Use of over-the-counter inhaled epinephrine in asthma

Epinephrine, a short-acting, nonselective adrenergic bronchodilator developed for asthma treatment in the early 20th century, has been supplanted by other medications, particularly selective β2-agonists. Current guidelines do not recommend epinephrine treatment for asthma.1,2 Epinephrine metered dose inhalers were removed from the market in 2011 because of chlorofluorocarbon propellants. A hydrofluoroalkane epinephrine inhaler received US Food and Drug Administration (FDA) approval for over-the-counter (OTC) use in November 2018 and was released on the market under the Primatene Mist brand shortly thereafter, despite concerns of numerous medical professional societies.