Patients often seek over-the-counter (OTC) medications to meet their health care needs before requesting prescription medication from their health care provider. The Food and Drug Administration (FDA) has recently approved a new version of the OTC Primatene Mist inhaler for the temporary relief of mild, intermittent asthma symptoms. Nurses should be familiar with this product and be able to discuss with patients how to use it appropriately.
The original Primatene Mist inhaler was removed from the market in 2011 because it used chlorofluorocarbon propellants, which are known to deplete the ozone layer. The new product uses a different propellant, hydrofluoroalkane, which is used in prescription inhalers such as albuterol. Like the original Primatene Mist, the newly approved OTC version uses epinephrine as its active, bronchodilation-producing ingredient. Unlike the original version, which was approved for people ages four years and older, the new Primatene Mist inhaler is approved for people ages 12 years and older.
The revised Primatene Mist's directions for use are different from those of the original product and are somewhat unique. Prior to use, the inhaler should be shaken and then sprayed into the air. This ensures that the medication is thoroughly mixed and will deliver a full dose. After these priming steps, the patient should first exhale and then inhale the medication. Two inhalations may be taken if needed, but prior to each the inhaler should be shaken and then sprayed into the air. Patients need to clean the inhaler at least once per day of use. These directions for dosing and administration, as well as any warnings, are printed on the packaging. Nurses should teach patients to read these instructions carefully and to adhere to them.
Because this drug is designed to relieve mild intermittent asthma symptoms (wheezing, chest tightness, and shortness of breath), patients should understand that if their symptoms do not resolve within 20 minutes of use, if they need more than eight inhalations in 24 hours, or if they have more than two asthma attacks in a week, their asthma may be progressing. For worsening asthma, a visit to a health care provider is indicated. Patients should not substitute Primatene Mist for prescribed asthma medications, which may contain drugs such as corticosteroids and which must be taken regularly. Although epinephrine can increase blood pressure and heart rate, these adverse effects are unlikely if Primatene Mist is used according to package directions. Patients who have heart disease or hypertension or who are taking prescription asthma medications should consult with a health care provider prior to using the Primatene Mist inhaler. To prevent serious drug interactions, Primatene Mist should not be used if the patient is taking a monoamine oxidase inhibitor (used as an antidepressant and to treat Parkinson's disease).
When assessing a patient's medication use, nurses should be sure to ask about any OTC medications, as some patients may fail to report these. To see the packaging label for Primatene Mist, go to http://www.accessdata.fda.gov/drugsatfda_docs/label/2018/205920Orig1s000lbl.pdf.