Albuterol Inhalers and Seizure Risk
Albuterol inhalers do not typically cause seizures at therapeutic doses, but seizures are a recognized manifestation of albuterol overdose. 1
Overdose-Related Seizure Risk
The FDA drug label explicitly lists seizures as a potential manifestation of albuterol overdose, along with anginal pain, hypertension, hypokalemia, and severe tachycardia (rates up to 200 beats/min). 1 This represents a toxicity concern rather than a therapeutic dose adverse effect.
Therapeutic Dose Safety Profile
At recommended therapeutic doses, albuterol's adverse effects are primarily cardiovascular and metabolic, not neurological:
- Cardiovascular effects include tachycardia (typically mild increases of 6-13 bpm with inhaled formulations), palpitations, and premature ventricular contractions 2
- Metabolic effects include mild hypokalemia (mean decrease of 0.52-0.54 mmol/L), hyperglycemia, and increased insulin levels 2, 3
- Other common effects include skeletal muscle tremor, headache, and dizziness 2, 4, 5
The incidence of adverse events with inhaled bronchodilators at therapeutic doses is low, with multiple studies showing no significant changes in vital signs or serious complications. 2
Important Clinical Context
Seizures from beta-agonists are specifically associated with highly lipophilic beta-blockers (like propranolol) in overdose, not beta-agonists like albuterol. 2 The mechanism differs entirely—lipophilic beta-blockers penetrate the blood-brain barrier causing delirium, coma, and seizures, whereas albuterol's toxicity profile centers on excessive beta-adrenergic stimulation. 2
Rare Paradoxical Reactions
While not seizures, paradoxical bronchoconstriction can occur rarely with albuterol administration via both MDI and nebulizer, requiring immediate recognition and alternative treatment. 2, 6 This represents an idiosyncratic reaction rather than a dose-dependent effect.
Clinical Monitoring Recommendations
When administering albuterol, monitor for:
- Heart rate changes (particularly in patients with cardiac disease) 2
- Serum potassium levels with repeated dosing 2
- Signs of excessive beta-adrenergic stimulation (tremor, tachycardia >200 bpm in children) 1
The risk-benefit profile strongly favors albuterol use for acute bronchospasm, as guidelines consistently recommend it as first-line therapy for asthma exacerbations. 2 Seizures should not be a clinical concern at therapeutic doses.