Published on Oct 03, 2011 with 34 comments
Primatine Mist is presently the only asthma inhaler available over-the-counter (OTC) and without a prescription. Primatine, a potent bronchodilator whose active ingredient is epinephrine, has been available for decades, but its days are clearly numbered. The FDA has announced that the product will be discontinued and removed from pharmacy shelves after December 31, 2011.
Since the advent of albuterol many years ago, Primatine Mist has fallen out of favor with physicians and patients due to concern about the cardiac side effects of Primatine and the potential for abuse and overuse. Albuterol and other bronchodilating inhalers, available as Proventil HFA, Ventolin HFA, Proair HFA, and others are presumably safer than Primatine due to the fact that they have less excitatory effects on the heart and their availability is regulated due to the fact that they can be purchased only with a prescription.
But, it is not for safety reasons that the FDA is requiring that the inhaler is being discontinued. Rather, it is for environmental reasons! The FDA has banned all inhalers that contain chlorofluorocarbons due to the concern that when exposed to the environment, chlorofluorocarbons deplete the ozone layer of the atmosphere. Chlorofluorocarbons which are used as propellants in asthma inhalers, have now been replaced by hydrofluoroalkane, or HFA, hence Proventil HFA and Ventolin HFA.
The OnlineAllergist, for one, will be sad to see Primatine Mist removed from the list of available medications to treat bronchoconstriction. While albuterol is clearly preferable in treating asthma symptoms that result from the constriction of small and medium sized bronchial tubes, epinephrine in the form of Primatine is most effective in treating airway constriction which occurs high in the airway, specifically in the larynx and in the large bronchial tubes. The classic clinical presentation of large airway constriction which is helped by an epinephrine inhaler such as Primatine Mist is croup, a very common respiratory illness in young children.