What is the frequency of tremors as a side effect of albuterol (bronchodilator)?

Frequency of Tremor Side Effects with Albuterol

Tremor is a common side effect of albuterol, occurring in approximately 20% of patients using the medication. 1

Incidence and Characteristics

Tremor is one of the most frequently reported dose-dependent side effects of albuterol. According to FDA data:

• Tremor occurs in approximately 20% of patients using albuterol sulfate inhalation solution 1
• It is considered a central nervous system side effect 1
• Tremor is typically skeletal muscle tremor 2

Factors Affecting Tremor Incidence

The likelihood and severity of tremor varies based on several factors:

• Route of administration: Tremor is more common with:

  • Oral administration (higher systemic concentrations)
  • Nebulizer delivery (higher doses delivered)
  • Less common with metered-dose inhalers (MDIs), especially when used with spacers 3, 2

• Dose-dependent relationship: Higher doses lead to increased tremor incidence and severity 4

  • A study comparing different doses showed significant dose-related increases in tremor amplitude 4

• Duration of therapy: Some tolerance to tremor may develop with continued use

  • After 3 weeks of maintenance dosing, tremor responses to rechallenge were diminished 5

Comparison to Other Beta-Agonists

Albuterol tends to cause less tremor than some other beta-agonists:

• In comparative studies, albuterol produced significantly less tremor than terbutaline
  • Postural tremor increased by 11.15 units with albuterol versus 32.80 units with terbutaline (p=0.01) 5

Clinical Considerations

For patients concerned about tremor:

• Using the lowest effective dose can minimize tremor 2
• MDIs with spacers result in less systemic absorption and fewer side effects including tremor 2
• Elderly patients and those with pre-existing cardiac conditions may be more sensitive to tremor and other side effects 2
• Tremor is typically most noticeable shortly after administration and diminishes as drug levels decrease

Other Common Side Effects

While tremor is common, other notable side effects include:

• Cardiovascular: tachycardia (1%), hypertension (1%) 1
• Other CNS effects: dizziness (7%), nervousness (4%), headache (3%) 1
• Metabolic: decreased serum potassium levels (hypokalemia) 2

Clinical Pearls

• Tremor is generally benign and self-limiting but can be bothersome to patients
• If tremor is problematic, consider:
  1. Reducing the dose if clinically appropriate
  2. Switching to MDI with spacer instead of nebulizer
  3. Considering alternative bronchodilators like anticholinergics for elderly patients with significant tremor concerns 2
• Patients should be counseled about the possibility of tremor when starting albuterol therapy

Tremor remains one of the most common and recognizable side effects of albuterol therapy but is rarely a reason to discontinue treatment when the medication is otherwise providing effective bronchodilation.