Albuterol

What is albuterol?

Albuterol is a bronchodilator. It works by stimulating beta2-adrenergic receptors in the lungs. This activates an enzyme that relaxes the smooth muscle surrounding the airways that causes the bronchospasm. This opens the airways, allowing for increased airflow and improved symptoms.¹

What is albuterol used to treat?

Albuterol is approved by the US Food and Drug Administration (FDA) for the treatment of bronchospasm, a reversible condition that results in wheezing and shortness of breath. Bronchospasm is caused by asthma, emphysema, chronic obstructive pulmonary disease (COPD), and other obstructive lung conditions.²

What You Need To Know About Asthma

The drug is also used to treat or prevent bronchospasm caused by exercise. This is often referred to as exercise-induced asthma.

Age indications depend on the formulation being given. Generally, metered-dose inhalers are used in children aged four years and older. Most younger children are unable to get accurate dosing with them.

Nebulized formulations are approved for children aged two years and older but are frequently administered off-label in younger children and infants. An off-label use is not FDA-approved.³

The tablet and syrup forms are not often prescribed for children, but their age indications are also based on the formulation used.

Albuterol is sometimes used to treat hyperkalemia (too much potassium in the blood) when other therapies have failed to resolve it. This is another off-label use.⁴

Dosage forms and strengths

Albuterol is usually administered as an inhaled aerosolized liquid using a nebulizer or metered-dose inhaler.

It can also be taken using a powder inhaler.

The dose per inhaler activation is typically 90 mcg.

An inhaler contains a limited number of doses. Do not use it once those doses are exhausted, even if it still contains medication. This is because it may not provide the appropriate amount of the drug.

The drug is also formulated for oral administration as a tablet, an extended-release tablet, and an oral solution.

Available dosage forms

Here are the available dosage forms of albuterol:⁵

• Tablet (generic): 2mg, 4mg⁶

• Extended-release tablet (generic): 4mg, 8mg

• Oral solution/syrup (generic): 2mg/5mL

• Aerosol metered-dose inhaler (generic, Proventil HFA, ProAir HFA, Ventolin HFA): 90mcg/actuation⁷ ⁸ ⁹ ¹⁰

• Powder metered-dose inhaler (ProAir Digihaler, ProAir RespiClick): 90mcg/actuation¹¹ ¹²

• Nebulization solution (generic):¹³

  • (0.021%): 0.63mg/3mL

  • (0.42%): 1.25mg/3mL

  • (0.083%): 2.5mg/3mL

  • (0.5%): 5mg/mL

How do you take albuterol?

Albuterol is given in different formulations depending on the condition being treated.

Tablets, extended-release tablets, and syrup

Follow your doctor’s instructions carefully. Take the medicine exactly as directed at the same time each day.

The recommended dosing schedule for the tablets and syrup is 3–4 doses per day.¹⁴

The extended-release tablets are usually taken once every 12 hours. Do not split, crush, or chew the extended-release tablets. Swallow them whole with water or another liquid.¹⁵

Inhaler

Albuterol is taken by inhalation for acute bronchospasm, either by using an inhaler or a nebulizer.

Upon improvement or when taken at home for mild bronchospasm, albuterol is usually inhaled every 2–4 hours as directed by your doctor. Some patients are prescribed a regular daily dose, such as 3–4 times a day, along with other medications for asthma or COPD.

If albuterol is prescribed for the control of exercise-induced bronchospasm, a dose is taken 5–30 minutes before exercising.

An aerosol-metered dose inhaler features a dose indicator, canister, and actuator. The dose indicator tells you how many puffs of medicine remain in the inhaler. A puff of medicine is released when you press the center of the dose indicator.

Store the inhaler with the mouthpiece pointing downward at room temperature (20–25°C or 68–77°F).

Priming the inhaler

Prime a new albuterol canister before using it for the first time.

The following are instructions for priming your inhaler:¹⁶

1. Check that the pointer on the dose indicator is pointing to the right of the inhalation label that says “200”.

2. Remove the cap from the mouthpiece and check inside for objects.

3. Check that the canister is fully inserted into the actuator.

4. Shake the inhaler well, holding it upright and away from your face.

5. Release a spray of medicine by pressing down fully on the center of the dose indicator.

6. Repeat the previous steps a further three times to release a total of four sprays.

7. After you have completed these steps, the dose indicator should point toward 200. This means the canister contains 200 puffs of medicine.

Reprime your inhaler before use if you haven’t used it for more than two weeks.

Using the inhaler

1. Carry out steps 2, 3, and 4 from the priming procedure.

2. Breathe out from your mouth as much as you can.

3. Hold the inhaler upright with the mouthpiece at the bottom and pointing toward you. Put the mouthpiece in your mouth and make sure your lips are closed around the mouthpiece to prevent air from escaping.

4. Breathe in slowly and deeply while pressing down once on the center of the dose indicator with your index finger. You can release your finger after the dose indicator has stopped moving and a puff of medicine has been released.

5. Hold your breath for up to ten seconds, remove the inhaler from your mouth, and breathe out.

6. If you need to take another puff, wait for one minute and then repeat steps 2, 3, 4, and 5.

7. Replace the cap after use.

Albuterol administration via an inhaler requires a certain amount of coordination to ensure an effective dose is delivered into the lungs (and not just the mouth). A spacer is often used to optimize this process, especially for children. Ask your doctor if a spacer could help you or your child.

Additionally, when the drug is administered to younger children (i.e., those aged 4–6 years), a face mask should be attached to the mouthpiece to keep the medication from escaping.

Nebulizer solution

Nebulized albuterol treatments can be given at home or administered in the emergency department for asthma or COPD exacerbations. They can be given continuously for very severe episodes or with a specified frequency (such as every 20 minutes or every 1–2 hours) for more moderate exacerbations.

Seeing results

Albuterol typically works quickly, with an onset of action of 25 minutes to two hours, depending on the formulation used.¹⁷

Its duration of action lasts around 4–6 hours to control the symptoms of bronchospasm.

You may need to take it more frequently when experiencing an exacerbation or worsening of symptoms due to an allergen, infection, or inflammatory process. In these cases, it may take longer to begin seeing an effect.

However, albuterol is not a curative treatment, and it’s important to follow your doctor’s instructions for daily use and for exacerbations. You should talk to your doctor if your symptoms worsen, even when taking the doses as prescribed.

Who should not take albuterol?

You should not take albuterol if you have had an allergic reaction or intolerance to albuterol or a similar drug in the past.

People with a severe milk allergy should not use the powdered form of the drug.

Patients with the following conditions should take albuterol with caution:¹⁸

• Cardiovascular disease

• Heart failure

• High blood pressure

• Cardiac arrhythmias

• Diabetes

• Seizure disorder

• Hyperthyroidism

• Kidney disease

• Glaucoma

• Use of tricyclic antidepressants or monoamine oxidase inhibitors within the past two weeks

• Low potassium levels or taking medications causing low potassium

• Pregnant or planning a pregnancy

• Breastfeeding or planning to breastfeed

Potential side effects of albuterol

Albuterol has been known to have the following adverse effects:

Common side effects

The most common adverse effects reported by people taking albuterol include any of the following:¹⁹

• Nervousness

• Tremors, shakiness

• Headache

• Cough

• Nausea and/or vomiting

• Changes in appetite

• Throat irritation

• Increased heart rate

• Muscle, bone, or back pain

• Muscle cramps

• Insomnia

• Dry mouth

• Hyperactivity

Severe side effects

While the following adverse effects are uncommon, they have been reported and can be serious:

• Chest pain

• Palpitations or irregular heartbeat

• Rash, itching, or hives

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

• Difficulty breathing or swallowing

• Low potassium levels

Rare side effects

In a few individuals, wheezing and difficulty breathing may occur immediately after taking albuterol. You should call your doctor immediately if this happens. Call your doctor if you experience any unusual symptoms after taking albuterol.

When to seek medical attention

Call your doctor or 911 if you experience any of the potentially severe side effects listed above.

If you have wheezing and breathing difficulties immediately after taking albuterol, seek medical attention and do not take albuterol again without talking to your doctor.

Overdose

It’s possible to overdose on albuterol. However, inhalers and nebulizers are designed to deliver metered doses to help prevent this.

Most overdoses are caused by doubling up on a dose or taking more medication than prescribed because of increased symptoms.

The typical symptoms of an overdose include any of the following:²⁰

• Headache

• Tremors

• Seizures

• Chest pain

• Fast or irregular heartbeat

• Nervousness

• Dry mouth

• Vertigo

• Nausea, vomiting

• Fatigue and lack of energy

• Difficulty falling or staying asleep

If you are concerned that you or somebody else might have overdosed on albuterol, call the National Poison Control helpline at 1-800-222-1222. If the person has very severe symptoms, has collapsed, lost consciousness, or is having seizures, call 911.

Allergy information

It is possible to be allergic to albuterol. Signs of an allergic reaction may include any of the following:²¹

• Rashes

• Hives

• Vomiting

• Increased wheezing or other respiratory symptoms

• Swelling of the tongue, lips, or face

• Loss of consciousness.

If you have any symptoms of an allergic reaction to albuterol, stop taking it and talk to your doctor. If you have a severe allergic reaction, call 911 or go to the nearest emergency department.

The powder formulation used in powder-based inhalers contains milk products, which can also cause an allergic reaction in individuals who are severely allergic to milk proteins. When discussing albuterol with your doctor, tell them if you are allergic to milk or have any medication allergies.

Long-term use of albuterol

Albuterol is typically prescribed for long periods to control persistent or recurring symptoms. The drug is considered safe for long-term use.

Speak to your doctor if you notice that your medication is less effective for easing your symptoms, your symptoms have worsened, and/or you are using the medication more often than usual.

Pregnancy category

Albuterol has been designated a pregnancy category C medication by the FDA. This means the risks of taking the drug while pregnant cannot be ruled out. There is no adequate human research to demonstrate the safety of albuterol during pregnancy, but animal studies have shown potential risks. In some cases, the benefits of taking the drug may outweigh the risks.²²

Albuterol and pregnancy

Experiments in mice showed an increased risk of cleft palate. However, human studies have not shown an increased risk to the fetus directly related to inhaled albuterol use during pregnancy.²³ ²⁴

The risk of uncontrolled asthma to you and your baby is higher, and albuterol may be needed to control your condition. However, you should not take albuterol while in labor as the drug can interfere with your uterus’ ability to contract.²⁵

Albuterol and breastfeeding

There have been no studies on the risk of breastfeeding while using albuterol. Because the drug is usually taken by inhalation, the amount likely to pass to the baby through breast milk is small. In most cases, breastfeeding will still be recommended after weighing the risks and benefits, but you should talk to your doctor to be sure of the best course of action in your case.²⁶

Missed doses

Take your missed dose as soon as you remember. If it’s close to the time when you need to take your next dose, skip it and take your next dose on schedule. Never take an extra dose to make up for a missed dose.

Drug interactions

Albuterol has been shown to interact with various medications. The following is a list of some of the more common drugs with known interactions:²⁷ ²⁸

• Any other bronchodilator, such as terbutaline, levalbuterol (Xopenex HFA), and salmeterol (Serevent Diskus)

• Attention-deficit/hyperactivity disorder drugs, such as dexmethylphenidate (Focalin), methylphenidate (Ritalin, Concerta, and others), dextroamphetamine (ProCentra), and other stimulants

• Antibiotics, such as linezolid (Zyvox)

• Chemotherapy drugs, such as procarbazine (Matulane), trastuzumab (Herceptin), and ibrutinib (Imbruvica)

• Digoxin (Lanoxin)

• Diuretics, such as furosemide (Lasix)

• Blood pressure medications

  • Angiotensin-converting enzyme inhibitors like benazepril (Lotensin) and enalapril (Vasotec)

  • Beta-blockers, such as atenolol (Tenormin), metoprolol (Toprol-XL), and propranolol (InnoPran XL)

  • Calcium channel blockers like verapamil (Verelan) and diltiazem (Cardizem)

• Epinephrine (EpiPen, Primatene Mist)

• Cold medications and decongestants like oxymetazoline nasal (Afrin) and phenylephrine (Sudafed PE)

• Immune system modulators, such as ozanimod (Zeposia) and tacrolimus (Prograf)

• Antidepressants

  • Tricyclics, such as amitriptyline, amoxapine, and clomipramine (Anafranil)

  • Monoamine oxidase inhibitors (MAOIs) like phenelzine (Nardil) and tranylcypromine (Parnate)

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as celecoxib (Celebrex), naproxen (Naprosyn), diclofenac (Zorvolex), and meloxicam (Mobic)

• Drugs for Parkinson’s disease, such as rasagiline (Azilect), safinamide (Xadago), and selegiline (Zelapar)

• Diabetes medications like glyburide, glipizide (Glucotrol XL), metformin (Riomet), and insulin

• Recreational drugs like cocaine

• Caffeine

Can I drink alcohol while taking albuterol?

Albuterol is not labeled as interacting with alcohol, but you should talk to your doctor. Bear in mind that alcohol can increase asthma symptoms in some people.

What to discuss with your doctor before starting albuterol

Make sure to tell your doctor about the following before you start taking albuterol:²⁹

• Your medical history, including health concerns such as heart disease, arrhythmias, diabetes, seizures, high blood pressure, kidney disease, glaucoma, and thyroid disease

• All of your prescription and over-the-counter drugs, supplements, and herbal preparations (or if you have taken MAOIs or tricyclic antidepressants within the last two weeks)

• Any allergies to medications or milk protein

• Any previous reactions you’ve had to medicines like albuterol

• Any history of low potassium levels

• If you are pregnant, planning a pregnancy, or breastfeeding

Stopping albuterol

Albuterol is not an addictive medication. You won’t experience withdrawal symptoms if you stop taking it. However, your asthma symptoms may return along with any potential complications.

You should not stop taking albuterol without consulting your doctor.

Drug approval history

Albuterol was first approved in the US in 1981.³⁰

Tips for taking albuterol

• Take albuterol exactly as prescribed by your doctor. Do not take it more frequently than recommended. Call your doctor if your prescribed dose does not control your symptoms.

• If giving albuterol to a child, make sure they know exactly how to use their inhaler. A spacer and mask should be used for young children. Children should use albuterol inhalers and nebulizers with adult supervision.

• Have someone show you how to get a good dose from your inhaler.

• Prime your inhaler upon first use or if you haven’t used it for two weeks or longer. The instructions for doing this will be included in the patient information that came with your prescription.

• Shake the inhaler before each use.

• Keep the mouthpiece of your inhaler or nebulizer clean. Do not immerse your inhaler in water.

• Do not use an inhaler that indicates there are no doses left or if you have used all the doses the label indicates.

• Do not use parts of another inhaler with your own. The parts will not be compatible.

• Be careful not to get the medication in your eyes.

• Do not use your inhaler near an open fire or source of intense heat.

• Store your albuterol inhaler at room temperature with the mouthpiece down and out of reach of children.

Frequently asked questions

Is albuterol a steroid?

No, albuterol is not a steroid — although you may be prescribed a corticosteroid to use alongside your inhaler to prevent the inflammation causing your condition.

It’s important not to mix the two. The steroid inhaler is not a rescue medication like albuterol, which is taken for symptoms.

Will albuterol help a cough?

Albuterol reduces coughing in people with reversible bronchospasm, typically seen in allergic or chronic obstructive lung disease. It will not help with coughs caused by colds or infections, unless you also have an underlying condition causing bronchospasm. You should not let somebody with a cough use your inhaler.

What is albuterol used for?

Albuterol is used to control, but not cure, coughing, wheezing, shortness of breath, and other symptoms caused by bronchospasm from allergic or chronic obstructive lung disease. It is also used to prevent and control wheezing during exercise.