The American College of Clinical Pharmacology (ACCP) is recommending against the use of over-the-counter epinephrine for the treatment of asthma in a practice statement entitled “Over-the-Counter Epinephrine for Asthma Treatment: Too Much Risk for Too Little Benefit.” 

Published in the December 2022 issue of The Journal of Clinical Pharmacology, the statement highlights ACCP formally joining numerous medical organizations in emphasizing the hazards of over-the-counter availability of inhaled epinephrine products for the treatment of asthma. 

The society recommends the removal of “potentially hazardous medication of questionable effectiveness” delivered by inhalation and intended for the self-treatment of asthma-related symptoms and supports the implementation of pharmacist-centered asthma management programs. According to a press release by ACCP, such programs would allow for the provision of asthma-related medication refills and care strategy related to pharmacotherapy. 

“The recommendations made are in the best interest of quality healthcare access and the awareness of inherent dangers of using OTC inhaled epinephrine products for asthma,” says ACCP in the release. 

In the practice statement, authored by Bruce I. Gaynes, OD, PharmD, on behalf of the ACCP Public Policy Committee, Gaynes notes that “it is suspected that the public wrongly perceives OTC inhaled epinephrine and its congener products as appropriate and effective pharmacotherapy for all forms of asthma, both chronic and acute, likely due in part to highly effective marketing by the manufacturer.” 

He continued by saying that “toxicity risk with inhaled epinephrine mist may be significant, particularly in susceptible individuals such as the elderly or those with cardiac arrhythmia.” 

The National Asthma Education and Prevention Program, an expert panel convened by the National Institutes of Health, also recommends against the use of epinephrine for treatment of asthma exacerbations, along with the American Thoracic Society, which published a statement of alarm in 2018 regarding Food and Drug Administration approval of OTC epinephrine mist for asthma treatment.