sedation. Use Caution/Monitor. albuterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.protriptylineMonitor Closely (2)albuterol and protriptyline both increase QTc interval. Use Caution/Monitor. protriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)protriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.pseudoephedrineMonitor Closely (1)albuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.quazepamMonitor Closely (1)quazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.quetiapineMonitor Closely (2)quetiapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. albuterol and quetiapine both increase QTc interval. Use Caution/Monitor.quinidineMonitor Closely (1)albuterol and quinidine both increase QTc interval. Use Caution/Monitor.quinineMonitor Closely (1)albuterol and quinine both increase QTc interval. Use Caution/Monitor.ranolazineMonitor Closely (1)albuterol and ranolazine both increase QTc interval. Use Caution/Monitor.ribociclibMonitor Closely (1)albuterol and ribociclib both increase QTc interval. Use Caution/Monitor.rilpivirineMonitor Closely (1)albuterol and rilpivirine both increase QTc interval. Use Caution/Monitor.risperidoneMonitor Closely (2)risperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. albuterol and risperidone both increase QTc interval. Use Caution/Monitor.romidepsinMonitor Closely (1)albuterol and romidepsin both increase QTc interval. Use Caution/Monitor.sacubitril/valsartanMonitor Closely (1)sacubitril/valsartan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sageMinor (1)sage increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.salicylates (non-asa)Monitor Closely (1)salicylates (non-asa) increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.salmeterolMonitor Closely (3)albuterol and salmeterol both decrease serum potassium. Use Caution/Monitor. albuterol and salmeterol both decrease sedation. Use Caution/Monitor. albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.salsalateMonitor Closely (1)salsalate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.saquinavirContraindicated (1)saquinavir, albuterol. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Contraindicated. Saquinavir boosted with ritonavir increases risk of hypokalemia, QT prolongation, and cardiac arrhythmias.Monitor Closely (1)albuterol and saquinavir both increase QTc interval. Use Caution/Monitor.scullcapMonitor Closely (1)scullcap increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.selpercatinibMonitor Closely (1)albuterol and selpercatinib both increase QTc interval. Use Caution/Monitor.serdexmethylphenidate/dexmethylphenidateMonitor Closely (1)albuterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sertralineMonitor Closely (1)albuterol and sertraline both increase QTc interval. Use Caution/Monitor.sevofluraneMonitor Closely (1)albuterol and sevoflurane both increase QTc interval. Use Caution/Monitor.shepherd's purseMonitor Closely (1)shepherd's purse increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.siponimodMonitor Closely (1)albuterol and siponimod both increase QTc interval. Use Caution/Monitor.sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycolMonitor Closely (1)albuterol and sodium sulfate/potassium chloride/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.solifenacinMonitor Closely (1)albuterol and solifenacin both increase QTc interval. Use Caution/Monitor.solriamfetolMonitor Closely (1)albuterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.sorafenibMonitor Closely (1)albuterol and sorafenib both increase QTc interval. Use Caution/Monitor.sotalolMonitor Closely (3)sotalol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor. albuterol and sotalol both increase QTc interval. Use Caution/Monitor. sotalol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.spironolactoneMonitor Closely (1)spironolactone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.succinylcholineMonitor Closely (1)succinylcholine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sufentanilMonitor Closely (1)sufentanil increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulfasalazineMonitor Closely (1)sulfasalazine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sulindacMonitor Closely (1)sulindac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.sunitinibMonitor Closely (1)albuterol and sunitinib both increase QTc interval. Use Caution/Monitor.tacrolimusMonitor Closely (1)albuterol and tacrolimus both increase QTc interval. Use Caution/Monitor.tapentadolMonitor Closely (1)tapentadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.telavancinMonitor Closely (1)albuterol and telavancin both increase QTc interval. Use Caution/Monitor.temazepamMonitor Closely (1)temazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.terbutalineMonitor Closely (3)albuterol and terbutaline both decrease serum potassium. Use Caution/Monitor. albuterol and terbutaline both decrease sedation. Use Caution/Monitor. albuterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.tetrabenazineMonitor Closely (1)albuterol and tetrabenazine both increase QTc interval. Use Caution/Monitor.thioridazineContraindicated (1)albuterol and thioridazine both increase QTc interval. Contraindicated.Monitor Closely (1)thioridazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.thiothixeneMonitor Closely (1)thiothixene increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.timololMonitor Closely (2)timolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor. timolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolfenamic acidMonitor Closely (1)tolfenamic acid increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolmetinMonitor Closely (1)tolmetin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.tolvaptanMonitor Closely (1)tolvaptan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.topiramateMonitor Closely (1)topiramate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.toremifeneMonitor Closely (1)albuterol and toremifene both increase QTc interval. Use Caution/Monitor.torsemideMonitor Closely (1)albuterol and torsemide both decrease serum potassium. Use Caution/Monitor.Minor (1)albuterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.tramadolMonitor Closely (1)tramadol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.tranylcypromineSerious - Use Alternative (1)tranylcypromine increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.trazodoneMonitor Closely (2)trazodone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. albuterol and trazodone both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)trazodone, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triamtereneMonitor Closely (1)triamterene increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.triazolamMonitor Closely (1)triazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triclabendazoleMonitor Closely (1)albuterol and triclabendazole both increase QTc interval. Use Caution/Monitor.triclofosMonitor Closely (1)triclofos increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.trifluoperazineMonitor Closely (1)trifluoperazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.trimipramineMonitor Closely (2)albuterol and trimipramine both increase QTc interval. Use Caution/Monitor. trimipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trimipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.triprolidineMonitor Closely (1)triprolidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.triptorelinMonitor Closely (1)albuterol and triptorelin both increase QTc interval. Use Caution/Monitor.valbenazineMonitor Closely (1)valbenazine and albuterol both increase QTc interval. Use Caution/Monitor.vandetanibMonitor Closely (1)albuterol and vandetanib both increase QTc interval. Use Caution/Monitor.vardenafilMonitor Closely (1)albuterol and vardenafil both increase QTc interval. Use Caution/Monitor.vemurafenibMonitor Closely (1)albuterol and vemurafenib both increase QTc interval. Use Caution/Monitor.voclosporinMonitor Closely (1)albuterol and voclosporin both increase QTc interval. Use Caution/Monitor.voriconazoleMonitor Closely (1)albuterol and voriconazole both increase QTc interval. Use Caution/Monitor.vorinostatMonitor Closely (1)albuterol and vorinostat both increase QTc interval. Use Caution/Monitor.xylometazolineMonitor Closely (2)albuterol and xylometazoline both decrease sedation. Use Caution/Monitor. albuterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.yohimbineMonitor Closely (2)albuterol and yohimbine both decrease sedation. Use Caution/Monitor. albuterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.ziconotideMonitor Closely (1)ziconotide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziprasidoneMonitor Closely (2)ziprasidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. albuterol and ziprasidone both increase QTc interval. Use Caution/Monitor. >10% Tremor (20%) Nervousness in children aged 2-6 years (20%) Insomnia in children aged 6-12 years receiving 4-12 mg q12hr (11%) 1-10% Nausea (10%) Fever (1.6-9%) Bronchospasm (8%) Vomiting (7%) Headache (4-7%) Dizziness (1-7%) Cough (5%) Allergic reactions (4%) Otitis media (3.3%) Epistaxis in children (3%) Increased appetite (3%) Urinary tract infection (3%) Dry mouth (<3%) Eructation or flatulence (<3%) Increased sweating (<3%) Pain (2.7%) Dyspepsia (1-2%) Hyperactivity (1-2%) Chills (<2%) Lymphadenopathy (<2%) Ocular pruritus (<2%) Sweating (<2%) Conjunctivitis in children aged 2-6 years (1%) Dysphonia (>1%) Flu syndrome Nervousness <1% Epigastric pain Epistaxis in adults Hyperactivity in children Frequency Not Defined Adverse reactions such as hypertension, angina, vertigo, central nervous system stimulation, insomnia, headache, metabolic acidosis, and drying or irritation of oropharynx Hypersensitivity Hypokalemia Increased blood glucose levels Prolonged QT interval and ST-segment depression Sleeplessness Tachycardia (incidence varies with formulation) Urticaria, angioedema, rash, bronchospasm, and oropharyngeal edema (rare) Contraindications Hypersensitivity to albuterol Severe hypersensitivity to milk proteins Cautions Some inhalers use hydrofluoroalkane (HFA) as propellant instead of chlorofluorocarbons (CFCs); otherwise, devices are equivalent Immediate hypersensitivity reactions may occur after administration of albuterol sulfate, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema Paradoxical bronchospasm may occur Need for more doses than usual may be a sign of deterioration of asthma and requires reevaluation of treatment Use with caution in patients with cardiovascular disease, asthma, glaucoma, diabetes, hypokalemia, hyperthyroidism, or seizures Use face mask in children <4 years Excessive use may be fatal; do not exceed recommended dose; serious adverse effects occur when administered dose exceeds recommended dose May exacerbate heart failure in patients with reduced ejection fraction (dose related increased risk for hospital admission) Use of beta-adrenergic-agonist bronchodilators alone may not be adequate to control asthma; consider adding anti-inflammatory agents (eg, corticosteroids) to therapy May produce significant hypokalemia, possibly through intracellular shunting, which potentially produces adverse cardiovascular effects Drug interactions overview Do not use other short-acting sympathomimetic bronchodilators concomitantly with an albuterol inhaler Additional adrenergic drugs by any route should be used with caution to avoid deleterious cardiovascular effects ECG changes and/or hypokalemia which may result from coadministration of non-potassium sparing diuretics (eg, loop or thiazide diuretics) can be acutely worsened by beta-agonists, especially when recommended dose of beta-agonist is exceeded Mean decreases of 16% and 22% in serum digoxin levels were demonstrated after single dose IV and oral administration of albuterol, respectively, to normal volunteers who had received digoxin for 10 days; clinical significance is unclear; carefully evaluate serum digoxin levels in patients who are concurrently receiving digoxin and albuterol inhaler Use extreme caution in patients being treated with monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants (TCAs), or within 2 weeks of discontinuation of such agents, because coadministration may potentiate cardiovascular effects of albuterol; consider alternative therapy in patients taking MAOIs or TCAs Pregnancy There are no randomized clinical studies of use during pregnancy Available data from published epidemiological studies and postmarketing case reports of pregnancy outcomes following inhaled albuterol use do not consistently demonstrate a risk of major birth defects or miscarriage In animal reproduction studies, when administered SC to pregnant mice there was evidence of cleft palate at ≤9x the maximum recommended human daily inhalation dose (MRHDID) Clinical considerations Disease-associated maternal and/or embryo/fetal risk In women with poorly or moderately controlled asthma, there is an increased risk of preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate Closely monitor pregnant women and adjust medications as necessary to maintain optimal control Labor or delivery Because of potential for beta-agonist interference with uterine contractility, restrict use for relief of bronchospasm during labor to those patients in whom the benefits clearly outweigh the risk Lactation There are no available data on the presence of albuterol in human milk, the effects on the breastfed child, or the effects on milk production Consider developmental and health benefits of breastfeeding along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from