Albuterol side effects and how to avoid them

If you’re prescribed albuterol, you might have questions about its safety and effectiveness. What side effects should you expect from this medication? Is it safe to use every day? Should you be concerned if you are taking other medicines? Learn the warnings and precautions, potential interactions with other drugs, and what you can do to minimize or avoid side effects. 

What is albuterol?

Albuterol, also called salbutamol in Canada, is a non-steroidal, short-acting beta2-agonist (SABA) medication used to treat wheezing, shortness of breath, coughing, and chest tightness caused by lung diseases, such as asthma, emphysema, and chronic obstructive pulmonary disease. It is also used to prevent bronchospasm in those with reversible obstructive airway disease and to help with shortness of breath and other breathing problems during exercise. It is in a class of medications called bronchodilators and works by relaxing muscles in the airways, thereby opening air passages. 

Types of albuterol
Name	Form	Age restrictions
Albuterol HFA	Inhalation aerosol	4+ years old
Proair HFA	Inhalation aerosol	4+ years old
Proventil HFA	Inhalation aerosol	4+ years old
Ventolin HFA	Inhalation aerosol	4+ years old
Proair Respiclick or Digihaler	Powder for oral inhalation	12+ years old
Albuterol	Syrup or tablets	2+ years old
Albuterol	Nebulizer solution	None
Albuterol ER	Extended-release tablets	6+ years old

 

RELATED: FDA approves first ProAir HFA generic

Common side effects of albuterol

Many people do not experience any side effects of albuterol, and, if they do, the side effects are mild. “Approximately 10%-20% of people using albuterol experience some side effects,” says Douglas P. Jeffrey, MD, a family physician in Oregon and medical advisor for eMediHealth. The most common adverse effects, according to the Food and Drug Administration (FDA) include:

• Rapid heart rate or palpitations
• Chest pain
• Tremors
• Nervousness

Some people also experience wheezing or trouble breathing immediately after using an albuterol inhaler, but this usually goes away after a short time.

Serious side effects of albuterol

There are also more severe side effects, including:

• Headache
• Nausea
• Vomiting
• Cough
• Throat irritation
• Muscle, bone, or back pain
• Uncontrollable shaking in some part of your body

Serious side effects are considered those that interfere with daily functioning. Side effects can last for four to six hours. They typically resolve within a few days or weeks after starting the medication. However, you should contact your doctor if you experience severe or persistent side effects. 

It is a good idea to discuss with your healthcare provider whether you should continue taking the medication or if you should discontinue using it immediately if you experience side effects. Your doctor might provide information about your symptoms to the adverse event program at the FDA. You can also complete the online form to report your symptoms.

Although allergic reactions are rare they can be life-threatening. Allergic symptoms include:

• Fast, pounding heartbeat
• Chest pain
• Rash
• Hives
• Itching
• Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• Even more difficulty breathing or swallowing
• Hoarseness

Another possible side effect is paradoxical bronchospasm, according to a report published in the American Journal of Case Reports. The condition is the unexpected constriction of the smooth muscle walls of the airways. It can cause shortness of breath, difficulty breathing on exertion, and temporarily decreased lung function. The report authors believe that paradoxical bronchoconstriction is an underreported side effect of beta2-agonist inhalers, including albuterol. According to this research, this side effect impacts up to 8% of people using this treatment. Changing to a different medication might help. 

Albuterol warnings

The FDA approved albuterol inhalers for people aged four and older for those with asthma and exercise-induced bronchospasm. 

Before taking albuterol, or any other prescription, you should tell your doctor about your medical conditions. This medication should be used with caution if you have heart disease, according to prescription information, which includes:

• Coronary insufficiency
• Cardiac arrhythmias
• High blood pressure
• History of irregular heartbeat

The American Heart Association lists albuterol as one of the drugs that may cause or exacerbate heart failure.  

You should also discuss the following health conditions with your healthcare professional before taking albuterol:

• Hyperthyroidism
• Diabetes
• Seizure disorder
• Hypokalemia (low potassium) 

Although rare, there have been reports of death in association with excessive use of inhalation asthma medications, according to the FDA. The exact cause of these deaths is unknown; however, researchers suspect cardiac arrest and the resulting lack of oxygen to the body. 

Pregnancy and breastfeeding

If you are pregnant or planning to become pregnant, you should tell your doctor. According to information from the manufacturer, there are no direct studies of albuterol in pregnant women but the risk to a fetus appears low. The lack of oxygen caused by asthma might be more harmful to the fetus. Somewhere between 4% and 12% of women who are pregnant in the United States have asthma, and 3% of those take asthma medications, including albuterol, according to the Centers for Disease Control and Prevention (CDC). 

A study published in Pediatrics found that using asthma medications did not increase the risk for most congenital disabilities. Albuterol was the most common medication used by people participating in the study. There might, however, be an increased risk for congenital disabilities of the esophagus, anus, and abdominal wall. 

The possible effects on a baby when you are breastfeeding are also not known. Using a bronchodilator will probably not cause high enough levels in your breast milk to cause a problem, according to MothertoBaby. However, you should speak with your doctor and proceed with caution, weighing the risks and benefits if you are pregnant, planning to be pregnant, or breastfeeding. 

Albuterol interactions

Albuterol can cause interactions with other medications. Interactions vary depending on the drugs you are taking, but can include:

• Increased blood pressure
• Increased heart rate
• Irregular heartbeat
• Increased risk of a cardiovascular event

You should tell your doctor if you are taking any other medicines, including prescription drugs, over-the-counter, supplements, and vitamins. “Certain medications are known to interact with albuterol and should be avoided,” according to Dr. Jeffrey. Prescriptions that could have dangerous drug interactions with albuterol include:

• Methacholine
• Midodrine
• Linezolid
• Propranolol

“There are many other medications that require monitoring or dose adjustments when used with albuterol. The list of potential interactions is quite long, with over 100 medications that might interact adversely with albuterol. It is best to consult with your health provider regarding potential interactions,” explains Dr. Jeffrey. 

Some of the drugs that could potentially interact with albuterol (although not as seriously as the ones listed above) include:

• Tenormin (atenolol)
• Trandate (labetalol)
• Lopressor, Toprol XL (metoprolol)
• Corgard (nadolol)
• Inderal (propranolol)
• Lanoxin (digoxin)
• Epipen, Primatene Mist (epinephrine)
• Xopenex (metaproterenol and levalbuterol)
• Hygroton (chlorthalidone)
• Diuril (chlorothiazide)
• Esidrix, Hydrodiuril, Microzide (hydrochlorothiazide)
• Lozol (indapamide)
• Mykrox, Zaroxolyn (metolazone)
• Lasix (furosemide)
• Elavil (amitriptyline)
• Asendin (amoxapine)
• Anafranil (clomipramine)
• Norpramin (desipramine)
• Silenor (doxepin)
• Tofranil (imipramine)
• Pamelor (nortriptyline)
• Vivactil (protriptyline)
• Surmontil (trimipramine)
• Marplan (isocarboxazid)
• Nardil (phenelzine)
• Eldepryl, Emsam (selegiline)
• Parnate (tranylcypromine) 

You should also avoid cold medicine, including over-the-counter products; however, there are no known drug interactions with albuterol and cough medicine. 

If you are taking any of these medications, your doctor might need to adjust your dose or monitor you carefully for side effects.

Albuterol overuse

Overuse of albuterol is relatively common, according to a report published in the Journal of Allergy and Clinical Immunology. This medication is meant for occasional use when you have acute asthma symptoms. However, about a quarter of people prescribed albuterol use it as a daily asthma-control medication instead of as a rescue inhaler for quick relief. Many doctors suggest one inhaler canister should last approximately one year. If you are using your inhaler more often or if it only lasts a few months, it might indicate your asthma is not well-controlled, and you might want to speak with your doctor about a daily medication. 

Overuse of albuterol can be dangerous and could have potential health consequences. You might notice you have asthma symptoms more often or the symptoms are worsening. People who overuse inhalers report more coughing, wheezing, nighttime awakenings, and more frequent symptoms than those who use albuterol only occasionally. They also stated they had a lower quality of life and higher rates of depression.  

Overuse can also lead to albuterol overdose, according to the report. Symptoms of an overdose include:

• Chest pain
• Rapid or irregular heartbeat
• Headache
• Tremors
• Nervousness
• Dizziness
• Dry mouth
• Nausea
• Fatigue
• Seizures

If you believe you, or someone else, is having an overdose, you should contact the poison control center at 1-800-222-1222 or seek immediate medical care.

How to avoid albuterol side effects

1. Take it as directed. The best way to avoid side effects from albuterol is to use it as directed. Your doctor should discuss the proper dosage and how often you should take the medication. For adults using a metered-dose inhaler, the recommended dose is one to two puffs every four to six hours. For tablets and syrup, the recommended dose is 2-4 mg every six to eight hours. The extended-release formula lasts 12 hours and can be taken twice a day. 

2. Use a spacer. The Medical Associates Clinic suggests using a spacer, which is an extension placed on the inhaler that can slow the inhalation of your medication. Using a spacer increases the amount of medicine that gets into your lungs, and might decrease the taste of the drug in your mouth while also reducing side effects such as sore throat and hoarseness. Another method that’s especially convenient for children is by taking (or administering) a breathing treatment through a nebulizer machine.

3. Supplement with different daily asthma medications. Albuterol is a quick-acting rescue medication for asthma symptoms. You should take it only if you are experiencing acute symptoms and only according to the recommended guidelines. If you find that you are still having symptoms or if the recommended dose does not seem to be relieving symptoms, you should talk to your doctor. A daily asthma medication might be best, with the albuterol reserved for acute attacks. 

4. Switch medications. If you are still experiencing side effects after a few days or weeks, talk to your doctor. “There are steps that can be taken if side effects are severe. You might need to stop the medication, but you should only do so after consulting your healthcare provider. A switch to an alternate medication used for the same purpose might help. Or your doctor might suggest lowering your dosage,” according to Dr. Jeffrey, “Side effects are less likely when using an inhaler instead of pills or liquid.” 

5. Make small lifestyle changes. Taking control of your asthma symptoms will also lessen your need for albuterol, therefore, reducing your side effects. Some ways to better control your asthma are:

• Understanding and avoiding triggers, such as pollen, pet dander, cold air, intense exercise, odors such as perfume or hair spray, and cigarette smoke
• Regular exercise
• Using a dehumidifier at home
• Frequent washing of sheets and blankets
• Regular vacuuming

Coupons for albuterol are available on singlecare.com or the app, available for Android and iOS. You can use the coupons at most major pharmacies as well as some regional ones. Once you type in your zip code, you can see the available pharmacies in your area.