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.

Did you enjoy that article? Here are some more I think you'd enjoy

How to PROPERLY Diagnose Asthma in Toddlers Are you sure that your toddler was CORRECTLY diagnosed with asthma? Or are your worried your child's symptoms may be asthma? This article will help ...
Did you know you can have asthma without any symptoms? – Asthma Poor ... It IS possible to have asthma without having any symptoms. I'ts called being a 'poor perceiver' and it's common! Read this post to see if you should...
How to Recognize your Child’s Asthma Attacks Asthma attacks can be scary, especially for your kids! This article explains how to recognize your child's asthma attacks and help them (and you) sto...
Is your child’s asthma well controlled? Is your child's asthma REALLY well controlled? Find out with the childhood asthma control test and fix it before you need an urgent care or ER visit!
Do you have the BEST asthma action plan? Only the BEST asthma action plan helps you stay healthy with allergy/asthma/eczema all winter, reduce unscheduled doctor’s visits and prevent ER/Urgen...

Comments

  1. 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.

Leave a Reply

Your email address will not be published. Required fields are marked *