Neonatal Intensive Care UnitChildren's Hospital

Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

(Racepinephrine, VaponefrinR)


  • to improve upper airway obstruction


  • racemic epinephrine is a mixture of the inactive "d" and the active "l" enantiomers of epinephrine. The racemic mixture was originally thought to provide the same dilatory effect with fewer adverse reactions than "l" epinephrine
  • beta adrenergic activity results in relaxation of smooth muscle
  • alpha adrenergic activity results in vasoconstriction; this is believed to reduce mucosal edema
  • racemic epinephrine also inhibits the release, and the effects, of histamine
  • the duration of action is short (<2 h) and relapse may occur rapidly

Side Effects

  • epinephrine may cause restlessness, tremor; it can cause ECG changes
  • overdosage can result in increased blood pressure with subsequent pulmonary edema, tachycardia, kidney failure, metabolic acidosis, and cold, white skin
  • monitor for rebound effect

Dose (administered via nebulizer)

  • Please note that Racemic Epinephrine is no longer being manufactured (March 2007).
  • Epinephrine ( = L-epinephrine) Nasal Solution 1 : 1,000 ("Epinephrine Topical Solution") is to be used instead.
  • Please not the conversion between Racemic Epinephrine and Epinephrine ( =L-epinephrine)

Old Dose
New Dose
0.25 mL Racemic Epinephrine (2.25%) 2.5 mL Epinephrine 1 : 1,000
0.5 mL Racemic Epinephrine (2.25%) 5 mL Epinephrine 1 : 1000


  • Epinephrine Topical Solution, 30 mL vial, 1 : 1,000
  • In instances where the Epinephrine Topical Solution 1 : 1,000 is not available, an Epinephrine 1 : 1,000 ampoule may be substituted.
  • Do not use if the solution is coloured or if there is any indication of precipitation (eg. particles, haziness)


  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  3. Smith J: Racemic epinephrine by inhalation (letter), The Canadian Journal of Hospital Pharmacy 1988; 41: 216.
  4. Constable K: Racepinephrine administration to children, The Canadian Journal of Hospital Pharmacy 1990; 43: 34-35.
  5. Personal Communication, Department of Pharmacy, The Hospital for Sick Children, 13 December 1989.
  6. Fraser BD : Nebulized levo-epinephrine as an alternative to racemic epinephrine in pediatrics, The Canadian Journal of Hospital Pharmacy 1995; 48: 303-304.
  7. Waisman Y, Klein BL, Boenning DA et al : Prospective double-blind study comparing L-epinephrine and racemic epinephrine in the treatment of laryngotracheitis, Pediatrics 1992; 89 : 302-306.
  8. Remington S and Meakin G : Nebolised adrenaline 1:1,000 in the treatment of croup, Anaesthesia 1986; 41 : 923-926.

Updated: June 2007

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