Can you overdose on albuterol?

albuterol dosing for albuterol overdose
Worried about albuterol overdose? This article will help you feel better!

Can you overdose on albuterol?

 

My daughter recently had an asthma attack and we had to use her albuterol [rescue inhaler]. The instructions were 2 puffs every 4 to 6 hours. We increased it to every 4 hours and it did work, but I was worried about causing side effects. Do you know if you can overdose on that [albuterol] inhaler?
– Sam

 

This is a great question! I know a lot of parents search for this every day (so thank you!)  There are actually 3 parts to fully answer your question, but I think your daughter’s albuterol dosing and your concern about albuterol side effects will make more sense by the end.

 

Normal Albuterol Dosing

When I write a prescription for albuterol rescue inhaler (any brand) the instructions are usually pretty similar: “Use 1-2 puffs every 4-6 hours as needed (for cough, wheezing, shortness of breath).” This sounds like what you were doing, and it is a great way to use albuterol under normal circumstances. Albuterol is a rescue inhaler or nebulizer designed to help break asthma symptoms. The medication provides immediate airway muscle relaxation allowing your daughter to breathe more easily. It does have side effects (discussed below) but is a safe and effective medication.

Most providers (myself included) prescribe it as a range of 1-2 puffs and a range of 4-6 hours as needed. This gives you the flexibility to help treat your daughter’s asthma symptoms without requiring too much medication. For the majority of the time, this system works well. Most kids need 1-2 puffs only every now and then and the fear of albuterol overdose isn’t an issue.

But what happens when your child is having an early asthma attack or their asthma symptoms require albuterol dosing more often? That’s really what your question is asking, and to answer that we need to look at asthma exacerbation albuterol dosing.

Asthma Exacerbation/ Asthma Attack Albuterol Dosing

In an asthma attack, you need to treat your daughter with enough albuterol to break the attack. Shifting your albuterol dosing to 2 puffs every 4 hours is an appropriate first step and still limits the risk of albuterol overdose. If you were to call me (or have one of my more aggressive asthma attack plans) then you might be told to increase your albuterol to 2 puffs every 2 hours. This is still less than in the ER or hospital, where we might write albuterol dosing every 1 hour or even albuterol every 20 minutes (for an hour)!

The real albuterol dosing during an asthma attack is to give what you need to help break the attack!

This doesn’t mean there is no risk of overdose, but it helps show you that the dosing we give you at home is unlikely to trigger any albuterol overdose.

But this also creates the question: “Why do I limit what you can give at home?”

Albuterol Dosing – Home Limitations

The main reason we limit home dosing to every 4 to 6 hours is a practical one: if your child is having an asthma attack and it is not controlled with every 4 hour albuterol dosing, then you should notify a physician and possibly be seen for a visit. Think of it in terms of safety: if you need albuterol more than every 4 hours, it’s best to let your provider know so that we can provide additional medical assessment and support if needed!

If my patients call me for their child’s early asthma attack, I often do a phone assessment and sometimes I tell them to advance their albuterol dosage to every 2 hours. I usually add to do the increased dose for half a day and if it works then reduce the dose again (and if it doesn’t to go to Urgent Care/ER). In this case, that phone call is often triggered by the 4 hour limit on normal albuterol dosing. Practically, that is the main reason we limit albuterol dosing to every 4 to 6 hours and not due to a fear of albuterol overdose.

albuerol-dosing

Albuterol Side Effects

Before I get to the final answer about albuterol overdose, I want to review albuterol side effects.

Albuterol works as a muscle stimulant. In the lung muscles, it works to relax the muscles and open the airway allowing your daughter to breath easier. The medication also stimulates the heart muscle, which causes it to beat faster, as well as your regular muscles, which causes them to get shaky or fidgety. Think of albuterol as doing everything you would want in a fight or flight response: if I saw a dinosaur I’d want my lungs to breath efficiently, my blood to circulate faster and my muscles to be ready to run away (I assume my ancestors didn’t have a fight response to dinosaurs because they’d probably be eaten. Or war heros, I guess. But probably eaten… my genetics aren’t very athletically coordinated).

Most of albuterol’s side effects are due to the way the medication works. Other common albuterol side effects are related as well: nervousness, tremor, headache, palpitations, muscle cramps, and nausea. For some kids, albuterol usage might cause an INCREASE in shortness of breath and not relieve it. In that case, it’s best to see your provider for an alternative.

If your told to increase your daughter’s albuterol dosing to every 2 hours, you will likely have an increased risk of these side effects. Luckily, these should wear off over about 30 minutes after use. If your daughter experiences these, then I would consider them an expected side effect and not an albuterol overdose.

Albuterol Overdose

Now, albuterol overdoses can happen. I have only seen this happen during very aggressive in-hospital treatment and even then it is very uncommon. But some of the albuterol overdose reactions are:

  • Chest pain
  • Heart arrhythmias
  • Low potassium levels
  • High blood sugar levels

These reactions are rare and usually only happen with hospital dosing. Even then, they are exceptionally rare and when you consider the risk vs benefit of that situation, the only time your daughter would need that much albuterol is if she had an asthma attack that couldn’t be broken… so the risk of albuterol overdose are out weighed by the fact that she can’t breathe!

I can comfortably tell you every 4 hours or even every 2 hour dosing is not going to cause an albuterol overdose. Every 1 hour should not either (although if you are doing every 1 hour dosing at home I would highly recommend seeing your provider or going to the Urgent Care/ER).

Questions?

That should provide you with some relief and help all my readers realize that every 4 hour albuterol dosing is not going to cause an albuterol overdose. But if you are still worried, please leave me a comment on Facebook (if you want others to learn from your question) or email me and I’ll be happy to help.

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  • David Clark says:

    I have a question Sir!
    I have COPD, emphysema, and I’m on an albuterol regiment.
    I have a pre-dosed home nebulizer, also 3 different rescue inhalers. ( Ventolin, Cymbicort 145/60, and Encruse powder inhaler.) I also have sleep apnea, and I’ve found that using CPAP in a passive mode, (no water for humidity).
    I’ve had more problems in the Spring and Fall seasons.
    My question is whether albuterol is more effective in higher humidity situations.
    I’m always having problems breathing, and any reply would be appreciated.
    Thank You Sir.

    • David,

      That is an excellent question. For COPD, it’s not just about the medicine but trying to make it as effective as possible. For albuterol, there is probably minimal benefit to additional humidity. The lungs regulate humidity fairly well so increased humidity won’t have additional benefit. Dryer conditions can often make asthma worse, but tend to have less effect for COPD. What I would say is that you could try to change around your medications. There is a good combination therapy called Bevespi which combines part of the Incruse as well as part of the Symbicort (which has 2 medicines) and I’ve been seeing some great benefits in my COPD patients (sounds like a commercial, doesn’t it? But I promise it’s not). If you made that change, you’d get a longer benefit of an albuterol type medicine as well as a longer benefit of an incruse medicine. Then they could take the extra symbicort part and change it to a Qvar, which has smaller particles and easier to get deep into the lungs. This approach would be something you may want to ask your pulmonologist/primary care about.

      Beyond that, if you treat your allergies aggressively in the spring and fall you might see some additional benefit from a breathing perspective. Allergies don’t directly interact with COPD, but since 80% of our breathing comes through our nose every little bit helps. Here is a post on the best nasal steroids (Flonase vs Nasonex) as well as the best over the counter antihistamines that you might want to check out for this step.

  • Michelle Doss says:

    What should be done in case of overdose of albuterol?

    • If you truly overdose on albuterol, most of the treatment is supportive. If your heart rate is too high, we can add a beta-blocker medication. If muscles are too shaky, perhaps a muscle relaxer? If blood sugar is too low, add glucose. But for probably >95% of people, its monitoring and waiting for the medicine to wear off. I wish there were something better I could recommend. But luckily it really doesn’t present as an issue that often.

      • That’s good because everywhere else on the internet it says fatal. I have no idea if my special needs child OD’d. She seems happy but she threw up. I found the inhaler over 100 doses empty next to her. she could have sprayed it in the air though. Her pulse is 142 but it was 131 last week so a high pulse is normal for her. She seems happy though if not hyper

        • If it is taken too much, it can cause heart irregularities. Like, 100 doses at once… so I’m glad she’s ok. There is no study for how much at one time causes this, which is frustrating. But also good… I guess it means its not a common occurrence. Either way, I am glad she’s ok.

  • I have a question I have asthma and since I’ve been young I’ve always had shaky hands and would bounce my legs. Although my hands are probably the most troublesome thing could that be because of the albuterol.

    • Alyssa,

      It is possible this is from albuterol, because it will cause shakiness of the muscles. But that is usually a short-lived reaction (improves within 30 minutes or so after albuterol use) and often the longer you’re on albuterol, the less your reaction over time.

      So if its just associated with albuterol use… then yes. But if it is all the time, then probably not.

      Does that help? If you want, you can Email me and tell me more and I can try to help.

  • I have asthma and have used a 200 dose inhaler every month since this December. I got on Advair 2 months ago which helped a bit…my asthma goes away once the weather warms up…I occasionally get headaches but other that that I feel fine…is there long term effects of using so much albuterol?
    Thanks

    • Fred,

      From what we know, there isn’t any long term problem with using that much albuterol.

      The problem (as you correctly mentioned) is IF you’re using that much, then the underlying asthma or lung problem isn’t being well controlled. I still use the following criteria as a quick way to see if your baseline asthma needs a medication increase:
      – Daytime symptoms more than 2 times a week
      – Nighttime awakenings more than 2 times per month
      – Using more than 2 canisters a year

      It’s not perfect, but if you are breaking these rules it is usually time to start a better controller medication, like you did. So good job adjusting your medicines after recognizing you were using albuterol too much!

  • Emma Marie Miller says:

    I have a question I’m freaking myself out because I had bronchitis about a month ago. I have since been taking Albuterol 3 times a day and inhaler about twice a day when short of breath. I was reading up on Albuterol overdose. I seem to have the symptoms. My nails are blue blood sugar is almost 200. I’m not a diabetic it’s usually normal my BP is 150/101 keeps going up and down. Resting heart rate is 86 to 98. It’s been 3 hours since I last took a breathing treatment I’m cold I’m hot I have chills. I have been pounding the water like crazy. I’m seriously afraid to go to sleep. I’m not confused or out of it or anything. My arm fingers and chest went numb after I took my treatment. However it’s going now. I’m debating on going to the emergency room or letting this stuff get out of my system. What’s your thoughts. Did I take to much?

    • I’m sorry this happened.

      I would say taking albuterol 3 times a day shouldn’t be too much (in terms of an OD reaction). My guess… and this is only a guess… maybe it was hyperventilation? Using albuterol with a lot of deep breathing might cause a hyperventilation type reaction, which could cause the numbness and tingling as well as some of the possible constriction of blood vessels? It’s just a guess, but look it up and see (and obviously, if it is still happening go the the ER or see your primary care. I’m a good allergist… but I’m definitely not able to assess severe reactions over the internet).

      Maybe reply back and let me (and everyone else) know when it went away and what your doctor thought was the cause?

  • yamila alfonso says:

    My daughter suffers from severe environmental allergies and asthma. She was taken to the hospital by rescue today because after 6 puffs at 730am and another 4 puffs at 1130am she was still having trouble breathing and had severe pain on her chest and back. She was given a treatment in the rescue. Given another cocktail of 3 in the ER (after the doctor examined her and said she had diminished breath sounds) and steroids as well then when he checked her again said they needed to give her a longer treatment because she was still having trouble breathing and the breath sounds were still diminished. But here’s my question…. Her heart rate was 180 when discharged but it has now been 6hrs and she is still really agitated and in her sleep is jittery… Is that normal?

    • Probably normal, yes. Heart rate can be increased by the albuterol as well as the steroids and even by breathing difficulty itself. There are many reasons for both. The key would be to monitor this and if it doesn’t get better within a short time (or if it gets worse) then go back to the hospital. Heart rate is often seen as a symptom for a lot of different possible causes.

  • My child is got a cold a few days ago. He started wheezing with chest congestion. He had a few episodes in the past when he developed the same symptoms. He was prescribed albuterol NEB. He responds well to albuterol. My question is after how many days using albuterol to relieve the symptoms we should take him to his doctor or urgent care. Maybe he needs steroids… idk. He’s able to cough but nothing comes out.. but he is congested. After albuterol the wheezing goes away.

    • As a general rule, if he is responding to the nebulizer well then give it about 2-3 days to see if he turns the corner. If he doesn’t, or if he gets worse/stops responding to nebs, then I’d make an appointment for the doctor because they may need to add a steroid to treat a more severe exacerbation.

  • My husband has COPD, congestive heart failure and afib. He uses Symbicort twice a day and has an albuterol rescue inhaler he uses 4 or 5 times a day. He also does nebulizer treatments. His question is how close together can he take puffs of his rescue inhaler and then do a breathing treatment? Sometimes he feels like the inhaler just isnt doing the trick. He is nearly 69, been smoking since he was 13. He has cut down from over 3 packs a day to one and a half. I dont see him ever quitting. Thanks for any help or suggestions.

    • This is tricky, but I have a great set of ideas for you. First, if he needs nebulizer treatments he can do them within 1-2 hours of each other without concern (can do them more if needed to break a breathing attack). BUT the risk is fast heart rate… no big deal for most people but this could risk setting off the afib (leading to worsening CHF and then worsening breathing). So as a general rule, limit the use to every 1-2 hours and if that doesn’t control breathing, then go to an urgent care to get higher doses and monitor cardiac rhythms.

      BUT that is the emergency treatment. I also want to make sure he has good baseline control of COPD. Prevention is the best way to manage all of this.

      For COPD treatment, Symbicort is a great medication but if he’s not on it ask if he is a candidate for a mucus-fighting component such as spiriva, incruse, or tudorza. There is even a product that combines them all called Trelegy. Often all 3 can be of benefit… and then improve breathing at baseline. Oxygen, if needed, should also be considered.

      Finally, if he has an asthma component (asthma-COPD overlap) then it is reasonable to check an CBC and look for eosinophils. There are products such as Fasenra (benralizumab) which can help manage severe persistent asthma with eosinophilic phenotype. This is NOT for use for COPD… but for asthma. I only bring it up because I see a lot of people who have both… and that gives you the opportunity to treat both!

  • Hello, I was wondering if you could possibly answer a question for me. I was in the hospital yesterday with severe breathing problems. The doctor on call had me take 3 Ventolin treatments in a row and gave me prednisone as well. He sent me home with instructions to take my inhaler at 6 puffs every 4-6 hours for one week along with 1 prednisone tablet at 50mg dose. My question is can this harm me? I also have high blood pressure and diabetes which he did not treat even though I told him I was on 500 MG of metformin. They did not even do blood tests nor check my sugar levels but sent me home to go to a clinic within a week. Any advice would be appreciated. Thank you

    • This should not harm you. If you are having a severe asthma (or any respiratory) attack, we often give treatments back to back to back just like this. It will definitely cause you to get jittery, have a fast heart rate. Can cause potassium to temporarily go down (trivia!). But doesn’t have any significant affect on glucose or blood pressure. The goal is to break the breathing attack and get breathing back to normal.

      My guess is they focused on the acute emergency and just let the blood sugar and blood pressure go for the time being. While that’s probably not a great plan as a big picture treatment plan, I would guess it was viewed to fix the breathing and stabilize that first… then have your primary care deal with the rest. I don’t like it… but that’s how ER/hospitals seem to be working these days.

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