Should You Induce Vomiting After Albuterol Ingestion?
Do not induce vomiting after albuterol (salbutamol) ingestion—this intervention is not indicated and may cause harm without providing benefit. 1
Why Vomiting Induction Is Not Recommended
The route of albuterol administration is critical to understanding this recommendation:
- Albuterol is administered via inhalation (nebulizer or metered-dose inhaler), not orally, which means it bypasses the gastrointestinal tract entirely and is absorbed directly through the respiratory mucosa 1
- For therapeutic use in acute bronchospasm, there are no contraindications related to recent vomiting because the drug never enters the GI system 1
- If vomiting has already occurred naturally, you can still safely administer inhaled albuterol without delay, as bronchospasm treatment is time-sensitive 1, 2
Management of Accidental Oral Ingestion
If the question pertains to accidental oral ingestion of albuterol tablets or syrup (a different scenario), the evidence still argues against inducing vomiting:
Toxicity Threshold and Clinical Course
- The threshold dose for significant toxicity is 1 mg/kg or higher, with most children experiencing only benign, self-limited symptoms 3
- For ingestions ≤0.6 mg/kg, home observation without intervention is sufficient 4
- For ingestions >0.6 mg/kg, direct medical evaluation and gastrointestinal decontamination should be considered, but this refers to activated charcoal administration in the emergency department, not ipecac-induced vomiting 4
Expected Clinical Effects
Common findings after oral albuterol overdose include 3, 5:
- Tachycardia (57% of cases)
- Widened pulse pressure (50%)
- Agitation or restlessness (45%)
- Tremor
- Hypokalemia (26%)
- Hyperglycemia (50%)
These effects are typically transient and resolve within 4-6 hours without specific treatment 4, 3, 6
Why Ipecac Is Contraindicated
In the retrospective study of 95 pediatric albuterol ingestions, only 12 patients received ipecac at home, and no serious events occurred in the entire series regardless of whether ipecac was given 4. Modern toxicology guidelines have largely abandoned ipecac-induced emesis because:
- It delays administration of activated charcoal (the preferred decontamination method)
- It provides minimal benefit for drug removal
- It can cause protracted vomiting that complicates clinical assessment
Appropriate Management Algorithm
For therapeutic inhaled albuterol use:
- Administer albuterol via nebulizer or MDI regardless of recent vomiting 1
- Use standard dosing: 2.5-5 mg every 20 minutes for 3 doses initially in adults 1
For accidental oral ingestion:
- If ≤0.6 mg/kg: Observe at home 4
- If >0.6 mg/kg: Seek emergency department evaluation for possible activated charcoal administration (not ipecac) 4
- Monitor for tachycardia, tremor, and agitation 3
- Expect resolution within 6 hours in 72% of cases 3
- Watch for late hypoglycemia (4+ hours post-ingestion) as a rare complication 6
Critical Pitfall to Avoid
Do not delay inhaled albuterol administration in a patient with bronchospasm while assessing vomiting history—the inhaled route bypasses the GI tract entirely, and bronchospasm treatment is time-sensitive 1, 2. The most common cause of death in severe asthma is asphyxia, not medication side effects 7.