Use albuterol with caution in patients with cardiovascular disorders, including ischemic cardiac disease (coronary artery disease), hypertension, cardiac arrhythmias, tachycardia, or QT prolongation. [31823] [43674] [49951] [59350] [64470] Geriatric patients may be more sensitive to the side effects of inhaled and systemic beta-agonists, especially tremor and tachycardia. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with citalopram include the beta-agonists. This drug is available at a higher level co-pay. Close observation for such effects is prudent, particularly if beta-2 agonists are administered during or within 2 weeks of use of an MAOI. 2 to 4 mg PO every 6 to 8 hours. Norepinephrine: (Major) Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia. Stimulation of beta2-receptors on peripheral vascular smooth muscle can cause vasodilation and a modest decrease in diastolic blood pressure. Mirtazapine: (Minor) There may be an increased risk for QT prolongation and torsade de pointes (TdP) during concurrent use of mirtazapine and short-acting beta-agonists. Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. Short-acting beta-2-agonists are the therapy of choice for the treatment of acute asthma symptoms. 2mg; 4mg; tablet, extended release. This risk may be more clinically significant with long-acting beta-agonists as compared to short-acting beta-agonists. It contains a microcrystalline suspension of albuterol sulfate in propellant HFA-134a (1,1,1,2-tetrafluoroethane), ethanol, and oleic acid. Inhaled bronchodilators are preferred over oral bronchodilators for the management of COPD. Dihydrocodeine; Guaifenesin; Pseudoephedrine: (Moderate) Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Risk for QT prolongation increases with increased dosage, and a 32 mg IV dose must no longer be used for prevention of chemotherapy induced emesis. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. This risk may be more clinically significant with long-acting beta-agonists as compared to short-acting beta-agonists. Albuterol 0.083% Inhalation Solutionis a bronchodilator used to treat or prevent the symptoms of asthma, … Phenelzine: (Major) Beta-agonists should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors (MAOIs) due to their sympathomimetic effects. Primaquine is associated with QT prolongation. Diphenhydramine; Phenylephrine: (Moderate) Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. ProAir Digihaler includes a built-in electronic module. Sertraline: (Minor) Use caution and monitor patients for QT prolongation when administering short-acting beta-agonists with sertraline. Disopyramide administration is associated with QT prolongation and torsade de pointes (TdP). Erythromycin: (Minor) Erythromycin administration is associated with QT prolongation and torsade de pointes (TdP). The cardiovascular effects of beta-agonists may be potentiated by concomitant use of MAOIs. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia. Drugs with a possible risk for QT prolongation that should be used cautiously and with close monitoring with voriconazole include the beta-agonists. Your list will be saved and can be edited at any time. Caution is advised when loop diuretics are coadministered with high doses of beta agonists; potassium levels may need to be monitored. Strength: EQ 0.090 mg Base/Inh . Clozapine: (Minor) Treatment with clozapine has been associated with QT prolongation, torsade de pointes (TdP), cardiac arrest, and sudden death. Amphetamine; Dextroamphetamine: (Moderate) Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. After the first hour, the dose required may vary from 4 to 10 puffs every 3 to 4 hours up to 6 to 10 puffs every 1 to 2 hours, or more often. Specific guidelines for dosage adjustments in renal impairment are not available. Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. Beta-agonists and beta-blockers are pharmacologic opposites, and will counteract each other to some extent when given concomitantly, especially when non-cardioselective beta blockers are used. Hydrochlorothiazide, HCTZ; Metoprolol: (Moderate) Use of a beta-1-selective (cardioselective) beta blocker is recommended whenever possible when this combination of drugs must be used together. Entrectinib has been associated with QT prolongation. Recommended Studies: In vitro and in vivo studies. Inhalation therapy with magnesium sulfate and salbutamol sulfate was applied to two groups, each consisting of 20 patients with acute asthma. Beta-agonists may also be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. Caution may be warranted during the administration of high doses in patients with renal impairment, as renal clearance is reduced. If concomitant drug use is unavoidable, frequently monitor electrocardiograms. Although there are no studies examining the effects of ranolazine in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation. Although QT interval prolongation has not been reported with gemtuzumab, it has been reported with other drugs that contain calicheamicin. Asthma may deteriorate acutely over a period of hours or chronically over several days or weeks. At least one case of hypertension occurred in a patient with previous episodes of high blood pressure who was receiving albuterol and selegiline, a selective MAOI related to rasagiline, concurrently. Bedaquiline has been reported to prolong the QT interval. Desipramine: (Minor) Tricyclic antidepressants (TCAs) share pharmacologic properties similar to the Class IA antiarrhythmic agents and may prolong the QT interval, particularly in overdose or with higher-dose prescription therapy (elevated serum concentrations). Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: (Moderate) Sensitive patients may wish to limit or avoid excessive caffeine intake from foods, beverages, dietary supplements and medications during therapy with beta-agonists. Trazodone: (Minor) Trazodone can prolong the QT/QTc interval at therapeutic doses. Higher maximum dosages for inhalation products have been recommended in NAEPP guidelines for acute exacerbations of asthma.13 to 14 years: 24 mg/day PO for syrup; 32 mg/day PO for tablets; FDA-approved labeling for inhaler recommends not exceeding 12 puffs/day; FDA-approved labeling for nebulizer solution for oral inhalation recommends not exceeding 4 doses/day or 10 mg/day (0.083% or 0.5% nebulizer solution), 2.5 mg/day (0.63 mg/3 mL nebulizer solution), and 5 mg/day (1.25 mg/3 mL nebulizer solution). 1 to 2 puffs/dose administered via inspiratory limb of the mechanical ventilator circuit appear to improve pulmonary mechanics in ventilator-dependent neonates. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia. According to FDA-approved labeling, initial dosing for albuterol 0.5% solution is 0.1 to 0.15 mg/kg/dose, with subsequent dosing titrated to achieve desired clinical response. Methadone: (Minor) The need to coadminister methadone with drugs known to prolong the QT interval should be done with extreme caution and a careful assessment of treatment risks versus benefits. 4 to 8 mg PO every 12 hours (Maximum: 32 mg/day PO). The dose counter only displays even numbers (example: 200, 198, 196, etc.) Some people may only need 1 inhalation every 4 hours. After oral inhalation, 80% to 100% of a dose is excreted via the kidneys within 72 hours; up to 10% may be eliminated in feces.[31823][49951][59350]. [59350] [64470] Inhalation solution for nebulizationFor a 2.5 mg dose of albuterol, dilute 0.5 mL of a 0.5% solution for nebulization to a final volume of 3 mL with 0.9% Sodium Chloride Solution or use 3 mL of the commercially available 0.083% solution for nebulization. Deutetrabenazine: (Minor) For patients taking a deutetrabenazine dosage more than 24 mg/day with a short-acting beta-agonist, assess the QTc interval before and after increasing the dosage of either medication. Sunitinib can cause dose-dependent QT prolongation. 90mcg (base)/actuation (equivalent to 108mcg albuterol sulfate) Powder metered-dose albuterol inhaler. Hydroxychloroquine increases the QT interval and should not be administered with other drugs known to prolong the QT interval. Beta-agonists can sometimes increase heart rate or have other cardiovascular effects, particularly when used in high doses or if hypokalemia is present. The effects of beta-agonists can be reduced with concurrent use of sotalol, which is a non-selective beta-blocker. Monitor the patients lung and cardiovascular status closely. In mature rats the subcutaneous (sc) median lethal dose of albuterol sulfate is approximately 450 mg/kg (approximately 110 times the maximum recommended daily oral dose for adults and … Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. If paradoxical bronchospasm occurs, albuterol should be discontinued immediately and alternative therapy instituted. Inhalation Aerosol: 1 inhalation (albuterol-ipratropium bromide 100 mcg-20 mcg) orally four times a day. The decrease is usually transient, not requiring supplementation. [44002][44003][44010] Extended-release formulationsThe bioavailability of extended-release (ER) tablets is 100% relative to the immediate-release (IR) tablets at steady state. Carbinoxamine; Hydrocodone; Phenylephrine: (Moderate) Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Halofantrine: (Severe) Halofantrine is considered to have a well-established risk for QT prolongation and torsade de pointes (TdP). The action of beta-agonists on the cardiovascular system may be potentiated by a halogenated anesthetic. Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. Cases of QT prolongation, TdP, ventricular tachycardia, and sudden death have been reported during postmarketing use of mirtazapine, primarily following overdose or in patients with other risk factors for QT prolongation, including concomitant use of other medications associated with QT prolongation. Clinically significant improvement (defined as maintaining at least a 15% increase in FEV1 and a 20% increase in mid-expiratory flow rate over baseline) was recorded for up to 6 hours in a controlled clinical trial of 55 children. A higher concentration product (0.083% or 0.5% solution for inhalation) may be more appropriate for treatment of acute asthma exacerbations. Levobunolol: (Moderate) Use of a beta-1-selective (cardioselective) beta blocker is recommended whenever possible when this combination of drugs must be used together. The Global Initiative for Asthma (GINA) guidelines recommend 2.5 mg/dose via nebulization with mouthpiece every 20 minutes for the first hour for acute exacerbations, with reassessment thereafter (further dosing not specified). This risk may be more clinically significant with long-acting beta-agonists as compared to short-acting beta-agonists. Continue monitoring during concomitant treatment and increase the digoxin dose by 20 to 40% as necessary. Dorzolamide; Timolol: (Moderate) Use of a beta-1-selective (cardioselective) beta blocker is recommended whenever possible when this combination of drugs must be used together. In addition, sotalol is associated with QT prolongation and torsade de pointes (TdP). Maprotiline: (Minor) Maprotiline has been reported to prolong the QT interval, particularly in overdose or with higher-dose prescription therapy (elevated serum concentrations). Albuterol Sulfate, Preservative Free 0.083%, 2.5 mg / 3 mL Unit Dose, Inhalation Solution Nebulizer Vial 25 Vials. Fluconazole: (Minor) Use fluconazole with caution in combination with beta-agonists as concurrent use may increase the risk of QT prolongation. This risk is generally higher at elevated drugs concentrations. Crizotinib has been associated with concentration-dependent QT prolongation. Beta-agonists and beta-blockers are pharmacologic opposites, and will counteract each other to some extent when given concomitantly, especially when non-cardioselective beta blockers are used. Therefore, caution is advised when administering olanzapine with drugs having an established causal association with QT prolongation. FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval. Do not increase the dose or frequency of albuterol sulfate inhalation solution without consulting your physician. Share cases and questions with Physicians on Medscape consult. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia. Dextroamphetamine: (Moderate) Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. [31823] [28532] Powder for Inhalation (e.g., ProAir RespiClick, ProAir Digihaler)Instruct patient on proper inhalation technique.Before using for the first time, check the dose counter window to ensure that the inhaler is full and the number "200" is in the window. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. Dosage Form; Route: Metered powder; inhalation . Oxaliplatin: (Minor) Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. Toremifene: (Minor) Use toremifene and short-acting beta-agonists together with caution due to the risk of QT prolongation. Beta-agonists may also be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. GINA recommends transfer to an acute care setting if there is no response to inhaled SABA within 1 to 2 hours or if more than 6 puffs are required during the first 2 hours; if more than 10 puffs are required in 3 to 4 hours, hospital admission is recommended. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. Doses should be delivered over 5 to 15 minutes. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia. Ketoconazole has been associated with prolongation of the QT interval. Concurrent use may increase the effects of sympathomimetics or thyroid hormone. This risk may be more clinically significant with long-acting beta-agonists as compared to short-acting beta-agonists. Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. Levofloxacin has been associated with a risk of QT prolongation and TdP. Safety and efficacy have not been established. Gemifloxacin: (Minor) Use gemifloxacin and short-acting beta-agonists together with caution due to increased risk for QT prolongation and torsade de pointes (TdP). Excessive doses (particularly in the overdose setting) or IV administration of haloperidol may be associated with a higher risk of QT prolongation. Beta agonists infrequently produce cardiovascular adverse effects, mostly with high doses or in the setting of beta-agonist-induced hypokalemia. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval. Inhaled bronchodilators are preferred over oral bronchodilators for the management of COPD. In addition, there are postmarketing reports of torsade de pointes. Fluctuations in plasma concentrations are similar for albuterol extended-release tablets administered at 12-hour intervals and immediate-release tablets administered at 6-hour intervals. Beta-agonists and beta-blockers are pharmacologic opposites, and will counteract each other to some extent when given concomitantly, especially when non-cardioselective beta blockers are used. Liothyronine: (Moderate) Based on the cardiovascular stimulatory effects of beta-agonists and other sympathomimetics, concomitant use with thyroid hormones might enhance the effects on the cardiovascular system. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses and/or when associated with hypokalemia. Drugs with a possible risk for QT prolongation that should be used cautiously with vemurafenib include the beta-agonists. Acetaminophen; Dextromethorphan; Pseudoephedrine: (Moderate) Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. [49951] Other products should be discarded when the labeled number of actuations has been used or by the expiration date printed on original packaging; whichever comes first. Buprenorphine: (Minor) Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes (TdP). QT prolongation and torsade de pointes (TdP) have been observed during haloperidol treatment. In general, inhaled long-acting beta-agonists are preferred since they are longer-acting and have fewer side effects than oral sustained-release agents. A mobile app is required for data transmission but is not required for the administration of albuterol to the patient.Throw away the inhaler 13 months after removing it from the foil pouch for the first time, when the dose counter displays "0", or after the expiration date on the package, whichever comes first. Monoamine oxidase inhibitors: (Major) Beta-agonists should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors (MAOIs) due to their sympathomimetic effects. 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