The People's Perspective on Medicine

Primatene Mist Is Back on Drugstore Shelves

The makers of Primatene Mist are bringing this OTC asthma inhaler back on the market after eight years away. Who could benefit?

More than 26 million Americans, roughly 8 percent of the population, have been diagnosed with asthma. In this condition, airway inflammation can lead to constriction. People may cough, wheeze and find it very difficult to breathe. Not only is this frightening, it can also be dangerous. However, when people are able to manage the symptoms of asthma, they can lead reasonably normal lives. Most asthma treatments are available by prescription only. One over-the-counter product, Primatene Mist, has recently returned to drugstore shelves.

Whatever Happened to Primatene Mist?

Q. I have had asthma for over 50 years and have been using an epinephrine inhaler since it came on the market in the mid 1950s. This allowed me to live a normal life.

I was extremely disappointed when Primatene Mist was taken off the market. The drugs my doctor prescribed didn’t work nearly as well. Whatever happened to it?

Epinephrine Is the Active Ingredient in Primatene Mist:

A. For more than a century, people with asthma have used epinephrine (adrenaline) to open their airways. In the mid-1950s epinephrine inhalers became available; Primatene was marketed starting in 1967. It was sold without a prescription until 2011.

Many people wondered why Primatene Mist disappeared at that time. The CFC propellant used to push the medicine into the lungs was banned by international treaty because it depletes ozone from the atmosphere.

In November of 2018 the FDA approved an alternative formulation with a different propellant. Primatene Mist is now back on pharmacy shelves and is the only over-the-counter medicine available for mild, intermittent asthma symptoms.

When Is It Appropriate to Use Primatene Mist?

Some doctors believe that asthma is far too serious for patients to treat on their own. They worry that if people rely on this OTC option that they may not get the preventive treatment they need, such as regular inhaled steroid medications to calm airway inflammation. The FDA defends its decision to return Primatene Mist to pharmacies as part of its push to make more products available without prescription. The agency does not see this product as a replacement for prescription asthma treatment.

We urge you and others who plan to use Primatene Mist for mild asthma to discuss this thoroughly with their physician first. Primatene Mist is only for treating asthma, not for other conditions that can cause wheezing. It is to be used for the temporary relief of mild symptoms, not as a sole treatment nor for a severe flare-up. If you need more than eight inhalations in the course of a day or if your breathing is not better within 20 minutes of using this medicine, you should seek medical attention promptly. Some medicines for Parkinson’s disease, depression or other conditions react badly with epinephrine. The FDA has offered further information here.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I believe many conditions will never be cured . WHY, because once you have a condition you are on their tread mill and they do not want for it to end. IF you think BIG drug companies &HOSPITALS-DOCTORS want this tread mill to end you are sadly mistaken.

I wonder how much the new formulation will cost. I’m betting substantially more. I am fed up with pharmaceutical company gouging. I especially love the question flashed on the TV screen near the end of the proliferating drug advertisements – “Can’t afford [medication name]? [Drug Company Name] may be able to help.” I call that the equivalent of someone who just stole your wallet offering to help you look for it.

Intal was another casualty of the CFC ban. It was also extremely effective with negligible side effects. Is it possible that Intal will be back on the market. I am reluctant to order from Canada where it is available in a reformulation.

It’s interesting that most inhaler ads show the patient holding the device directly into their mouth when that is not the prescribed way to use the device. Inhaler should be used with a spacer to get full benefit of the medication. The other misuse is that two puffs are not administered without first waiting for the device to ‘reboot’ usually about 20-30 seconds. I learned this only after attending pulmonary rehab and found I had been losing 20% of the medication by using a poor delivery. No need to use as often and get the full dose.

Interesting how manufacturers don’t pass this important information along to patients.

It was a crime when they removed Primetine Mist and they changed all the effective inhalers to be not as good. Less than 1% in the ozone if even that and they thought it doesnt matter if we breathe or not. Many people were seriously affected and some I know died.

I used Primatene mist for many years for asthma relief, and it worked well. I had noticed that Primatene was no longer available, and I never knew why but my doctor had switched me to prescription albuterol anyway. After using albuterol for a few years the price had sky-rocketed, and I later learned that it was due to a change in propellant from CFC to HFC. Apparently, the drug company can classify it as a new or reformulated drug and jack the price way up.

This sounds immoral to me, and the whole issue of CFC’s causing ozone problems sounds like a pretty dopey reason for asthma patients to be denied their medication. I mean come on, how much could the propellent of asthma medication affect the ozone??? When I next see my asthma doctor I will ask about switching back to Primatene, as it is considerably cheaper than prescription albuterol.

Please could you explain how Primatene Mist use differs from the indications for the prescription inhaler albuterol (Pro Air). I have used ProAir for years, one puff now and then, for “temporary relief of minor symptoms.” Would Primatene Mist be more appropriate?

Sadly, many can not afford inhalers such as Albuterol due to the high cost. Maybe this non-RX inhaler is better than nothing? Big Pharma shamelessly makes people choose meds before food and other basic items. Glad something is available to those who don’t have $60-500 for an inhaler.

What about Primatine Mist for a mild allergic reaction: for example, for someone with a mild peanut allergy who has that itching feeling in her mouth when the food she just ate has nuts in it? It seems to alleviate subsequent symptoms – diarrhea – for my wife.

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