Albuterol (Salbutamol Sulfate)
What is Albuterol?
Albuterol is an inhaled medication that is indicated for:
- Treating bronchospasm
- Preventing bronchospasm
- Preventing exercise-induced bronchospasm
- Treating wheezing and chest tightness in those with chronic obstructive pulmonary disease (COPD)
Albuterol is normally taken as one to two inhalations every four to six hours each day. If a patient is to take two puffs, they should wait one full minute in between puffs. Additionally, if they are using another inhaler, they should wait one minute before using the other inhaler.
How does Albuterol Work?
Albuterol has an effect on beta2-adrenergic receptors. Albuterol’s effect on these adrenoreceptors contributes to increased cyclic AMP levels, causing the bronchial smooth muscle to relax and the inhibition of mediator release. This relaxes the muscles in the walls of the lung, opening the airways. This mechanism, therefore, alleviates wheezing, cough, and chest tightness allowing the individual to breathe easier.
Side effects of Albuterol include:
- Nausea and vomiting
- Anxiety or irritability
- Hyperactivity in children
- Irritated or dry throat
Warnings & Precautions
Albuterol can cause paradoxical bronchospasm like other inhaled medications. This event can be life-threatening. If this occurs, stop Albuterol right away and start a different therapy.
Deterioration of Asthma
A patient’s asthma may deteriorate for hours or days after administration. If an individual requires more Albuterol doses, this may indicate that their asthma is becoming destabilized. The patient may need to be reevaluated and require a different treatment regimen. Specifically, providers should consider anti-inflammatory treatment with something like corticosteroids.
Beta-adrenergic agonist bronchodilators, such as Albuterol, alone may not provide enough asthma relief. If this is the case, providers should consider using adjunct anti-inflammatory agents such as corticosteroids.
Beta2-adrenergic agonists can cause certain cardiovascular effects. These effects can include changes to blood pressure or pulse rate. If this happens, providers should stop therapy with Albuterol. Beta-agonists have also demonstrated electrocardiogram (ECG) alterations. Therefore, Albuterol and other sympathomimetic agents should be used with caution in those that have cardiovascular disorders. In particular, those with cardiac arrhythmias, hypertension, and coronary insufficiency should use caution.
Beta-agonists, such as Albuterol, can cause hypokalemia. These changes can lead to cardiovascular events. However, decreases in potassium levels are usually transient and do not necessitate supplementation.
Albuterol has been shown to cause hypersensitivity events such as rash, angioedema, hypotension, and bronchospasm.
Therapy with sympathomimetic amines such as Albuterol should be monitored in those with certain conditions. These conditions include those with diabetes mellitus, convulsive disorders, and hyperthyroidism. Additionally, large doses of albuterol have been shown to exacerbate diabetes mellitus and ketoacidosis.
Inhaled sympathomimetic drugs have been shown to cause death when used at doses that exceed what is recommended. The mechanism causing this is unknown. However, cardiac arrest and hypoxia are potential sources.
Beta-adrenergic Receptor Blocking Agents
Beta-blockers stop beta-agonist effects on the pulmonary system. Additionally, they may cause serious bronchospasm in those with asthma. Any patient with asthma should avoid beta-blockers. If necessary, providers can consider cardio-selective beta-blockers but should still use caution.
Beta-agonists, such as salmeterol, can worsen hypokalemia and/or ECG changes caused by non-potassium-sparing diuretics like thiazide or loop diuretics. Providers should use caution when prescribing Albuterol in patients on these types of diuretics.
Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs)
Providers should use caution when prescribing Albuterol with MAOIs or TCAs. Salbutamol’s effect on the vascular system can be increased by these types of medications.
In one study, serum digoxin levels decreased after oral and intravenous administration with salbutamol. Providers, therefore, should carefully monitor serum digoxin levels in those that are taking digoxin concomitantly with albuterol.
Frequently Asked Questions