Contraindications for Albuterol
The only absolute contraindication to albuterol is a documented history of hypersensitivity to albuterol or any of its components. 1
Absolute Contraindication
- Hypersensitivity reaction: Patients with a known allergic reaction to albuterol sulfate or any component of the formulation should not receive this medication 1
Important Clinical Considerations (Not Absolute Contraindications)
While the following conditions are not contraindications, they warrant careful consideration and monitoring:
Cardiovascular Concerns
- Cardiac disease patients can receive albuterol, but require closer monitoring due to potential tachycardia and increased myocardial oxygen demand 2
- Beta-2 agonists cause dose-dependent cardiovascular effects including tachycardia, increased pulse pressure, and decreased systemic vascular resistance 3
- Nebulized albuterol produces greater increases in heart rate (average 6.47 bpm more) compared to metered-dose inhalers 2
- Case reports document rare severe events like takotsubo cardiomyopathy with repetitive albuterol use, though these are exceptional 2
- Notably, beta-2 blockers may diminish albuterol effectiveness but are not contraindicated 2
Heart Failure Considerations
- Heart failure is NOT a contraindication to acute albuterol use 4
- Evidence from 24 studies comprising 434 heart failure patients showed that acute beta-2 agonist administration resulted in transient improvements in pulmonary function and cardiovascular hemodynamics 4
- No evidence of increased clinically significant dysrhythmias was found, especially with inhaled administration 4
- Animal models demonstrated resolution of pulmonary edema with beta agonist administration 4
Metabolic Effects to Monitor
- Hypokalemia: Albuterol causes mild decreases in serum potassium (typically 0.52-0.54 mmol/L), though clinical significance is uncertain 2
- Other metabolic effects include decreased plasma phosphate, calcium, and magnesium; increased glucose, insulin, and lactate 3
- These effects are dose-dependent and more prominent with systemic (oral/IV) versus inhaled administration 3
Common Dose-Dependent Side Effects (Not Contraindications)
- Tremor, anxiety, heart pounding, and tachycardia are common but do not preclude use 2
- Most patients tolerate these effects well, though some individuals are highly sensitive 2
- Importantly, albuterol does NOT cause hypertension 2
Clinical Pitfalls to Avoid
- Do not withhold albuterol from dyspneic patients who may have heart failure - insufficient evidence supports this practice, and acute administration appears safe 4
- Paradoxical bronchospasm: Rare case reports document severe bronchospasm after albuterol exposure, requiring immediate discontinuation 2
- Ocular exposure with nebulizers: Ipratropium (often combined with albuterol) can cause unilateral mydriasis if nebulized medication contacts the eye 2
- Oxygen saturation may initially decrease after successful beta-2 agonist treatment due to increased ventilation-perfusion mismatch from bronchodilation 2
Summary for Clinical Practice
Albuterol has remarkably few true contraindications. The only absolute contraindication is documented hypersensitivity 1. Cardiovascular disease, heart failure, and metabolic concerns require monitoring but do not preclude use, as the benefits of bronchodilation in acute respiratory distress typically outweigh these manageable risks 2, 4.