Understanding Albuterol: Side Effects to Know

Albuterol Sulfate Overview

Albuterol (also called salbutamol) belongs to a group of drugs called short-acting beta agonists or bronchodilators. It is a quick-relief medication that is used for the prevention and treatment of breathing problems caused by asthma, chronic obstructive pulmonary disease (COPD), and other lung diseases. Albuterol is used to treat and prevent symptoms such as wheezing, coughing, shortness of breath, difficulty breathing, chest tightness, and exercise-induced bronchospasm. 

The generic drug albuterol is also sold under brand names such as Proair Respiclick, Proair HFA, Ventolin HFA, Proventil HFA, and Accuneb.

Mechanism of Action

Albuterol relaxes the muscles in the airways. This causes the airways to open up and makes breathing easier. Learn more about how albuterol works.

Albuterol Dosage Forms

• Albuterol nebulizer solution: Nebulized albuterol is inhaled by mouth after a special device called a nebulizer turns the liquid medication to a fine mist.

• Albuterol inhalation powder or aerosol: This dosage form of albuterol is inhaled by mouth with a metered dose inhaler that releases a measured dose of the medication with each pump. 

• Oral dosage forms: Oral salbutamol or albuterol is taken by mouth. Available formulations include an oral tablet, extended-release tablet, and oral syrup.

Albuterol Side Effects

Common Side Effects of Albuterol Treatment

• Headache

• Nervousness

• Uncontrolled shaking or constant movement

• Throat irritation

• Cough

• Nausea

• Vomiting

• Tachycardia (rapid heartbeat)

• Skeletal muscle pain, bone pain, or joint pain

Serious Side Effects of Inhaled Albuterol: When to Seek Medical Attention?

Less commonly, albuterol can cause more serious side effects, including an allergic reaction. Seek emergency medical attention if you develop:

• Chest pain

• Fast, pounding, irregular, or racing heartbeat

• Skin rash, hive-like swelling, itching

• Swelling of the face, eyes, lips, tongue, throat, hands, lower legs, ankles, or feet

• Increased difficulty breathing 

• Difficulty swallowing

• Hoarseness

• Urine trouble (decreased urination), increased thirst, dry mouth

• Seizures (Check out Seizure First Aid: A Step-By-Step Guide)

High-Risk Groups for Albuterol Use: Who Should Be Cautious?

People with Prior Hypersensitivity Reactions

People with a history of allergic reactions to albuterol should not take this medication again. Those who have had hypersensitivity reactions to similar drugs should take albuterol with caution. 

Some people develop wheezing and breathing difficulty immediately after they inhale albuterol. This is called paradoxical bronchospasm. If your symptoms worsen immediately after a dose of albuterol, stop using the medication and call your doctor immediately. Do not use albuterol to treat asthma or COPD again without consulting your doctor. Find out “What Are The 4 Stages Of COPD?”

Before starting albuterol treatment, tell your doctor and pharmacist if you have ever had an allergic reaction to albuterol, levalbuterol (Xopenex), any of the active or inactive ingredients in albuterol formulations, or any other medications. Also, tell your doctor if you are allergic to milk proteins (these are present in albuterol inhalation powder). Your pharmacist can give you a list of ingredients in albuterol formulations.

People with Pre-Existing Health Conditions

Albuterol may not be safe for people with certain health conditions. Tell your doctor if you have high blood pressure, an irregular heartbeat, heart failure, heart disease, diabetes, hyperthyroidism (overactive thyroid gland), or a seizure disorder.

Also, tell your doctor if you are pregnant, could be pregnant, are planning a pregnancy soon, or are breastfeeding an infant. Call your doctor if you become pregnant while on albuterol. Learn Which Medications Are Safe to Take During Pregnancy.

Age-Related Considerations: Use of Albuterol in Children and Elderly Individuals

Albuterol inhalers and the solution for use in albuterol nebulizers are approved for use in different age groups.

• Albuterol powder for oral inhalation (Proair Respiclick inhaler) is for use in children 12 years of age and older. 

• Albuterol inhalation aerosol (Proventil HFA, Proair HFA, Ventolin HFA) inhalers are for use in adults and children 4 years of age and older. 

• Albuterol solution for oral inhalation with a nebulizer machine is for use in adults and children 2 years of age and older.

There aren’t enough clinical studies on older adults (age 65 years and above) to determine if they respond differently to albuterol than younger patients. Based on clinical experience, there does not appear to be a difference in the response to albuterol between older and younger patients. However, doctors usually start at the lower end of the dosing range for elderly patients. This is because older patients are more likely to have reduced liver, kidney, and heart function. Find out “What is Adult Asthma? Causes, Symptoms, and Treatments.”

Note: Albuterol is eliminated from the body by the kidneys. The risk of toxicity is therefore higher in patients in impaired kidney function. Older adults are more likely to have reduced kidney function. Therefore, careful dosing is necessary, along with periodic monitoring of kidney function in older adults taking albuterol.  

Learn about Common Respiratory Illnesses In Children.

Albuterol Drug Interactions

Taking albuterol with certain other medications can affect how it works. Interactions with other drugs can also increase the risk of severe adverse effects. Your doctor may adjust your dose, switch you to a different medication, and/or monitor you carefully for albuterol side effects if there are known interactions with your other medications. 

Albuterol can interact with commonly prescribed medications used to treat high blood pressure (beta blockers), heart disease (digoxin), fluid retention (water pills or diuretics), severe allergic reactions (EpiPen), other bronchodilators, medications used to treat colds, and certain antidepressants.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medications, dietary supplements, and herbal remedies to avoid potentially dangerous interactions.

Minimizing the Risks: Techniques and Tips to Avoid Albuterol Side Effects

Proper Use of Albuterol Metered Aerosol Inhaler 

• Keep the mouthpiece of the inhaler covered with the dust cap when it’s not in use.

• You need to prime the inhaler by shaking it well and releasing 4 sprays into the air with the first use or if you use it after a gap of more than 2 weeks. 

• To use the inhaler, you should shake it well, breathe out as deeply as possible, place the mouthpiece in your mouth, tighten your lips around it, and press down on the pump to release the medicine while you inhale slowly. Hold your breath for around 10 seconds and breathe slowly after removing the device from your mouth. If your dose is 2 puffs, repeat the above steps after 1 minute.

• Keep your inhaler clean as recommended by the manufacturer.

Proper Use of Albuterol Powder with Respiclick Inhaler

• The Proair Respiclick inhaler should not be used with spacers.

• After you remove the foil packaging of a new inhaler, make sure that the number 200 is displayed in the dose counter window. 

• Open the protective dust cap only when you are ready to take a dose. This action reduces the dose counter by one. Opening the cap unnecessarily will result in wasted doses. 

• Hold the inhaler upright, upside down (with the bottom pointing up). Breathe out deeply. With the mouthpiece in place, tighten your lips around it and inhale slowly through your mouth. Make sure the vent on the mouthpiece is not blocked by your fingers or lips. Try to hold your breath for around 10 seconds. Then, remove the inhaler and resume normal breathing. Make sure you don’t blow into the inhaler. Replace the cap on the inhaler immediately.

• Read the manufacturer’s instructions on how to keep your inhaler clean with a clean, dry cloth or tissue. The inhaler should not be washed with water.

Don’t have an inhaler? Check out our blog, “What to Do for an Asthma Attack Without an Inhaler?”

Proper Use of Nebulized Albuterol

• Take a vial of the albuterol sulfate solution. After you remove the foil, make sure the liquid in the pouch is colorless and there are no visible floaters. 

• Remove the cap of the vial and squeeze the medicine into the reservoir of the nebulizer machine. Check with your pharmacist or doctor before mixing other nebulized medications and albuterol together.

• Sit upright in a comfortable position. After you connect the mouthpiece or mask to the nebulizer machine, place it in your mouth, start the machine, and breathe in slowly and deeply for 5-15 minutes. Stop when there is no more fine mist forming in the machine.

• The nebulizer should be cleaned periodically as recommended by the manufacturer.

Albuterol Dosing Precautions

Dose Adjustments, Missed Dose, and Stopping Treatment

Read the prescription label carefully and take albuterol exactly as prescribed. Do not change the dosage form, dose, or dosing frequency of albuterol without consulting with your healthcare provider. This will maximize clinical efficacy and lower your risk of side effects on albuterol. 

If you are using inhaled albuterol on a regular schedule and miss a dose, take it as soon as you remember it. But if it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not use extra medicine or a double dose to make up for a missed dose.

You should know that while albuterol can help to control COPD and asthma symptoms and reduce the frequency of asthma attacks, it does not cure these lung diseases. Do not stop using albuterol unless your healthcare provider tells you to.

How to Count Inhaled Albuterol Doses

Your inhaler may come with an attached counter to keep track of the inhalations you have used up. Call your doctor or pharmacist for a refill when you are about to run out. Do not fiddle with the counter on your inhaler in any way. 

If your inhaler does not have a counter, you will need to keep track of the inhalations you have used up manually. You can calculate how many days your inhaler will last by dividing the total number of inhalations in a new inhaler by the number of inhalations you typically use each day. Floating the inhaler canister in water is not a good way to tell if it contains enough medication.

The albuterol aerosol inhaler provides 60-200 inhalations and the albuterol powder inhaler provides 200 inhalations. Do not use the inhaler after you have used up the inhalations mentioned on the label, even if there is some medicine remaining in the canister. This remaining medicine will not contain the correct dose and could lead to worsening symptoms. 

Albuterol Overdose

In case of an overdose, call the National Poison Control Center at 1-800-222-1222. Call 911 if someone has collapsed, stopped responding, has trouble breathing, or has had a seizure. Symptoms of an albuterol overdose may include fast heartbeat, chest pain, seizures, headache, nervousness, uncontrolled shaking, nausea, tiredness, and insomnia. Find out 20 signs of an overdose to look for.

Storage and Disposal of Albuterol Inhalers

The albuterol powder inhaler should be discarded after you have used all the inhalations, after 13 months of opening the foil wrapper, or after the expiration date, whichever is the earliest.

The albuterol aerosol inhaler should be stored at room temperature. The aerosol canister should never be punctured or discarded in a fire or incinerator.

Store albuterol nebulizer solution in its original container, safely out of reach of children. Do not remove the unused vials of nebulizer solution from the foil pouch until they are to be used. The nebulizer solution vials can be stored at room temperature or in the refrigerator. Do not store them in the bathroom where they can be exposed to excess heat and moisture. 

Additional Precautions While Using Inhaled Albuterol Sulfate

• Do not use the inhaler that comes with the albuterol aerosol to inhale other medications. Do not use any other inhaler that came with other medications to inhale albuterol. 

• Avoid getting inhaled albuterol into your eyes.

• Do not use albuterol inhalers near flames or heat sources (this can make them explode). 

• Make sure you understand how to use the albuterol inhaler and how to prime it. If a child is using the device, observe them the first few times to ensure they are doing so correctly. 

The Importance of Regular Medical Check-Ups

Keep all your medical and laboratory appointments while using albuterol. Your doctor may want to adjust your dose or order certain lab tests while you are on this medicine. 

Call your healthcare professional for medical advice if albuterol side effects are severe or do not go away in a few days after your body adjusts to the medicine. Seek emergency medical care if you develop any of the serious side effects of albuterol (listed above).