Primatene Mist: What To Know

Epinephrine inhalers were available over the counter (OTC) for many years. The most famous one was Primatene Mist. To the ire of many asthmatics, they were taken off the U.S. market in 2010. Here’s what to know.

What is epinephrine (Epi)?

It’s a neurotransmitter that binds with receptors in your lungs and heart. It was isolated in 1901. By 1910 it was discovered to rapidly end asthma attacks. It had to be injected into a muscle, so it was only available in hospitals. A few years later it was discovered to be a powerful bronchodilator. It was used in emergency rooms util the late 1990s. It’s still available, but is rarely used in favor of better, stronger, safer medicines like albuterol breathing treatments.

What’s a bronchodilator?

It’s a medicine that dilates the bronchial airways. Epinephrine binds with special receptors lining airways. Once this happens, a series of chemical reactions occur that cause these muscles to relax. The effect here is to open airways to allow the free flow of air through them. This makes breathing easier. This is the intended effect of taking the medicine. However, unfortunately, there are also other, undesired side effects. This is because epinephrine is also a powerful vasoconstrictor.

What’s a vasoconstrictor?

It’s a medicine that constricts blood vessels. Epinephrine binds with special receptors lining blood vessels. Once this happens, a series of chemical reactions occur that cause them to constrict. This forces your heart to pump harder in order to pump blood through your blood vessels. This increases your heart rate and blood pressure. In our case, this is an undesired side effect. This is one reason doctors don’t like asthmatics to use epi inhalers.

What’s an epi inhaler?

It’s an inhaler that contains epinephrine. The first one entered the market in 1957. It was called the Medihaler Epi. It was a huge boon to asthmatics as it gave them easy access to the only rescue medicine on the market at that time. They could easily carry these inhalers in their pockets and purses. There were usable anywhere and anytime. As a bonus, they were available over the counter (OTC) at a low cost.

So, why do doctors hate them so much?

Well, doctors loved them at first. They were happy to prescribe these rescue inhalers. This was because they helped so many asthmaticis breathe easier. But, they continued to be leery of side effects. There are essentially four reasons doctors grew to hate them:

  • Asthma-related deaths. After epi inhalers entered the market in the 1950s, there was a surge in asthma-related deaths. One suspected reason for this was the rise in epi inhaler prescriptions and sales. Another suspected reason was that asthmatics were over relying on their inhalers in lieu of seeking help. I describe this in more detail in my post, “Why No More OTC Rescue Inhalers.”
  • Better alternatives. During the 1980s, stronger and safer rescue inhalers entered the market, like albuterol (Ventolin). Albuterol is a much stronger bronchodilator than epinephrine. Plus, cardiac side effects are essentially negligible. So, it’s a much better and safer medicine to epinephrine. Doctors loved this and so too did asthmatics. So, this has made albuterol the most prescribed asthma medicine of all time.
  • A change in emphasis of asthma treatment. Back in the day, the emphasis of asthma treatment was treating acute (it’s happening now) symptoms. If you were having an attack, you just went to your local pharmacy and bought some asthma medicine. Today, the emphasis is on controlling chronic underlying airway inflammation. Most asthma experts recommend you have rescue medicine nearby at all times. But, when controlled, you shouldn’t need it very often.
  • It’s recommended you work with a doctor. Using your rescue inhaler too much is a sign of poorly controlled asthma. Seeing a doctor regularly can assure your asthma is being monitored over time. They can prescribe asthma controller medicine if needed. And they can help you adjust your treatment regimen as needed. If your asthma is getting worse, your treatment can be adjusted. If your asthma is doing well, you may be able to scale back treatment.

Why were they taken off the market?

Ironically, it had nothing to do with what doctors wanted. It had to do with the propellant needed to make them work. It was banned by a world-wide agreement called the Montreal Protocol. The makers of albuterol now use a safer propellant. The makers of Primatene Mist didn’t see this as profitable. So, they chose to take their inhalers off the market instead. So, they were gradually phased out by 2011.

What to make of this?

Well, it’s sad in away that Primatene Mist is no longer available. Sure, you can probably still find it on the Internet. But, just know that it’s better to see a doctor so your asthma can be properly monitored over time. Because, with proper treatment, you may no longer need that old inhaler after all.

Editor's Note: As of November 2018, Primatene Mist is back on the market. Learn more about Primatene Mist in this article.

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