Racemic Epinephrine Deserves More Respect

​Some medications enjoyed years of glory but later ended up on the trash heap of clinical medicine, often put there by a systematic review or small case series of adverse outcomes or complications that led to black box warnings and a culture of fear and rejection. Still, the heyday lasted for years for some medication outcasts, such as acetaminophen with codeine, promethazine (Phenergan), aminophylline, droperidol, and meperidine (Demerol).Of course, a few of these medications probably deserved their bad rap, but most of them served us well for many years when we had few other options. Medications like racemic epinephrine are still widely used but carry an undeserved negative reputation or have unrecognized benefits. In fact, the malicious and false accusations against racemic epinephrine (or racemic adrenaline; RA) actually occurred on several clinical fronts.The Rebound MythI was taught during my pediatric residency about the dreaded rebound reaction that happens to croup patients treated with RA. Supposedly, these children would transiently improve only to rebound with significantly worse symptoms. This, unfortunately, was not true, and if anything, the croupy child just returned to his initial baseline degree of severity.I'm not sure why rebound was applied to RA. Its effects eventually wear off, and the term rebound has negative connotations. The debate on mandatory observation after RA for croup has resulted in millions of hours of wasted time for patients who could h...
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