and trifluoperazine both increase QTc interval. Avoid or Use Alternate Drug.trimethoprimMonitor Closely (1)epinephrine racemic and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.trimipramineMonitor Closely (2)trimipramine increases effects of epinephrine racemic by unknown mechanism. Use Caution/Monitor. trimipramine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (2)epinephrine racemic and trimipramine both increase QTc interval. Avoid or Use Alternate Drug. trimipramine, epinephrine racemic. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triprolidineMonitor Closely (1)triprolidine increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tropisetronMonitor Closely (1)epinephrine racemic and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.vasopressinMinor (1)epinephrine racemic decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.venlafaxineMonitor Closely (1)epinephrine racemic and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.voriconazoleMonitor Closely (1)epinephrine racemic and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.xylometazolineMonitor Closely (2)epinephrine racemic and xylometazoline both decrease sedation. Use Caution/Monitor. epinephrine racemic and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.yohimbineMonitor Closely (2)epinephrine racemic and yohimbine both decrease sedation. Use Caution/Monitor. epinephrine racemic and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.ziconotideMonitor Closely (1)ziconotide increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)epinephrine racemic and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug. Frequency Not Defined Tachycardia Arrhythmias Headache Nausea Sweating Tremor Restlessness Rebound airway edema may occur Angina Autonomic hyperreflexia Cardiac dysrhythmia Ventricular fibrillation Cerebral hemorrhage Pulmonary edema Contraindications Epiglottitis Coadministration with MAOIs, or within 2 weeks after discontinuing an MAOI Cautions For oral inhalation only Because asthma may be life threatening, instruc patient to seek immediate medial attention when not relieved within 20 minutes, feeling worse after treatment, need more inhalations than recommended for 24 hours, have more than 2 asthma attacks in a week Do not use if product is brown in color or cloudy, pinkish or darker than slightly yellow, or if it contains a precipitate Only used when diagnosed with asthma by healthcare practitioner Not for use if taking a prescription for monoamine oxidase inhibitor (MAOI; certain drugs taken for depression, psychiatric or emotional conditions, or Parkinson’s disease), or for 2 weeks after stopping the MAOI drug If patient not sure if prescription drug contains an MAOI, ask doctor or a pharmacist before using product Before using, patient should ask healthcare professional especially if history of hospitalization for asthma, heart disease, high blood pressure, diabetes, trouble urinating due to an enlarged prostate gland, thyroid disease, seizures, narrow-angle glaucoma Pregnancy Category: C Lactation: Excreted in breast milkPregnancy 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. Mechanism of Action Elicits agonistic action on alpha, beta-2, and beta-2 receptors resulting in bronchial smooth muscle relaxation, cardiac stimulation, vasodilation in skeletal muscle, and stimulation of glycogenolysis in the liver Pharmacokinetics Onset: 1-5 min Duration: 1-3 hr Metabolism: liver Metabolites: metanephrine & 3-methoxy-4-hydroxymandelic acid (vanillylmandelic acid, VMA) Excretion: unknown BRAND FORM. UNIT PRICE PILL IMAGE S2 Racepinephrine inhalation- 2.25 % nebulizer solnAsthmanefrin Refill inhalation- 2.25 % nebulizer solnCopyright © 2010 First DataBank, Inc.Print Patient Educationracepinephrine inhalation RACEPINEPHRINE - ORAL INHALATION (RAYSE-ep-i-NEF-rin) COMMON BRAND NAME(S): Asthmanefrin USES: Racepinephrine is used to treat wheezing and shortness