What is the effect of Salbutamol (albuterol) on potassium levels?

From the Guidelines

Salbutamol (albuterol) can decrease serum potassium levels by approximately 0.5 mmol/L, as noted in the most recent study from 2023 1. The effect of salbutamol on potassium levels is a significant consideration in clinical practice.

• The potassium-lowering effect of salbutamol is dose-dependent, with higher doses causing greater reductions.
• For acute management, nebulized salbutamol is typically given at doses of 10-20 mg, which is higher than the usual 2.5-5 mg doses used for bronchospasm.
• The potassium-lowering effect occurs because salbutamol activates beta-2 adrenergic receptors, which stimulate the sodium-potassium ATPase pump, driving potassium from the bloodstream into cells.
• This effect is temporary, lasting about 2-4 hours, and does not eliminate potassium from the body but merely redistributes it.
• Patients with underlying heart conditions should be monitored carefully when using salbutamol for potassium lowering, as higher doses can cause tachycardia and other cardiac effects, as reported in the 2023 study 1.
• In clinical practice, salbutamol is often used alongside other treatments like insulin with glucose when treating significant hyperkalemia, as discussed in the 2021 study on clinical management of hyperkalemia 1. The most recent and highest quality study from 2023 1 provides the strongest evidence for the effect of salbutamol on potassium levels, and its findings should be prioritized in clinical decision-making.

From the FDA Drug Label

The ECG changes and/or hypokalemia which may result from the administration of nonpotassium-sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by beta-agonists, especially when the recommended dose of the beta-agonist is exceeded

The effect of Salbutamol (albuterol) on potassium levels is that it may worsen hypokalemia when coadministered with nonpotassium-sparing diuretics. However, the direct effect of albuterol on potassium levels is not explicitly stated in the label. 2

From the Research

Effect of Salbutamol on Potassium Levels

• Salbutamol has been shown to significantly reduce serum potassium levels in various studies 3, 4, 5, 6, 7.
• The peak effect of salbutamol on reducing serum potassium levels varies depending on the route of administration and dosage, with nebulized salbutamol producing a significant decrease in serum potassium at 120 minutes 3 and intravenous salbutamol producing a significant decrease at 30 minutes 6.
• Studies have compared the efficacy of salbutamol with other interventions, such as insulin-dextrose, bicarbonate, and aminophylline, with salbutamol appearing to be one of the most effective agents at reducing serum potassium 3.
• The hypokalaemic effect of salbutamol has been observed in both adults and children, with one study finding that hypokalaemia occurred in about one-third of patients treated with nebulized salbutamol therapy 5.
• Salbutamol has been shown to be a safe and effective treatment for hyperkalaemia, with minimal clinical side-effects, and may be considered as a first-line treatment for this condition 7.

Comparison of Salbutamol Administration Routes

• Nebulized salbutamol has been compared to intravenous salbutamol, with both routes producing a significant decrease in serum potassium levels 6.
• The choice of administration route may depend on the clinical situation, with intravenous salbutamol preferred in patients requiring a rapid lowering of plasma potassium and nebulization preferred in patients with coronary artery disease 6.

Clinical Implications

• Salbutamol may be a useful treatment option for patients with hyperkalaemia, particularly in situations where other treatments are not available or effective 3, 7.
• Monitoring of serum potassium levels is recommended in patients treated with salbutamol, particularly in those with underlying renal disease or other risk factors for hyperkalaemia 5.