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Epinephrine: Friend or Foe?
Epinephrine Formulations in the Top 300

Course Author(s): M. Louay Taifour, BDS, DMD; Géza T. Terézhalmy, DDS, MA

Epinephrine Formulations in the Top 300

DrugStats uses generic drug synonyms and salts to aggregate all epinephrine formulations.2 Predicated on the delivery systems of these formulations, the drugs were prescribed for “self-administration” by patients (or caretakers) in ambulatory settings (Table 1). The majority of epinephrine formulations in the 2014 database were auto-injectors indicated for intramuscular (IM) administration in the emergency treatment of Type I allergic reactions, i.e., anaphylaxis.

Table 1. Epinephrine-containing Prescription-formulations in the Top 300 Prescription Drugs of 2017.2
Generic Drug Synonyms and Salts* Mechanisms of Action Indications
Epinephrine

Epinephrine hydrochloride

Epinephrine bitartrate		 Alpha (α)- and beta (β)-adrenoceptor agonism Type I allergic reactions

Mild, intermittent asthma

Reversible bronchospasm associated with chronic obstructive pulmonary disease (COPD)
*Brand names in the original data (MEPS) included Adrenaclick, Adrenalin, Auvi-q, Bronkaid Mist, Epi E Z Pen Jr, Epi E Z Pen, Epipen Jr., Epipen, Primatene Mist, Sus-phrine Sulfite Free, Twinject 0.15, and Twinject 0.3 - some of these products are no longer marketed or are very infrequently prescribed.

Some of the drugs (Bronkaid Mist, Primatene Mist, and Sus-phrine Sulfite Free) were formulated for delivery by metered-dose inhalers (MDIs) intended for the treatment of mild, intermittent asthma and as rescue medication in the treatment of acute asthma. However, in 2012, the FDA began to phase out MDIs with chlorofluorocarbon (CFC)-based propellants, a substance that harms public health and the environment by destroying the ozone in the upper atmosphere.4

Epinephrine formulations in MDIs that were available in 2014 for the symptomatic treatment of acute asthma and COPD are no longer available commercially in the United States.4 Today, albuterol in MDIs, (a non-catecholamine, orally inhaled, short-acting, strongly β2-adrenoceptor-selective agonist) is the cornerstone of treatment of mild, intermittent asthma and as rescue medication in the treatment of acute exacerbations of asthma and COPD.5,6

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