S-2
S-2 Uses, Dosage, Side Effects, Food Interaction and all others data.
S-2 works by stimulating α-adrenergic receptor in the airway with resulting tightening of the mucosa (mucosal vasoconstriction) and decreased fluid in the airway (subglottic edema) and by stimulation of α-adrenergic receptor causing relaxation of the bronchial smooth muscle.
Epinephrine acts on α- and β-adrenergic receptors. When given subcutaneously or intramuscularly, epinephrine has a rapid onset and short duration of action . Epinephrine induces bronchial smooth muscle relaxation to relieve respiratory distress in asthma. In a clinical trial of paediatric patients with bronchiolitis, administration of aerosolized racemic epinephrine via inhalation resulted in improved clinical symptoms such as wheezing and retractions . The clinical efficacy of racemic epinephrine was comparable to that of salbutamol or albuterol, which are commonly used bronchodilators .
| Trade Name | S-2 |
| Availability | Rx and/or OTC |
| Generic | Racepinephrine |
| Related Drugs | albuterol, dexamethasone, methylprednisolone, Ventolin, Xopenex, Ventolin HFA |
| Type | |
| Protein binding | To refer to the pharmacokinetic data of L-epinephrine, refer to the drug entry for Epinephrine. |
| Groups | Approved |
| Therapeutic Class | Anaphylaxis |
| Manufacturer | |
| Available Country | |
| Last Updated: | September 19, 2023 at 7:00 am |
Uses
For temporary relief of mild symptoms of intermittent asthma:
- Wheezing
- Tightness of chest
- Shortness of breath
S-2 is also used to associated treatment for these conditions: Asthma
How S-2 works
Epinephrine is a non-selective agonist at α- and β-adrenergic receptors, which are all G-protein-coupled receptors. The main therapeutic effect of epinephrine arises from its agonist action on β2-adrenergic receptors, which activate adenylyl cyclase and increase intracellular cyclic AMP production. Epinephrine causes smooth muscle relaxation on various tissues, including bronchial smooth muscles . As a result, epinephrine serves to alleviate bronchospasm, wheezing and tightness of chest that may occur during asthmatic attacks . Via its relaxer effects on the smooth muscle of the stomach, intestine, uterus and urinary bladder, epinephrine may also alleviate pruritus, urticaria, and angioedema and may relieve gastrointestinal and genitourinary symptoms associated with anaphylaxis.
Epinephrine also acts on the α-adrenergic receptors on vascular smooth muscles, particularly in the skin and splanchnic vascular beds, to cause constriction. Epinephrine is thought to reduce capillary leakage by constricting precapillary arterioles, reducing hydrostatic pressure and consequently bronchial mucosal edema .
Dosage
S-2 dosage
Usual Adult Dose for Acute Asthma:For temporary relief of shortness of breath, tightness of chest, and wheezing due to bronchial asthma: Add 0.5 ml (contents of one vial) of solution to a hand-held rubber bulb nebulizer. 1 to 3 inhalations not more than every 3 hours.
Usual Pediatric Dose for Acute Asthma:For temporary relief of shortness of breath, tightness of chest, and wheezing due to bronchial asthma in children 4 years old and older: Add 0.5 ml (contents of one vial) of solution to a hand-held rubber bulb nebulizer: 1 to 3 inhalations not more than every 3 hours. The use of this product by children should be supervised by an adult.
Side Effects
Cardiovascular side effects have included elevations of heart rate and blood pressure. In smaller doses, racepinephrine has caused peripheral coronary arterial vasodilation, but in larger doses, racepinephrine has caused diffuse vasoconstriction. This has caused increased peripheral vascular resistance, which was important in patients with coronary artery disease (worsened myocardial ischemia/angina) or hypertension (risk of emergent hypertension/stroke).
Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease. Rapid rises in blood pressure have produced cerebral hemorrhage, particularly in elderly patients with cardiovascular disease. Angina may occur in patients with coronary artery disease.
Gastrointestinal side effects have included nausea and vomiting.
Nervous system side effects have included fear, agitation, anxiety, tenseness, restlessness, headache, tremor, dizziness, lightheadedness, nervousness, sleeplessness, excitability, weakness, and increased parkinsonian tremors.
Psychiatric side effects have included agitation, disorientation, impaired memory, aggressive or assautive behavior, hallucinations, and psychosis.
Toxicity
Oral LD50 of racepinephrine hydrochloride in mouse is 90 mg/kg .
Overdosage of epinephrine may cause extremely elevated arterial pressure, which may further lead to cerebrovascular hemorrhage, particularly in elderly patients. Peripheral vascular constriction in conjunction with cardiac stimulation may produce pulmonary oedema. Treatment consists of rapidly acting vasodilators or alpha-adrenergic blocking drugs and/or respiratory support. Transient bradycardia followed by tachycardia may also be observed, and may be accompanied by potentially fatal cardiac arrhythmias. remature ventricular contractions may appear within one minute after injection and may be followed by multifocal ventricular tachycardia (prefibrillation rhythm). Subsidence of the ventricular effects may be followed by atrial tachycardia and occasionally by atrioventricular block. In case of arrhythmias, treatment should involve administration of a beta adrenergic blocking drug such as propranolol. Overdosage may also produce extreme pallor and coldness of the skin, metabolic acidosis, and kidney failure, which should each be treated with suitable corrective measures .
Food Interaction
- Avoid caffeine.
S-2 Hypertension interaction
[Moderate] Adrenergic bronchodilators can stimulate cardiovascular beta- 1 and beta- 2 receptors, resulting in adverse effects such as tachycardia, palpitation, peripheral vasodilation, blood pressure changes, and ECG changes (e.g., flattening of the T wave; prolongation of the QT interval; ST segment depression).
Direct stimulation of cardiac tissues is mediated by beta- 1 receptors and thus less likely to occur with beta-2-selective agents such as albuterol.
However, beta-2-selectivity is not absolute and can be lost with larger doses.
High dosages of these agents have been associated with precipitation or aggravation of angina, myocardial ischemia, and cardiac arrhythmias.
Therapy with adrenergic bronchodilators should be administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, and The recommended dosages should not be exceeded.
S-2 Drug Interaction
Moderate: fluticasone / salmeterol, formoterol / mometasone, albuterol / ipratropium, metoprolol, budesonide / formoterol, levalbuterolMinor: methylprednisoloneUnknown: ipratropium, diphenhydramine, glucose, haloperidol, ipratropium, furosemide, acetylcysteine, naloxone, mometasone nasal, esomeprazole, montelukast, cholecalciferol, ondansetron
S-2 Disease Interaction
Volume of Distribution
To refer to the pharmacokinetic data of L-epinephrine, refer to the drug entry for Epinephrine.
Elimination Route
To refer to the pharmacokinetic data of L-epinephrine, refer to the drug entry for Epinephrine.
Half Life
To refer to the pharmacokinetic data of L-epinephrine, refer to the drug entry for Epinephrine.
Clearance
To refer to the pharmacokinetic data of L-epinephrine, refer to the drug entry for Epinephrine.
Elimination Route
To refer to the pharmacokinetic data of L-epinephrine, refer to the drug entry for Epinephrine.
Pregnancy & Breastfeeding use
S-2 has not been formally assigned to a pregnancy category by the FDA. There are no data on the excretion of racepinephrine into human milk.
Contraindication
Hypersansitivity
Storage Condition
Protect from light. Avoid excessive heat. Protect from freezing. Store between 2°C and 25°C
Innovators Monograph
You find simplified version here S-2
S-2 contains Racepinephrine see full prescribing information from innovator S-2 Monograph, S-2 MSDS, S-2 FDA label
FAQ
What is S-2 used for?
S-2 used to open up the airways in your lungs to make it easier to breathe. It should only be used by someone who has asthma.
How safe is S-2?
S-2 can damage the skin or tissues around the injection site if the medicine accidentally leaks out of the vein.
How does S-2 work?
S-2 work by binding to α- and β-adrenergic receptors (or adrenoceptors, so named for their reaction to the adrenal hormones) in different tissues.
What are the common side effects of S-2?
Common side effects of S-2 include:
- Slow heart rate
- High blood pressure (hypertension)
- Irregular heartbeats (arrhythmias)
- Confusion
- Anxiety
- Shortness of breath, with or without respiratory difficulty
- Headache
- Nausea and vomiting
- Sweating
- Tremor
- Restlessness
- Urinary retention
- Leakage of intravenous (IV) fluid
- Gangrene
- Dizziness
- Weakness
- Redness and swelling at the injection site
Is S-2 safe during pregnancy?
Use is considered acceptable during pregnancy, use with caution during labor and delivery,avoid use during the second stage of labor.
Is S-2 safe during breastfeeding?
any S-2 in milk is unlikely to affect the infant. High intravenous doses of S-2 might reduce milk production or milk letdown as well as decrease the concentration of beta-casein in milk.
Is S-2 affected by alcohol?
Some researchers have found that drinking actually increases levels of S-2, another transmitter that's responsible for arousing the nervous system.
How long does S-2 take to work?
After intravenous administration, a pressor response occurs rapidly and reaches steady state within 5 minutes. The pharmacologic actions of S-2 are terminated primarily by uptake and metabolism in sympathetic nerve endings. The pressor action stops within 1-2 minutes after the infusion is discontinued.
What happens when I take S-2?
Slow heart rate. High blood pressure (hypertension) Irregular heartbeats (arrhythmias) can happen.
How do you I S-2?
S-2 should only be administered as an intravenous infusion via a central venous catheter to minimize the risk of extravasation and subsequent tissue necrosis.
How long can I take S-2?
S-2 is usually given for as long as needed until your body responds to the medication. Some people must receive S-2 for several days.
How long does S-2 last?
Onset of action: 1–2 minutes. Duration of action: 5–10 minutes. Half-life: 3 minutes.
Who should not take S-2?
Tell your caregivers at once if you have a serious side effect such as a cold feeling anywhere in your body, blue lips or fingernails, trouble breathing, little or no urination, irritation or skin changes where the medicine was injected, slow heart rate, sudden numbness or weakness, severe headache, or problems with vision, speech, or balance.
What does S-2 interact with?
Together with adrenaline, S-2 increases heart rate and blood pumping from the heart.S-2 also increases blood pressure and helps break down fat and increase blood sugar levels to provide more energy to the body.
Does S-2 make anxiety worse?
S-2 is responsible for how the person reacts to stress and anxiety and is associated with the fight-or-flight response.
How does S-2 affect the brain?
In the brain, S-2 increases arousal and alertness, promotes vigilance, enhances formation and retrieval of memory, and focuses attention; it also increases restlessness and anxiety.
How is S-2 given?
S-2 is given as an infusion into a vein. A healthcare provider will give you this injection.S-2 is usually given for as long as needed until your body responds to the medication. Some people must receive S-2 for several days.
What happens if I miss a dose?
Since S-2 is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.
What happens if I overdose?
Seek emergency medical attention.Overdose symptoms may include slow heartbeats, severe headache, sweating, vomiting, increased sensitivity to light, pale skin, and stabbing chest pain.
