Can albuterol (bronchodilator) cause hallucinations?

Albuterol and Hallucinations

Yes, albuterol can cause hallucinations, particularly with excessive use, though this is a rare adverse effect that is not commonly highlighted in clinical guidelines. 1

Neuropsychiatric Effects of Albuterol

• Hallucinations have been documented in case reports, particularly in pediatric patients with excessive use of albuterol inhalers 1
• Neurological effects including dizziness, nervousness, and headache are recognized adverse effects of albuterol 2, 3
• Altered behavior patterns can develop with excessive bronchodilator use 2

Mechanism and Risk Factors

• The exact mechanism for hallucinations is not fully established, but may be related to:

  • Direct central nervous system effects of beta-agonists 3
  • In some cases, the fluorocarbon propellants used in metered-dose inhalers rather than the albuterol itself 1
  • Systemic absorption of medication, particularly with excessive or improper use 2, 3

• Risk factors that may increase likelihood of neuropsychiatric effects:

  • Excessive dosing beyond recommended guidelines 2, 1
  • Pediatric or elderly patients may be more susceptible 1, 4
  • Route of administration (nebulized solutions cause more systemic effects than metered-dose inhalers) 2, 3

Common Adverse Effects of Albuterol

• Cardiovascular effects are more commonly reported than hallucinations:

  • Tachycardia (heart rate increases averaging 13 beats per minute) 2
  • Palpitations 2
  • Hypertension 2
  • Arrhythmias 2

• Metabolic effects:

  • Hypokalemia (mean decreases in serum potassium of 0.52-0.54 mmol/L) 2
  • Hyperglycemia 2, 3
  • Increased lactate levels 2, 3

• Musculoskeletal effects:

  • Skeletal muscle tremor 2, 3
  • Weakness 2

Prevention and Management

• Use the lowest effective dose to minimize adverse effects 2
• Consider metered-dose inhalers rather than nebulizers when appropriate, as they cause fewer systemic effects 2, 3
• For patients experiencing hallucinations:
  • Discontinue or reduce the dose of albuterol 1, 4
  • Consider switching to a different formulation (e.g., from metered-dose inhaler to powder formulation without fluorocarbon propellant) 1
  • Symptoms typically resolve rapidly after discontinuation 1, 4

Clinical Pearls

• Hallucinations and other neuropsychiatric symptoms should prompt evaluation of bronchodilator use patterns 1
• The temporal relationship between initiation of albuterol and onset of hallucinations can help establish causality 4
• Elderly patients and children may be particularly susceptible to neuropsychiatric effects 1, 4
• Always consider the possibility of paradoxical reactions to albuterol, including bronchospasm, which though rare, can occur 5