Albuterol – Drug class, Side Effects, Dosage, Contraindications, Overdose

Albuterol - Side Effects, Uses, Dosage, Overdose, Pregnancy, Alcohol

What is Albuterol?

Contents

Albuterol is used to treat tightening and swelling of muscles in the airways. It increases the flow of the air to lungs. It is used to improve the condition of children and adults in asthma. It also prevents exercise-induced asthma.

It comes in many forms- metered dose inhaler, oral syrup, and extended-release tablets.  It also comes in immediate release tablets and nebulizer solution. It can be taken by mouth or as an inhalation. The brand for metered dose inhalers is by the name of Ventolin, Proventil and ProAir.

Side effects are irregular or fast heart rate, nervousness, sore throat, headache, shakiness and runny nose. The albuterol effect lasts for 6-12 hours. Take this drug according to the recommendation of the doctor. This drug is a prescription based drug. This drug is not available as a generic drug.

Albuterol can be combined with some drug therapy like inhaled corticosteroids, beta agonists, and bronchodilators.
Albuterol Inhaler: Uses, Dosage & Side Effects

Albuterol molecular formula and weight

It has not less than 98.5% and not more than 101% of C13H21NO3. It is calculated on the anhydrous basis.

Molecular Formula- C13H21NO3

Molecular weight- 239.315 g/mol

Molecular structure of albuterol:

Albuterol molecular structure

Albuterol drug class

Albuterol belongs to the class of beta2- adrenergic bronchodilators. This helps you to breathe more easily. Albuterol is also known as salbutamol. Bronchodilators aid the opening of airways. It opens passages for breathing and relaxes muscles.

For what conditions is albuterol prescribed?

It is used to treat and prevent difficulty while breathing, coughing, and wheezing. Also, used to treat shortness of breath, and tightness in chest. These all symptoms are caused by asthma and COPD (chronic obstructive pulmonary disease). Albuterol in the form of inhalation, aerosol and powder is used for oral inhalation. Aerosol inhalation is used in children of four years of age or above and adults. Oral inhalation powder like Proair Respiclick is used in children of age 12 years or older. The solution for oral inhalation is used in children of age 2 years or older and adults.

Why is albuterol prescribed?

It is a beta 2 adrenergic agonist. Its effects are activation of these receptors on smooth muscles of the airway. Activation of receptors leads to the activation of adenyl cyclase and increase of the amount of Cyclic AMP. It further activates protein kinase that inhibits myosin phosphorylation and lowering of calcium concentration. It results in relaxation of muscles. Albuterol helps in the relaxation of smooth muscles of the airways from bronchioles to the trachea.  Albuterol protects the airways against all bronchi constrictor activities. Increase in the concentration of cyclic AMP results in the inhibitory release of chemicals from mast cells. Beta 2 adrenergic receptors are the most important receptors.

It is been shown in clinical trials that albuterol has the therapeutic effect on the respiratory tract. It results in relaxation of smooth muscles of bronchi. In the case of inhaled albuterol, can produce the effect on cardiovascular system. It can be measured by changes in blood pressure and pulse rate.

Albuterol brand names

It comes under the brand name of Ventolin, Proventil and ProAir, Accuneb

What is albuterol used for?

  • Bronchospasm

The aerosol inhaler is used for the treatment of Bronchospasm. It can be used to treat the patients of age 4 or older and adult.

  • Exercise-induced bronchospasm

It is used to prevent exercise-induced bronchospasm in the patients of age 4 years or older and adults.

Albuterol dosage for different indications

  1. Average adult dose for Acute Asthma and Bronchitis

IV infusion-Dilute 5ml of this drug in 500 ml of NaCl injection. The infusion is started from 5 mcg/min that can be increased to 10 mcg/min and 20 mcg/min at the interval of 15-30 minutes.

Nebulizer inhalation-It can be taken 2.5 mg three to four times once in a day.

  1. Average adult dose for Bronchospasm Prophylaxis

Inhalation powder- 2 inhalations of 180 mcg orally. 15-30 minutes prior to exercise.

Inhalation capsule- 1 inhalation of 200 mcg 15 minutes prior to exercise.

  1. Average adult dose for maintenance of asthma, reversible airways and COPD

Inhalation powder- 1-2 inhalations of 90-180 mcg. It can be taken orally in every 4-6 hours.

Inhalation capsules- it can be taken 200 mcg orally in every 4-6 hours. You can take maximum dose of four inhalations per day.

Nebulizer inhalation- 2.5 mg can be taken 3-4 times in a day.

Oral tablets:

Immediate releasing tablets- Initial dose is 2-4 mg orally 3-4 times in a day. Dosage can be increased to maximum of 8 mg for four times in a day.  In the elderly patients, the initial dose must be 2mg 3-4 times a day. The dose can be increased to 8 mg 3-4 times a day.

Extended release tablets- initial dose is 4-8 mg orally 12 hours in a day. Dosage can be increased to the maximum of 32 mg in a day.

Oral syrup- The initial dose is 2-4 mg orally that can be taken 3-4 times in a day. It can be increased by 8 mg for four times in a day. In the case of old patients, the initial dose must be given 2 mg for 3-4 days.

  1. Average pediatric dose for acute asthma, bronchitis and COPD

4 years or older

You can take 1 or 2 inhalations from powder of 90-180 mcg orally in every 4-6 hours. In the case of inhalation capsules, take 1 inhalation of 200 mcg orally in every 4-6 hours. The total dose must not exceed 4 inhalations.

2- 12 years

Less than 15 kg- 0.1 to 0.15 mg/kg/dose can be used by nebulization. 0.5% of inhalation solution can be diluted in saline solution to a 3ml. The dose must not exceed 2.5 mg for 3-4 times in a day.

15 kg or more- 2.5 mg can be taken 3-4 times in a day by nebulization. The 0.5 % of the solution can be diluted with 2.5 ml of sterile solution.

13 years or older- inhalation solution is 0.5 % can be taken 3-4 times a day.

Albuterol side effects

Various common side effects are as follows. If you face any of these side- effects consult your doctor

Common side effects are:

  • Nervousness
  • Shaking
  • Headache
  • Nausea and vomiting
  • Cough and Irritation in the throat
  • Pain in the muscle, back and bone.

Serious side-effects are:

  • Chest pain, difficulty in swallowing, and problem in breathing
  • Rash, hives, or itching
  •  Irregular heartbeat
  • Swelling of the face, eyes, lips, throat, and tongue
  • Swelling of hands, legs, feet, and ankles
  • Hoarseness

How to take albuterol? 

The liquid medicine can be inhaled with the help of nebulizer. A nebulizer is a machine that converts liquid medicines into the mist. You must strictly follow the instructions of doctor.

Albuterol is also taken from inhaler. It is used in every 4-6 hours. It comes in the form of canister. Every canister has 200 inhalations.

The tablets can be taken with a glass of water.

To inhale aerosol by using an inhaler, you must follow these simple steps

  • Remove the cap from the mouthpiece. Clean the mouthpiece in case of dust. The canister must be firmly and fully places inside the mouthpiece.
  • If using inhaler for the first time, you must prime it. Shake the inhaler and press canister. Repeat this for 4 times and release the spray in the air.
  • Pay extra attention that the inhaler must not go into your eyes or face.
  • Breathe out from your mouth
  • Hold the canister from bottom. Canister must point upwards. Tightly close your lips on the mouthpiece.
  • Breathe slowly and deeply from the mouthpiece. Press the container to spray the medicine directly in your mouth.
  • Hold your breath for 20 seconds. Remove inhaler and breathe out slowly.
  • If you have to repeat the puffs, then wait for one minute and repeat the process.
  • You must clean your inhaler regularly.

To inhale powder by using inhaler, you must follow these steps.

  • If you are using inhaler for the first time, then remove wrapper. Look at the dose counter at the back and check for 200 number in the window.
  • Hold the inhaler upright and pointing upwards. Load the dose by opening cap at the end of mouthpiece. Open the cap only when you are ready to inhale. When you open the cap, the dose is ready to inhale. Don’t waste the doses by opening the inhaler unnecessary.
  • Breathe out completely from your mouth.
  • Place the mouthpiece tightly between your lips into your mouth. Your fingers or lips must not block vent on the mouthpiece.
  • Remove inhaler from your mouth. Hold your breath for 10 seconds.
  • Close the cap on the mouthpiece.

Inhale the solution by using nebulizer and follow these simple steps

  • Remove the vial of albuterol solution from pouch.
  • The liquid in the vial must be clear and colorless. The vial must not be used if it is discolored or cloudy.
  • Twist the vial top and squeeze all the liquid. The liquid must be taken into the nebulizer.
  • Attach the reservoir of nebulizer to the mouthpiece. Attach nebulizer into the compressor.
  • Keep the mouthpiece in your mouth. By sitting in the comfortable position and use the compressor.
  • Breathe in deeply for 5-15 minutes. Keep breathing in until mists stop forming in the chamber.
  • Clean your nebulizer on the regular basis.

albuterol nebulizer dose

Overdose of albuterol

If there is overdose of albuterol. Consult the doctor immediately. Symptoms of overdose are

  • Uncontrollable shaking, nervousness and seizures
  • Chest pain and headache
  • Irregular heartbeat
  • Dry mouth
  • Nausea and dizziness
  • Lack of energy and tiredness
  • Difficulty in sleeping

Missed dose of albuterol

If you miss any dose of albuterol, take immediately. If it is the time of your next dose, then don’t take missed dose. Take the scheduled dose. Don’t take double doses.

Precautions and warnings during albuterol use

You must not use Albuterol if you are allergic to it. You must tell your doctor if you have the following diseases-

  • High blood pressure
  • Heart disease and congestive heart failure
  • Epilepsy and seizure
  • Diabetes
  • Low level of potassium in blood
  • Overactive thyroid
  • Pregnant or planning to conceive.
  • Nursing mother

Large doses of albuterol can aggravate diabetes in the patient who has the history of diabetes. It can also produce low potassium level in the body.

The action of albuterol can last for eight hours. It must not be taken frequently. If you want to increase the dose of the medicines, consult doctor. If the symptoms are getting worse, consult your doctor immediately. When you are taking albuterol, other asthma medications must be taken under the guidance of doctor. Adverse effects are nervousness, tremor, chest pain, rapid heart rate, and palpitations.  Consult your doctor before taking albuterol if you are pregnant or a nursing mother.

How long does albuterol take to work?

The adsorption value is 83. The value of bioavailability is 44. The protein binding is 10. It is metabolized by liver. It gets hydrolyzed by esterase in blood and tissue.

Albuterol pharmacokinetics

Albuterol is rapidly absorbed after oral administration of one 4 mg Albuterol tablet in normal volunteers. Maximum plasma concentrations of about 18 ng/mL of Albuterol are achieved within 2 hours, and the drug is eliminated with a half-life of about 5 hours.

In other studies, the analysis of urine samples of patients given 8 mg of tritiated Albuterol orally showed that 76% of the dose was excreted over 3 days, with the majority of the dose being excreted within the first 24 hours. Sixty percent of this radioactivity was shown to be the metabolite. Feces collected over this period contained 4% of the administered dose.

How long does albuterol stay in body?              

It is available in inhaled and oral form. Its half -life is six hours. It refers to the duration of time for half of the albuterol to be out of our body. It gets metabolized in GIT (gastrointestinal tract) by SULTIA3 enzyme. It gets excreted from the body through kidneys. Renal excretion amounts to 80-100 %. And rest takes place through feces.

Albuterol use during pregnancy

During the clinical trials, albuterol is found to be teratogenic in the mice. In a reproduction study in rabbits, there occurred cranioschisis in 37% of fetuses in the administration of this drug.

This drug should be used during pregnancy only if the benefit outweighs the risk to the fetus. AU TGA pregnancy category: A US FDA pregnancy category: C Comments: -This drug is known to cross the placental barrier, as evidenced by increases in fetal heart rate. -Beta-agonists, including this drug, may potentially interfere with uterine contractility. -In women with poorly or moderately controlled asthma, there is an increased risk of preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate. Pregnant women should be closely monitored and the dose adjusted as necessary to maintain optimal control. -In some countries, intravenous injection presentations of this drug have been approved for delay pre-term labor (tocolytic agent) and should not be used in the management of uncomplicated premature labor.

Albuterol use during breastfeeding

We don’t have enough evidence that this drug gets excreted in the milk. A decision to give albuterol must be made at your own discretion.

Can albuterol cause paradoxical bronchospasm?

This tablet produces paradoxical bronchospasm that can be life threatening. If paradoxical bronchospasm occurs, this medicine must be discontinued with immediate effect.

Can albuterol cause cardiovascular problems?

Albuterol that is a beta adrenergic agonists produces cardiovascular effects. It can be measured by blood pressure or pulse rate. If these side effects continued to occur after the administration, albuterol must be discontinued. According to report, beta agonists can cause changes in ECG, prolongation of QTc interval or t-wave flattening. This drug must be used carefully in the patient with cardiovascular disorders. These disorders include hypertension and cardiac arrhythmias.

Albuterol and deterioration of Asthma

Asthma can be deteriorated. If you require more doses of albuterol than usual it means that your asthma is getting destabilized. You must consult your doctor immediately. He will reevaluate your treatment regimen. May be you require ant-inflammatory agent like corticosteroids.

Albuterol and allergies

You must tell your doctor if you have allergy to any medicine. Also discuss if you have any allergy to food, preservative, dye and animals.

Use of anti-inflammatory agents with albuterol

Sometimes the use of beta-adrenergic agonist bronchodilators are not sufficient to treat asthma. Adding anti-inflammatory agents like corticosteroids prove beneficial.

 Hypersensitivity reactions during albuterol use

With the administration of albuterol, it can result in hypersensitivity reactions. The symptoms are rash, edema, and urticaria.

Albuterol use in patients with Cardiovascular problems like Heart disease, Hypertension and Hyperthyroidism

Albuterol stimulates beta 1 & beta 2 receptors. It results in adverse effects like changes in blood pressure, tachycardia and palpitation. Higher doses may worsen the symptoms of Angina, myocardial ischemia and arrhythmias. Therefore the recommended doses must not be exceeded in the patients suffering from hypertension, hyperthyroidism and heart disease.

Albuterol use and Diabetes

Albuterol can cause increase in blood glucose levels. If the large doses of albuterol are given it can result in the disturbance of blood glucose levels. It can cause exacerbation of pre-existing diabetes and ketoacidosis. The therapy of albuterol must be administered with caution.

Albuterol use and Hypokalemia

Albuterol causes decrease in serum potassium level if given by IV or nebulization. Hypokalemia is caused in some patients. Albuterol must be given with great care in the patients who have the history of hypokalemia or are the risk of developing the disorder of hypokalemia.

Albuterol use and Seizures

Albuterol can cause stimulation of CNS. It must be given with great caution if the person is suffering from seizures.

Albuterol use and renal dysfunction

Albuterol is excreted by kidneys. If the person is suffering from renal dysfunction, then it may interfere with its excretion. The risk of toxic effects increases with the impaired renal function. Dose titration is required to be taken into consideration when administering the dose of Albuterol

Interaction of albuterol with nadolol

Simultaneous administration of both these drugs reduces the benefits of each other. These drugs have the opposing effect in the body. Nadolol causes narrowing of the airways that worsen breathing problems or trigger severe attacks. Nadolol is not recommended in the patients that are suffering from COPD or asthma.

Interaction of albuterol with bendroflumethiazide

Simultaneous administration of them increases the risk of hypokalemia. Serious cases can cause paralysis, muscle weakness, difficulty in swallowing, breathing and irregular heart rhythm. You are advised not to exceed your dose. Consult your doctor if you are experiencing serious symptoms like nausea, constipation, confusion, fainting, and muscle cramp.

Interaction of albuterol with timolol

Simultaneously administration of albuterol and timolol reduces the effect of both medicines. They have the opposing effect on the body. It is not recommended if you have the history of asthma or COPD. It can cause narrowing of airways that can cause serious breathing problems or worsening of asthma.

Interaction of albuterol with carteolol

Don’t consume these both drug together as they have opposite effect on the body. It can cause worsening of asthma and problem in breathing by causing narrowing of airways. You must tell your doctor if you are having the history of asthma or COPD.

Interaction with albuterol and carvedilol

These both when taken together reduces the therapeutic effects of each other. Carvedilol is not recommended in the patient suffering from asthma or COPD. You must tell your doctor if you have the history of asthma or problem in breathing,

 Interaction with albuterol and fingolimod

Tell your doctor if you are taking albuterol. Taking fingolimod with albuterol can cause irregular heart rhythm that can be life-threatening. If you have heart disease, conduction abnormalities, or electrolyte imbalance take caution while taking this combination. You must take your first dose of fingolimod in front of the doctor. It is required to observe the condition till 6 hours. You must consult your doctor immediately if you develop fainting, dizziness, shortness of breath, lightheadedness and heart palpitations.

Interaction between albuterol and propranolol

Co-administration of both these drugs causes reduce effects of both these drugs. These drugs have opposite effect to each other. Propranolol may cause narrowing of airways that can trigger asthmatic attack or breathing problems.  It is not recommended if you gave history of asthma, asthma, and COPD. You must consult your doctor and discuss the medications that you are taking.

Interaction between albuterol and hydrochlorothiazide

Co-administration of both these drugs increases the risk of low potassium level of blood or hypokalemia. It can lead to paralysis, difficulty in swallowing, muscle weakness and irregular heart rhythm. Do not use the excess dose of albuterol. Tell your doctor if you have symptom of nausea, confusion, numbness, rapid heartbeat and swelling in feet or legs.

Interaction between albuterol and labetalol

Concomitant use of both these drugs reduces the therapeutic effects of both these drugs. It causes narrowing of the airways that worsen the asthma and breathing. It is not recommended in the patient suffering from asthma. You must talk to your doctor and tell him that you are taking albuterol.

Interaction between albuterol and levobunolol

When you use ophthalmic levobunolol with albuterol, it decreases the effect of both of the drug as they are opposite to each other. It can cause narrowing of airways. You must consult doctor if you are taking albuterol and want to take levobunolol. Your doctor can prescribe the alternatives that do not interact with albuterol.

Interaction between albuterol and letrozole

It may cause prolongation of QT interval. It can result in additive effects. There is an increased risk of ventricular arrhythmias and death also. The risk factors are cardiac disease and disturbances in electrolyte. However, if the combination has to be given then clinical monitoring is required. ECG can be used to access the condition.

Interaction between albuterol and metipranolol

Simultaneous use of both these drugs reduces the therapeutic effect of these drugs. They work opposite to each other in the body. Metipranolol ophthalmic causes narrowing of the air passage. It can result in triggering of asthmatic attack or breathing problems. It is not recommended to take both drug simultaneously if you are having history of asthma.

Interaction between albuterol and mifepristone

Taking these two drugs together increases irregular heartbeat. It may cause serious and life threatening effect. If you have the history of congenital QT syndrome, electrolyte imbalance and lowering of potassium, then avoid this combination. You must consult your doctor as he is aware of all the health risk related to this combination. You must tell your doctor if you are taking these drugs individually also. If you have the symptoms of muscle cramp, nausea, dizziness, shortness of breath, fainting, rapid heartbeat and swelling in legs.

Interaction between albuterol and papaverine

If you are seeking for the treatment with papaverine, consult your doctor that you are taking albuterol. The combination of these drugs can cause irregular heartbeat. Your doctor knows every side effect and how to handle the serious side-effects. You must seek the help of your doctor if you are developing heart palpitations, fainting, and dizziness.

Drug interaction between albuterol and pindolol

The combination of these drugs reduces the effect on the body as they work opposite to each other. It is not recommended to take if you have the history of asthma or COPD. If taken without the consultation of doctor, it can lead to worsening of breathing problem and asthmatic attack.

Drug interaction between albuterol and penbutolol

Penbutolol must not be used along with albuterol as the combination results in deterioration of your asthma and breathing. It leads to narrowing of the air passage. You must consult your doctor as he would be able to prescribe you the alternatives of this medicine.

Interaction between albuterol and ribociclib

Ribociclib can lead to prolongation of QT interval. It results in additive effects and increased arrhythmias. It can also lead to sudden death. The risk factors like cardiac disease, hypokalemia and electrolyte disturbances can result in worsening of your condition.

Interaction between albuterol and sotalol

The combination of these drugs has the opposite effect of each other. They can trigger asthmatic attack and worsening of breathing. Consult doctor if you have the prior history of asthma or COPD. Your doctor can give the alternative of this combination.

Can I take albuterol with digoxin?

Mean decreases of 16% to 22% in serum digoxin levels were demonstrated after single-dose intravenous and oral administration of Albuterol, respectively, to normal volunteers who had received digoxin for 10 days. The clinical significance of these findings for patients with obstructive airway disease who are receiving Albuterol and digoxin on a chronic basis is unclear. Nevertheless, it would be prudent to carefully evaluate the serum digoxin levels in patients who are currently receiving digoxin and Albuterol.

Can I take albuterol with diuretics?

The ECG changes and/or hypokalemia that may result from the administration of nonpotassium-sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by beta-agonists, especially when the recommended dose of the beta-agonist is exceeded. Although the clinical significance of these effects is not known, caution is advised in the coadministration of beta-agonists with nonpotassium-sparing diuretics.

Albuterol tips for patients

  • Always keep albuterol on hand at all times, and refill your prescription before you run out completely. Keep using all other medications as prescribed by your doctor.
  • If you use an inhaler, ask your pharmacist or doctor to check that you are using it correctly. You may need to prime your inhaler before first use, or shake it prior to use. Follow the instructions provided.
  • Most inhalation devices require regular cleaning or else they will clog. Follow the instructions provided on how to clean your device and mouthpiece
  • Store your device at room temperature away from heat, cold, open flames and moisture. Do not puncture or burn an empty canister.
  • Avoid spraying into the eyes. Rinse eyes with water if this happens by accident.
  • Seek emergency help if you have signs of an allergic reaction (breathing difficulties, facial swelling, hives), chest pain or fast heart rate, pain or burning when you urinate, signs of high blood sugar (increased thirst, increased urination, hunger, dry mouth), or signs of low potassium (such as leg cramps, irregular heartbeat).

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About Miljan Krcobic 257 Articles

My name is Miljan Krčobić. I was born on 14th of November 1989. in Negotin, Serbia, where I finished elementary and high school. In June 2015 I graduated from the Faculty of Pharmacy in Belgrade and thus acquired the title Master of Pharmacy. From the July of 2015 to January 2016 I worked in a pharmaceutical company Hemofarm a.d.(Member of STADA group) based in Vrsac, Serbia, as an expert associate for GMP compliance within the sector Quality Assurance. I am currently working in a pharmacy called Zivkovic in Negotin. As a freelancer I write medical articles on Elance and Upwork.