What to Know About Albuterol

Albuterol is an inhaled medication that can quickly relieve the symptoms of asthma. Classified as a short-acting beta-agonist (SABA) and bronchodilator, albuterol relaxes the muscles in your airways that tighten during an asthma attack. This causes the airways in the lung to increase in size, which allows air to move more freely through them.

Albuterol and other SABAs are often referred to as rescue inhalers. Several brands of albuterol are available, including Proair, Proventil, and Ventolin. The medication in these brands is identical. A generic form of albuterol also is available (approved in April 2020).

Oral forms of albuterol are available, but inhaled forms are preferred.

Uses

For decades, albuterol has been approved by the United States Food and Drug Administration (FDA) for:

• Treatment or prevention of bronchospasm in people age 4 and up
• Prevention of exercise-induced bronchospasm in people age 4 and up

Albuterol is to be used as a rescue inhaler when you have an asthma attack. For prevention, your healthcare provider may instruct you to use it at different times, such as before you exercise (if you have exercise-induced bronchospasm).

You should not rely on a rescue inhaler for frequent asthma attacks. A need to do so indicates that your treatment plan needs reevaluation.

You may need controller medications, taken daily for prevention, in addition to albuterol if:

• You use a rescue inhaler more than twice a week
• You have asthma symptoms twice a week or more
• Asthma interrupts your sleep more than twice a month
• Asthma interferes with daily activities

Off-Label Uses

While it's not approved for other uses, healthcare providers frequently use albuterol for some respiratory problems that aren't asthma-related. These include:

• Non-infectious respiratory problems such as chronic obstructive pulmonary disease (COPD)
• COVID-19

In 2020, nebulized albuterol became part of the treatment regimen for people hospitalized with severe COVID-19 symptoms. At-home use of albuterol inhalers or nebulizers is often recommended for people who have COVID-19 symptoms that aren't severe enough for hospitalization.

Before Taking

If your healthcare provider diagnoses you with asthma of any type or severity, you'll likely be given a SABA rescue inhaler right away as they're the first-line treatment for your condition. Albuterol is the most common SABA prescribed.

Depending on the severity of your symptoms and their triggers, albuterol may be the only medication you are put on, or it could be part of a larger treatment regimen that may include an inhaled corticosteroid as a daily control medication and allergy medications (if relevant).

Always talk to your practitioner about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Precautions and Contraindications

If you have certain conditions, your healthcare provider may want to be cautious about prescribing albuterol or monitor you more closely while you're using it.

Before taking albuterol, let your practitioner know if you have a:

• Cardiovascular disorder (heart disease, stroke)
• Seizure disorder
• Sensitivity to adrenergic (stimulant) drugs, which includes albuterol, amphetamine, pseudoephedrine, and many other prescription drugs as well as street drugs such as methamphetamine and cocaine

You should not use albuterol if you're allergic or hypersensitive to any ingredient in an albuterol inhaler.

Pregnancy and Breastfeeding

Well-controlled trials of albuterol during pregnancy haven't been performed. In years of worldwide use during pregnancy, some birth defects have been reported. However, a causal link to albuterol has not been established and a consistent pattern of effect has not emerged.

It's unknown whether albuterol or other components of inhaled medications are expressed in breastmilk or what impact that may have on a nursing child, if so.

If you're pregnant, breastfeeding, or planning to be when your healthcare provider brings up albuterol, discuss the benefits of this drug versus its risks in your case. Because uncontrolled asthma is a risk factor for several serious pregnancy-related consequences—for both you and your baby—your practitioner may consider it safer for you to take the medication than to avoid it.

Other SABA Rescue Inhalers

Currently, albuterol is one of two FDA-approved SABAs on the market. The other one is levalbuterol, which is marketed under the names Xopenex and salbutamol.

Older-generation SABAs have been discontinued due to safety concerns.

Dosage

Inhaled albuterol comes in a few different forms:

• Metered dose inhaler (MDI)
• Solution for nebulization
• A powder-filled capsule that is inhaled using a powder inhaler

According to the manufacturers, each inhalation or puff delivers 108 micrograms (mcg) of solution, of which 90 mcg are the medication. You can typically use two puffs every four hours as needed to relieve asthma symptoms. Some may get adequate relief from just one puff.

If you're using an albuterol MDI to prevent exercise-induced bronchoconstriction, the recommended dose is two puffs taken between 15 and 30 minutes before exercise or physical activity.

Your healthcare provider may give you different instructions for taking albuterol based on your personal health history or other factors. Be sure to follow them and ask for clarification on any aspect of your treatment plan that you are unsure about.

Modifications

For people over 65, the lowest possible dosage of albuterol is recommended due to the age-related increased incidence of liver, kidney, or heart problems, other diseases, and the use of other medications (if applicable).

Safe and effective dosages for children under age 4 haven't been established.

How to Take and Store

A member of your healthcare team and/or your pharmacist should go over the proper way to use your inhaler when it is first prescribed. Using your inhaler correctly is essential to ensuring you get a full dose of medication.

Albuterol inhalers are relatively easy to operate. A spacer (an attachment that increases the distance between the mouth and mouthpiece) is recommended as it ensures the medication goes deeper into the throat rather than being dispersed in the mouth.

If you're using the inhaler for the first time or have not used it in the past 14 days, you will need to prime it by shaking the canister and pressing it down four times to clear the opening.

Then, follow these five steps:

1. Exhale completely through your mouth.
2. Place the end of the mouthpiece into your mouth and close your lips tightly around the opening.
3. Inhale deeply as you press the canister down to expel one puff.
4. Hold your breath for 10 seconds, remove the inhaler, and exhale slowly.
5. If you require more than one puff, wait for one minute before repeating these steps.

Be sure to clean your inhaler at least once a week to prevent clogs and contamination. Just remove the canister from its holder, rinse the holder under warm water for 30 seconds, and then allow it to dry overnight.

Side Effects

As with any drug, albuterol is known to cause side effects in some users.

Common

The most common side effects of albuterol include:

• Headaches
• Shakiness
• Nervousness
• Nausea and vomiting
• Cough
• Sore throat
• Muscle, bone, or back pain

These rarely require medical attention, but you should let your healthcare provider know about any that are ongoing or problematic for you.

Severe

If you have any of these more serious side effects, talk to your practitioner about whether you should stop using albuterol. If any of these are severe, get medical help right away:

• Allergic reactions like skin rashes, hives, or itching
• Heart palpitations
• Chest pain or chest tightness
• Dizziness
• Fast or irregular heart rate
• Fever or chills
• High blood pressure
• Visual changes
• Worsened breathing

If used excessively or for long periods of time, albuterol can lead to low potassium levels (hypokalemia), which may be serious in people with kidney failure.

Warnings and Interactions

Albuterol isn't a replacement for corticosteroids or other long-acting asthma-control medications (LABAs). Always check with your healthcare provider before discontinuing any asthma maintenance medications.

Albuterol can have negative interactions with certain drugs. Let your practitioner know if you take:

• Beta blockers: Caution is advised as these drugs may block albuterol's ability to open your airways during an asthma attack. Examples include Lopressor (toprol) and Tenormin (atenolol).
• Lanoxin (digoxin): Albuterol may decrease levels of this drug in your blood. If you're taking both of them, your healthcare provider may monitor your levels via periodic blood tests.
• Diuretics (non-potassium sparing): Caution is advised. Albuterol may increase the risk of low potassium levels and changes to your heart. Examples of diruetics include Microzide (hydrochlorothiazide) and indapamide.
• MAO inhibitors and tricyclic antidepressants: Extreme caution is advised. These drugs may increase albuterol's impact on your circulatory system. Examples include Nardil (phenelzine) and Elavil (amitriptyline).