Asthmanefrin: A New Twist on a Life-Saving Medicine, by Cynthia J. Koelker, MD

Ever since Primatene Mist was taken off the market a year ago, SurvivalBlog readers have asked about a replacement for this potentially life-saving over-the-counter drug.    Now there is one, in the form of Asthmanefrin.
If you don’t have asthma, should you care?  Definitely so.
Although the drug is officially only indicated for asthma, in the event of societal collapse, it may be the only effective and available treatment for:

  • Serious allergic reactions to foods, drugs, stinging/biting insects, or other substances
  • Widespread hives
  • Anaphylactic swelling of the face, lips, or throat (or angioedema)
  • Dropping blood pressure
  • Narrowed airways due to infection, inflammation, COPD, or exposure

If you don’t have any of these problems, you surely know someone who does. Or maybe you have a young child who may one day suffer from croup.  Or perhaps you occasionally contract acute bronchitis.  Or possibly you’ll be around a campfire where you accidentally inhale poison ivy smoke.  Any of these conditions may require an (adrenergic) bronchodilator, and the only available such medicine over-the-counter is Asthmanefrin.  Anyone who has struggled with asthma in the middle of the night can tell you why a rescue inhaler is worth its weight in gold. 
When the FDA banned the manufacture of Primatene Mist as of December 31, 2011 (due to the CFC propellant and concerns about the ozone layer) asthmatics were left with no OTC alternative to prescription rescue inhalers.  Although Armstrong Pharmaceuticals does hope to release a new version of Primatene Mist using an approved hydrofluoroalkane (HFA) propellant, no date has yet been set. 

The new product, Asthmanefrin, contains 11.25 mg of racepinephrine per 0.5 ml vial, in a solution equivalent to 1% epinephrine.  Epinephrine is the same medication contained in the Epi-Pen, the well-known injection for bee sting and other allergic reactions.  Although inhaled epinephrine is most active in the airways, some of it enters the bloodstream, which delivers it to the rest of the body, hence its ability to raise blood pressure, accelerate the heart rate, and relieve the vascular-related swelling common to hives and allergic reactions. 
These potential benefits are also sometimes considered side-effects, which may be dangerous to patients with heart disease, hyperthyroidism, high blood pressure, tremor, and other nervous conditions.  Doctors don’t like over-the-counter epinephrine products due to 1) the potential harm they may cause in susceptible individuals, and 2) the potential delay they may cause in seeking needed professional care.  However, in a young, otherwise healthy population epinephrine is generally safe.

The product insert includes dosing recommendations for adults and children down to the age of 4 years old.  For adults, one 0.5 ml vial of solution is placed in the EZ Breathe Atomizer, with a recommendation of not more than 12 inhalations in 24 hours.  By comparison, Primatene Mist inhaler delivers 0.22 mg of epinephrine per inhalation, also with a limit of 12 inhalations per day. 

The Starter Kit contains 10 vials plus one Atomizer and costs approximately $50, with the 30-vial Refill Kit priced at about $25, a small price to save a life. 

About the Author: Cynthia J. Koelker, MD is SurvivalBlog’s Medical Editor. Some in-depth additional information on using over-the-counter medications like prescription drugs is available free on her web site at