From the FDA Drug Label
Adults and children 4 years of age and over: 1 to 3 inhalations not more often than every 3 hours. Do not use more than 12 inhalations in 24 hours. The recommended frequency for nebulizing racemic epinephrine for stridor is not more often than every 3 hours, with a maximum of 12 inhalations in 24 hours 1.
From the Research
Racemic epinephrine nebulization for stridor should be administered every 1-2 hours as needed, with the frequency decreasing as symptoms improve, as supported by the most recent and highest quality study available 2. The standard dose is 0.5 mL of 2.25% racemic epinephrine solution mixed with 3-5 mL of normal saline. Key points to consider when administering racemic epinephrine for stridor include:
- Treatment should be monitored closely in a healthcare setting due to potential rebound effects that can occur 2-4 hours after administration 3.
- For severe cases, up to 3-4 doses may be given in the first few hours, but the frequency should be reduced as the patient stabilizes 4.
- Continuous cardiac monitoring is recommended during treatment, especially in patients with underlying cardiac conditions.
- Racemic epinephrine works by stimulating alpha-adrenergic receptors, causing vasoconstriction in the upper airway mucosa, which reduces edema and inflammation, thereby improving airflow 5. This medication is most commonly used for viral croup, post-extubation stridor, or other causes of upper airway edema. The treatment should be part of a comprehensive approach that may include corticosteroids, which have a longer duration of action and can reduce the need for repeated racemic epinephrine treatments 2.