Can albuterol (beta-2 adrenergic agonist) cause tachycardia?

Albuterol and Tachycardia

Yes, albuterol can cause tachycardia as a common side effect due to its beta-2 adrenergic agonist properties. 1, 2

Mechanism and Cardiovascular Effects

• Albuterol, while primarily a beta-2 adrenergic agonist targeting bronchial smooth muscle, has some cardiac effects that can lead to tachycardia 1
• The FDA label for albuterol specifically lists tachycardia (1% incidence) as a cardiovascular side effect 1
• Beta-2 agonists can increase heart rate by an average of 9.1 beats per minute (range: 5.3-12.9 beats/min) according to meta-analysis data 3
• The American Heart Association notes that excessive bronchodilator use can cause serious cardiovascular effects, including tachycardia and other arrhythmias 2
• In overdose situations, tachycardia can be more pronounced, with rates up to 200 beats/min in adults and even higher in children 1

Risk Factors and Severity

• The route of administration affects the likelihood and severity of tachycardia:
  • Nebulized delivery typically causes more tachycardia than metered-dose inhalers (MDIs) 2
  • Intravenous administration causes more rapid and pronounced heart rate increases than inhaled routes 2, 4
• Dose-dependent relationship exists - higher doses or frequent use increases risk of tachycardia 2, 5
• Patients with baseline tachycardia may experience less additional heart rate increase (1.3-2.1%) compared to those without baseline tachycardia (5.0-6.7%) 6

Other Cardiovascular Concerns

• Beyond simple tachycardia, albuterol can occasionally cause:
  • Palpitations 2
  • Arrhythmias, including atrial fibrillation and supraventricular tachycardia 1
  • Premature ventricular contractions 2, 7
  • Diastolic hypotension, which when combined with tachycardia, may contribute to myocardial injury in certain populations 5
  • In rare cases, more serious cardiac complications like myocardial ischemia in patients with underlying cardiac disease 2

Clinical Implications

• For most patients, the tachycardia associated with albuterol at standard therapeutic doses is mild and well-tolerated 7
• In critically ill adult patients, nebulized albuterol with ipratropium typically does not cause significant tachycardia or tachyarrhythmias 7
• The risk of serious arrhythmias with standard therapeutic dosing is low (0.6% incidence of arrhythmias in one study) 7
• Monitoring heart rate is advisable, particularly in patients with pre-existing cardiovascular disease or when using high doses 2

Prevention Strategies

• Use the lowest effective dose to minimize cardiovascular side effects 2
• Consider metered-dose inhalers rather than nebulizers when appropriate, as they cause fewer systemic effects 2
• Be vigilant for signs of overdose, which include exaggerated tachycardia and other cardiovascular effects 1
• Monitor potassium levels in patients receiving high doses, as hypokalemia can worsen arrhythmia risk 2, 8