Who should not use an albuterol (beta-2 adrenergic receptor agonist) inhaler?

Contraindications and Precautions for Albuterol Inhaler Use

Albuterol should be used with extreme caution or avoided in patients with cardiovascular disorders (especially coronary insufficiency, cardiac arrhythmias, and hypertension), convulsive disorders, hyperthyroidism, diabetes mellitus, and those unusually responsive to sympathomimetic amines. 1

Absolute Contraindications

• Patients currently taking MAO inhibitors or tricyclic antidepressants should not receive albuterol, as the drug's vascular effects may be dangerously potentiated 1
• Patients on beta-receptor blocking agents should avoid albuterol, as these medications mutually inhibit each other's effects 1
• Patients with known hypersensitivity to albuterol or who have experienced paradoxical bronchoconstriction with previous use should not use the medication 2

High-Risk Populations Requiring Extreme Caution

Cardiovascular Disease

• Coronary insufficiency, cardiac arrhythmias, and hypertension represent significant risk factors, as albuterol can produce adverse cardiovascular effects including tachycardia 1
• Large doses have been associated with cardiotoxicity, though only selective short-acting beta-agonists like albuterol should be used when high doses are necessary 3
• In animal studies, cardiac fibrosis occurred at doses 19 times the clinical dose in dogs, though the safety margin in humans appears adequate 4

Metabolic Disorders

• Diabetes mellitus patients require careful monitoring, as large doses of intravenous albuterol have been reported to aggravate pre-existing diabetes and ketoacidosis 1
• Hypokalemia risk: Albuterol may produce significant potassium decreases (20-25% decline in serum levels) through intracellular shunting, potentially causing adverse cardiovascular effects 1

Neurological Conditions

• Patients with convulsive disorders should use albuterol with caution due to sympathomimetic effects 1
• Hyperthyroidism patients require careful consideration given increased sensitivity to sympathomimetic amines 1

Special Clinical Situations

Pregnancy

• Pregnancy Category C: Albuterol showed teratogenic effects (cleft palate) in mice at 1.25 times the human dose 1
• Should only be used if potential benefit justifies the potential fetal risk 1
• May delay preterm labor, requiring cautious use to avoid interference with uterine contractility 1

Non-Asthma Related Cough

• Albuterol is not recommended for acute or chronic cough not due to asthma, as evidence shows no benefit 3

Drug Interactions

• Other sympathomimetic aerosol bronchodilators or epinephrine should not be used concomitantly with albuterol 1
• Compatibility with other drugs mixed in a nebulizer has not been established 1

Important Clinical Caveats

Paradoxical bronchoconstriction is a rare but serious complication that can occur with albuterol administration via both metered-dose inhaler and nebulizer 2. Clinicians must monitor for worsening bronchospasm immediately after administration and discontinue use if this occurs.

Regular scheduled use is not recommended for mild asthma; albuterol should be prescribed on an as-needed basis, as regularly scheduled use provides no additional benefit over as-needed use 5. Increasing use of albuterol (>2 days per week for symptom relief) indicates inadequate asthma control requiring intensification of anti-inflammatory therapy 3.