BRONKAID MIST
Clinical safety rating
cautionComprehensive clinical and safety monograph for BRONKAID MIST (BRONKAID MIST).
Epinephrine, the active ingredient, is a direct-acting sympathomimetic amine that stimulates alpha- and beta-adrenergic receptors. Beta-2 receptor activation in bronchial smooth muscle causes bronchodilation. Alpha receptor activation causes vasoconstriction, reducing mucosal edema.
| Metabolism | Metabolized primarily by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) in the liver and other tissues. |
| Excretion | Renal: 40-70% unchanged; fecal: minor (biliary) <5% |
| Half-life | Terminal elimination half-life: 3-6 hours; clinical context: shorter half-life in children, prolonged in hepatic impairment; requires frequent dosing |
| Protein binding | 55% bound primarily to albumin |
| Volume of Distribution | Vd: 1-2 L/kg; reflects extensive distribution into tissues, particularly lungs |
| Bioavailability | Inhalation: 10-20% (systemic); oral: 40-60% (variable due to first-pass metabolism) |
| Onset of Action | Inhalation: 1-5 minutes; oral: 15-30 minutes |
| Duration of Action | Inhalation: 3-6 hours (short-acting); oral: 4-6 hours; clinical note: tolerance may develop with repeated use |
| Molecular Weight | 183.204 |
2 inhalations (200 mcg per inhalation) every 4 hours as needed for bronchospasm. Maximum 12 inhalations in 24 hours.
| Dosage form | AEROSOL, METERED |
| Renal impairment | No dose adjustment required for renal impairment. Drug is primarily hepatically metabolized. |
| Liver impairment | No specific dose adjustment guidelines available. Use with caution in severe hepatic impairment (Child-Pugh class C) due to potential for increased systemic exposure. |
| Pediatric use | Not recommended for children under 12 years of age. For children 12 years and older, same as adult dosing: 2 inhalations every 4 hours as needed, max 12 inhalations per day. |
| Geriatric use | No specific dose adjustment required. Use with caution due to increased risk of tachycardia, hypertension, and CNS stimulation. Consider starting at lower doses if tolerated. |
| 1st trimester | Avoid due to potential teratogenicity; epinephrine may cause fetal hypoxia and malformations. |
| 2nd trimester | Use only if clearly needed; risk of uterine vasoconstriction and reduced placental perfusion. |
| 3rd trimester | Avoid near term; may inhibit labor and cause fetal tachycardia. |
Clinical note
Comprehensive clinical and safety monograph for BRONKAID MIST (BRONKAID MIST).
| Placental transfer | Crosses placenta via passive diffusion; rapid transfer to fetal circulation. |
| Breastfeeding | Excreted in breast milk in small amounts; potential for infant tachycardia and hypertension. Use caution. |
| Lactation Rating | L3 - Moderately Safe |
| Teratogenic Risk | FDA Pregnancy Category C. First trimester: Inadequate human data; animal studies show no teratogenicity at clinically relevant doses but fetal toxicity at high doses. Second/third trimesters: Risk of fetal tachycardia, hypoglycemia, and transient neonatal hyperexcitability due to beta-agonist effects. Avoid use near term due to potential for uterine relaxation and delayed labor. |
| Fetal Monitoring | Monitor maternal heart rate, blood pressure, and blood glucose. Fetal monitoring for heart rate abnormalities (tachycardia) and signs of preterm labor. Assess for maternal tremor, anxiety, and palpitations. |
| Fertility Effects | No known adverse effects on fertility. Animal studies with epinephrine have not shown impaired fertility at therapeutic doses. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to epinephrine or any componentNarrow-angle glaucomaCardiac arrhythmias (e.g., ventricular fibrillation)Hypertension with severe coronary insufficiencyPatients receiving MAO inhibitors or tricyclic antidepressants (risk of hypertensive crisis)
| Precautions | Do not use if solution is brown or cloudy, Do not use if more than the number of inhalations prescribed per 24 hours are needed, May cause increased blood pressure, tachycardia, and other cardiovascular effects, May cause nervousness, tremor, or insomnia, Do not exceed recommended dosage |
| Food/Dietary | Avoid caffeine-containing foods and beverages (coffee, tea, cola, chocolate) as they may increase the risk of cardiovascular side effects such as palpitations and tachycardia. No other significant food interactions are known. |
| Clinical Pearls | BRONKAID MIST contains epinephrine, a non-selective adrenergic agonist. Inhaled epinephrine is rapidly absorbed and can cause tachycardia, hypertension, and cardiac arrhythmias. It is contraindicated in patients with coronary artery disease, hypertension, or hyperthyroidism. Use with caution in patients with diabetes, as it may increase blood glucose. Note that BRONKAID MIST delivers a fixed dose; repeated use more than every 3-4 hours or exceeding 12 inhalations in 24 hours may indicate inadequate control and need for medical evaluation. |
| Patient Advice | Do not use if you have heart disease, high blood pressure, diabetes, or thyroid disease without consulting a doctor. · Seek emergency medical help if symptoms worsen or do not improve after 20 minutes. · Do not exceed 12 inhalations in 24 hours or use more often than every 4 hours. · If you miss a dose, take it as soon as you remember, but do not double up. · Keep away from children; accidental ingestion can be fatal. · Store at room temperature away from heat and open flame (pressurized container). · Do not puncture or incinerate the canister, even when empty. |
Loading safety data…