5 Albuterol Interactions You Should Know About
Key takeaways:
Albuterol (ProAir, Ventolin, Proventil, Accuneb) is a prescription medication used to provide quick relief when asthma or chronic obstructive pulmonary disease (COPD) symptoms flare up.
Most people use albuterol as an inhaler or with a nebulizer. Others take it as an oral tablet or syrup. All forms can interact with other medications that you take.
Albuterol interactions often require medication changes or close monitoring. Be sure to check with your healthcare team on how best to manage these combinations.
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If you have asthma or chronic obstructive pulmonary disease (COPD), there’s a good chance you may have a rescue inhaler. The most commonly used rescue inhalers contain the medication albuterol (ProAir, Ventolin, Proventil, Accuneb). And they can come in handy for providing quick relief when your symptoms flare up.
Albuterol is usually inhaled using an inhaler or nebulizer machine. You may also see it as an oral tablet or syrup. No matter which form you use, albuterol can interact with other medications you’re taking. Sometimes, this can affect how well albuterol works to help you breathe. While this sounds serious, many interactions can be avoided or managed. Your healthcare team can help you avoid potentially dangerous interactions. So be sure to share your current medication list with them.
Below, we’ll discuss five albuterol interactions you should know.
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1. Beta blockers
Many medications work by either activating or blocking chemical binding sites (receptors) in your body. And sometimes, two medications can have opposite effects on the same receptor, causing an interaction. This is the case with albuterol and beta blockers.
Beta blockers are medications used to treat a variety of heart conditions. Examples include carvedilol (Coreg), labetalol (Trandate), and propranolol (Inderal). They typically work by blocking beta receptors in your heart and blood vessels. This helps to lower your heart rate and blood pressure.
Albuterol works by activating these beta receptors, primarily in your lungs. This causes the muscles around your airways to relax, which helps you breathe easier. But beta blockers can bind to these receptors and have an opposite effect. This can prevent albuterol from working as well. And in some cases, beta blockers may cause your airways to tighten (called a bronchospasm).
For this reason, beta blockers are typically avoided in people with certain breathing problems. But if you need to take one, there are some beta blockers that are more specific to your heart. Examples include atenolol (Tenormin) and metoprolol (Lopressor, Toprol XL). These options may be less likely to affect your airways.
Your prescriber will weigh the potential benefits and risks to determine whether you can take a beta blocker. And, if you’re prescribed this combination, they may ask you to watch closely for breathing problems.
2. Certain diuretics
Loop and thiazide diuretics are used to treat high blood pressure. Some are also used to treat edema (swelling) from medical conditions like heart failure. Examples of loop diuretics include furosemide (Lasix) and bumetanide (Bumex). Hydrochlorothiazide (Microzide) is an example of a thiazide diuretic.
Diuretics (water pills) help your kidneys remove excess water from your body. But loop and thiazide diuretics can cause your kidneys to get rid of potassium, too. Albuterol can also decrease the amount of potassium in your blood.
When taken together, your potassium levels may get too low (hypokalemia). Symptoms include muscle weakness, feeling tired, numbness, and irregular heartbeat.
If you’re taking a diuretic, your healthcare team is likely monitoring your potassium levels. They may need to watch you more closely when starting albuterol. Let them know if you start taking albuterol more frequently.
3. Digoxin
Digoxin (Lanoxin) is a medication used to treat heart failure and heart rhythm problems. It requires frequent monitoring to make sure your digoxin levels are within a safe and effective range. High levels can cause unwanted side effects. And low levels can prevent digoxin from working as well.
Albuterol can decrease digoxin levels in your blood. But the significance of this interaction isn’t clear. Still, it’s important to keep an eye on your digoxin levels during treatment. Your prescriber may need to adjust your dosage if your levels are too high or too low.
4. Tricyclic antidepressants
Tricyclic antidepressants (TCAs) are used to treat mental health conditions such as anxiety and depression. Some are also taken for insomnia. Examples of TCAs include amitriptyline, nortriptyline (Pamelor), and doxepin (Silenor).
But TCAs can cause serious heart rhythm problems, including QT prolongation, which can cause an abnormal heartbeat. Albuterol has the potential to do this too. So, this combination can cause dangerous changes in your heart rate, heart rhythm, and blood pressure.
Because of this, extreme caution is recommended if you have to use albuterol while taking a TCA. The risk even extends for 2 weeks after stopping a TCA.
If you’re currently being treated with a TCA and albuterol, watch for symptoms of QT prolongation. Call 911 if you feel like you’re about to faint. Seek immediate medical help if you have:
Palpitations or chest pain
Weakness
Lightheadedness
Vision changes
There are other antidepressants that may be less likely to interact with albuterol. Your prescriber may recommend a safer alternative.
5. Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOIs) are an older class of antidepressants. They’re used to treat depression and manage symptoms of Parkinson’s disease. Examples include selegiline (Zelapar) and phenelzine (Nardil).
Just like TCAs, MAOIs can cause heart rate and blood pressure changes. The same caution should be used when combining albuterol and an MAOI. And that continues for 2 weeks after stopping an MAOI.
Your healthcare team may monitor your heart function more closely. They may also discuss treatment alternatives to avoid these risks.
Frequently asked questions about albuterol interactions
You may have other concerns about whether it’s safe to take other medication with albuterol. Below, we answer a few frequently asked questions about albuterol interactions.
Yes, it’s generally OK to use an albuterol inhaler while taking Benadryl (diphenhydramine) or other antihistamines. In fact, some people have allergic asthma that can benefit from both medications. In this case, something you’re allergic to may trigger an asthma attack. So a rescue inhaler and an antihistamine can be a common combination.
Yes. It’s safe to use albuterol and budesonide (an inhaled steroid) together. For convenience, they’re available in a combination inhaler for asthma called Airsupra.
Albuterol isn’t known to directly interact with cough medicines such as guaifenesin (Mucinex) or dextromethorphan (Robitussin, Delsym). But it’s good to keep in mind that these ingredients are often included in combination cold and flu products.
Be sure to read the cough medicine label, since it may contain other ingredients that can interact with albuterol. For example, pseudoephedrine (Sudafed) may worsen certain albuterol side effects, such as increased heart rate, tremors, and anxiety.
The bottom line
Albuterol (ProAir, Ventolin, Proventil, Accuneb) is commonly used to help provide quick relief for breathing conditions like asthma and chronic obstructive pulmonary disease (COPD). Even though many people use an inhaled version, it can still interact with other medications. With some albuterol interactions, your albuterol may not work as well to relieve your symptoms.
Always report medication changes to your healthcare team. You should also watch out for changes in how well your medications work. It’s also important to monitor for unusual or worsening side effects. If you notice any of these changes or effects, contact your healthcare team.
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References
Ajimura, C. M., et al. (2018). Drug interactions with oral inhaled medications. Journal of Pharmacy Technology.
Johnson, D. B., et al. (2024). Albuterol. StatPearls.
Li, M., et al. (2017). Drug-induced QT prolongation and torsades de pointes. Pharmacy and Therapeutics.
Prasco Laboratories. (2024). Albuterol sulfate HFA [package insert]. DailyMed.
Tucker, W. D., et al. (2022). Selective beta-1 blockers. StatPearls.
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