Albuterol

Albuterol is a drug used to treat coughing, wheezing and difficulty breathing in people who suffer from conditions such as asthma.

Overview

When you breathe in, air travels through your mouth or nose and down the trachea (windpipe). The end of the trachea branches off into two passageways, each leading into one of your lungs. These are known as the bronchial tubes.

In people with certain medical conditions such as asthma, the air does not flow freely through the bronchial tubes. This may be due to inflammation, or because the muscles around the bronchial tubes are contracted. As a result, such people may experience breathing problems such as wheezing, shortness of breath, or coughing fits. In extreme cases, such as an asthma attack, the bronchial tubes can become so constricted that they block the flow of air completely, which can be fatal.

Albuterol, which is also known as salbutamol or Ventolin, belongs to a class of drugs known as adrenergic bronchodilators. These drugs relax the smooth muscle around the bronchial tubes, and in doing so they widen, or “dilate”, the airways. This allows the air to pass through more easily and relieves the breathing difficulties.

When delivered orally, albuterol does not take immediate effect and so it is not suitable to treat attacks of breathing difficulties. The purpose of oral albuterol is to make these attacks less likely to occur, and to help patients breathe more easily throughout the day.

Conditions Treated

  • Asthma
  • Breathing problems
  • Bronchospasm
  • Chronic obstructive pulmonary disease
  • Exercise-induced bronchoconstriction
  • Acute hyperkalemia

Type of medicine

  • Adrenergic bronchodilator
  • Sympathomimetic
  • Beta-2-agonist

Side Effects

Albuterol is generally well-tolerated - in fact, it is listed on the World Health Organization's List of Essential Medicines. Most people will not experience any side effects of the drug, and for those that do, the side effects often wear off after a short period of time. However, if you experience any of the side effects on the lists below, you should seek medical attention immediately:

More Common Side-Effects

  • A fast or pounding heartbeat
  • Pain or tightness in the chest area
  • An irregular heartbeat
  • Any problem with breathing, or a worsening of your asthma symptoms
  • Sudden wheezing
  • Coughing
  • High blood pressure

Less Common Side-Effects

  • Fainting, loss of consciousness, or lightheadedness
  • Convulsions, muscle spasms or body jerking
  • Pain, including muscle pain and headaches
  • Mental changes, including mood changes, irritability, anxiety, confusion hallucinations, or nightmares
  • Nausea or vomiting
  • Numbness or tingling
  • Decreased urine, dry mouth, higher level of thirst than usual

Allergic Reactions

Allergic reactions to albuterol are very rare, however, they do occur in some people. You should seek medical attention immediately if you notice any of the symptoms that are usually associated with allergic reactions. These include:

  • A rash, hives, or redness of the skin
  • Itching or swelling, particularly when this is located in the face, throat or tongue
  • Dizziness
  • Difficulty breathing
  • Difficulty swallowing

Less Serious Side Effects

As with all medications, side effects are difficult to predict on an individual basis. You may experience minor side effects that are just a consequence of your body adapting to the medication, and they may clear up over time. Furthermore, different people may experience entirely different side effects depending on their individual biology, genetics, demographics, or interactions with other medication they may be taking.

If you notice any unusual or bothersome side effects while taking albuterol, even if not listed above, seek advice from your doctor or pharmacist. They may be able to offer advice on preventing or reducing the side effects, and can monitor you to ensure that they do not develop into something more serious.

Dosage

Because the effects of oral Albuterol last around six hours, it is typically taken three to four times each day, at regularly-spaced intervals. You will usually start with a fairly low dose which will build up gradually over time. This allows the body to adapt to the drug and hopefully prevent any serious side-effects from occurring. Typical dosing regimes are as follows:

Children younger than 2 years: albuterol is not recommended for this age group.

Children aged between 2 and 5 years: a starting dose of 0.1 mg per kg of body weight, three times daily. This may increase gradually to 0.2 mg per kg of body weight, three times a day. The maximum daily dose is 12 mg.

Children aged between 6 and 12 years: a starting dose of 2 mg up to four times a day. This may increase to 6 mg four times a day. The maximum daily dose is 24 mg.

Children aged 13+ years and adults: an initial dose of 2-4 mg up to four times a day, which increases gradually up to 8 mg four times a day. The maximum daily dose is 32mg.

Elderly individuals: an initial dose of 2 mg up to four times daily, which may gradually increase to 8 mg four times a day. The maximum daily dose is 32 mg.

It is important to note that these are only guidelines, and your doctor will prescribe a dosage of albuterol that is unique to you, based on the severity of your condition along with other factors such as your demographics, medical history, and other medications you might have taken. Always take your medication as directed by your doctor.

If you have been given albuterol in syrup form, be sure to use the measuring instrument provided to you rather than using a household spoon or other method of estimation. This will ensure that you are taking the correct dose.

If you miss one of your scheduled daily doses, take it as soon as you can. An exception to this is when you are approaching the time of your next dosage. In this case, just continue on with your dosing schedule as normal. Do not double dose when you forget to take the medication - doing so will not provide any additional benefit and may be harmful to you.

Interactions

Albuterol is known to interact with several other medications in ways that can be harmful to you. Always discuss any other medication you are taking with your doctor, including over-the-counter remedies and medications. You should also contact your doctor or pharmacist for further advice before you take any of the medications listed below at the same time as you are taking albuterol:

Sympathomimetics

Albuterol should not be taken at the same time as other sympathomimetic drugs unless you have been told to do so by your doctor. The overuse of this type of drug can have negative effects on the cardiovascular system. One common exception is the concurrent use of an inhaled bronchodilator which may be prescribed to you to keep on your person and use if you experience an attack of difficult breathing. If you are given an inhaler, use it only as directed by your doctor.

Monoamine Oxidase Inhibitors

This type of drug, also referred to as an MOI, is used in the treatment of depression. These drugs are not widely used in the present day, largely because they interact in negative ways with many other drugs, including albuterol. If you have previously taken MOIs, it is recommended that you wait at least 14 days from the last day you took the MOI before you begin using albuterol.

Tricyclic Antidepressants

The advice for tricyclic antidepressants, also called TCAs, is the same as for MOIs. They should not be taken with albuterol, and you should wait for at least 14 days after stopping TCAs before you take your albuterol. TCAs and MOIs greatly increase albuterol’s effects on the cardiovascular system, which can cause problems with the heart, circulation, and blood pressure.

Beta-Blockers

Albuterol is a “beta-agonist.” This refers to the type of receptor in your body that the drug attaches to. When albuterol attaches to this receptor, this triggers the muscles in the bronchial tubes and other locations to relax. A “beta-blocker,” as the name implies, blocks these receptors, which prevents albuterol from attaching to them. Therefore beta-blockers will generally cancel out the effects of the albuterol. In addition, beta-blockers can also make breathing problems worse. For these reasons, beta-blockers are not recommended for use in people who are taking albuterol.

Nonpotassium-Sparing Diuretics

If you take nonpotassium-sparing diuretics, your body will excrete fluid at a higher rate than normal, and the level of potassium in the blood will drop. Albuterol also removes potassium from the blood -- in fact, albuterol is sometimes prescribed to people with hyperkalemia (excessively high blood potassium levels). Therefore, taking albuterol at the same time as nonpotassium-sparing diuretics will lower potassium levels much further than usual, which can be harmful. If this is the case, your doctor may want to monitor your potassium levels and perform other checks, such as tests of kidney function, to make sure no adverse effects are taking place.

Warnings

Albuterol, when administered orally through tablets or syrup, does not take effect on the airways straight away. This means it is not suitable to relieve sudden and intense breathing difficulties, such as an asthma attack.

If your condition makes you susceptible to such attacks, your doctor will likely prescribe an inhaler, which may contain albuterol or another drug in the same family. These inhalers deliver the drug directly to the bronchial tubes, and are better suited to deal with sudden attacks.

Do not change the dose or frequency at which you take albuterol without first consulting with your doctor. Taking a higher dose than recommended can potentially lead to cardiovascular problems, while taking a lower dose may mean that your symptoms are not being adequately relieved. If you are prescribed other medications, including inhaled drugs, be sure to only use these as prescribed by your doctor.

In some people, albuterol can cause side-effects including minor dizziness or drowsiness. This often occurs for only a short period, as the body adapts to the medication, and is not experienced by all patients. Do not drive or operate heavy machinery after you start taking albuterol until you are sure that you can do so safely.

If you are pregnant or become pregnant while you are taking albuterol, consult your doctor for further advice. Your dosing schedule may have to be altered, or you may have to switch to a different medication. It is also unclear whether albuterol can be safely taken by women who are breastfeeding -- consult your doctor before proceeding.

Storage

How you store your medication can affect its potency. Follow the guidelines below to safely store your albuterol medication.

Avoid heat: as with most oral medications, you should store albuterol in a sealed container at room temperature. Store your medications away from sources of heat such as heaters, radiators and ovens. It is also not advisable to store your medication in a cabinet in your bathroom, as the heat from the sink and shower can affect the medicine. The glove compartment of your car can also become too hot to store medicines. You should also keep the medication away from direct sunlight.

Avoid cold: do not refrigerate or freeze your medicine -- doing so will not increase their lifespan and may be damaging to the medication.

Avoid moisture: Store your albuterol medication in a dry location. This is another reason that the bathroom cabinet is not ideal. If you are taking albuterol tablets and the bottle contains a cotton ball, take it out as this can bring moisture into the bottle.

Keep away from children: Always keep medication out of the reach of children, and ideally inside a container with a childproof lock on it.

Inspect the medication before you take it. If it appears to be damaged - for example, if it has changed color or smell, or if the tablets are cracked or stuck together - do not take it. This applies even if the medication is still within the expiration date.

If the medication has passed its expiration date, do not take it. Consult your doctor, pharmacist or local authority for instructions on how to safely dispose of any expired or unused medicine.

Summary

Oral albuterol is a medicine given in tablet or syrup form that opens up the airways in the lungs. It is widely used as a treatment for asthma, asthma attacks, exercise-induced bronchoconstriction, and chronic obstructive pulmonary disease, among other problems with the breathing.

Orally-administered albuterol does not provide instant relief and is not suitable as an instant treatment in the case of an asthma attack or other sudden onset breathing problems. Patients are given inhalers containing albuterol or a similar medication for this purpose. However continued oral administration serves to keep the airways in the lungs dilated throughout the day, making such attacks less likely to occur. Oral albuterol’s effects typically last for around six hours, and for this reason, patients will often take their medication three to four times throughout each day.

Albuterol is generally very well tolerated, as noted by its inclusion in the World Health Organization's (WHO) List of Essential Medicines. However, side effects are experienced by some people, most commonly relating to cardiovascular function, such as pain in the chest, high blood pressure, or irregular heartbeat. Furthermore, albuterol can be dangerous when combined with certain other medications, including monoamine oxidase inhibitors, tricyclic antidepressants, beta-blockers, and nonpotassium-sparing diuretics. Albuterol is generally not used in conjunction with these medicines, or at the very least would be done so with caution and with close monitoring by a doctor or other healthcare professional.

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