albuterol/budesonide inhaled (Rx)

Brand and Other Names:Airsupra
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

albuterol/budesonide

inhalation aerosol

  • 90mcg/80mcg per actuation

Asthma

Fixed dose inhaler indicated for as needed treatment or prevention of bronchoconstriction and for prevention of exacerbations in adults with asthma

2 actuations inhaled PO PRN for asthma symptoms

2 actuations = albuterol 180 mcg and budesonide 160 mcg

Not to exceed 6 doses (12 inhalations) per 24 hr

Dosage Modifications

Renal impairment

  • Formal pharmacokinetic studies have not been conducted

Hepatic impairment

  • Formal pharmacokinetic studies have not been conducted
  • Budesonide is predominately cleared by hepatic metabolism and hepatic impairment may lead to plasma accumulation
  • Monitor patients with hepatic impairment

Dosing Considerations

Not for use as maintenance treatment for asthma

<18 years: Safety and efficacy not established

Next:

Interactions

Interaction Checker

and albuterol/budesonide inhaled

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            Contraindicated (4)

            • cisapride

              albuterol and cisapride both increase QTc interval. Contraindicated.

            • dronedarone

              albuterol and dronedarone both increase QTc interval. Contraindicated.

            • saquinavir

              saquinavir, albuterol. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Contraindicated. Saquinavir boosted with ritonavir increases risk of hypokalemia, QT prolongation, and cardiac arrhythmias.

            • thioridazine

              albuterol and thioridazine both increase QTc interval. Contraindicated.

            Serious - Use Alternative (16)

            • amitriptyline

              amitriptyline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              amoxapine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • azithromycin

              albuterol and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • clomipramine

              clomipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desipramine

              desipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • doxepin

              doxepin, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • fexinidazole

              fexinidazole and albuterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

            • hydroxychloroquine sulfate

              albuterol and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

              imipramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • isocarboxazid

              isocarboxazid increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • linezolid

              linezolid increases effects of albuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • lofepramine

              lofepramine, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • lonafarnib

              lonafarnib will increase the level or effect of budesonide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • lopinavir

              albuterol and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              budesonide inhaled, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH growth hormone release before administering prior to administration of macimorelin. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin.

            • maprotiline

              maprotiline, albuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            Monitor Closely (302)

            • acebutolol

              acebutolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              acebutolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • aceclofenac

              aceclofenac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • acemetacin

              acemetacin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              alfentanil increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alprazolam

              alprazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amiloride

              amiloride increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • amiodarone

              albuterol and amiodarone both increase QTc interval. Use Caution/Monitor.

            • amisulpride

              albuterol and amisulpride both increase QTc interval. Use Caution/Monitor.

              amisulpride and albuterol both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended if coadministered.

            • amitriptyline

              amitriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and amitriptyline both increase QTc interval. Use Caution/Monitor.

            • amobarbital

              amobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amoxapine

              amoxapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • anagrelide

              albuterol and anagrelide both increase QTc interval. Use Caution/Monitor.

            • apomorphine

              albuterol and apomorphine both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              albuterol and arformoterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and arformoterol both decrease sedation. Use Caution/Monitor.

              albuterol and arformoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              aripiprazole increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • armodafinil

              albuterol and armodafinil both decrease sedation. Use Caution/Monitor.

            • arsenic trioxide

              albuterol and arsenic trioxide both increase QTc interval. Use Caution/Monitor.

            • artemether/lumefantrine

              albuterol and artemether/lumefantrine both increase QTc interval. Use Caution/Monitor.

            • asenapine

              albuterol and asenapine both increase QTc interval. Use Caution/Monitor.

            • asenapine transdermal

              asenapine transdermal and albuterol both increase QTc interval. Use Caution/Monitor.

            • aspirin

              aspirin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aspirin rectal

              aspirin rectal increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atenolol

              atenolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              atenolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine, albuterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of tachycardia, increased blood pressure.

            • azelastine

              azelastine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bedaquiline

              albuterol and bedaquiline both increase QTc interval. Use Caution/Monitor.

            • belladonna and opium

              belladonna and opium increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bendroflumethiazide

              albuterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

            • benperidol

              benperidol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benzphetamine

              albuterol and benzphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • betaxolol

              betaxolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              betaxolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • bisoprolol

              bisoprolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              bisoprolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • brompheniramine

              brompheniramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bumetanide

              albuterol and bumetanide both decrease serum potassium. Use Caution/Monitor.

            • buprenorphine

              buprenorphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and buprenorphine both increase QTc interval. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              buprenorphine buccal and albuterol both increase QTc interval. Use Caution/Monitor.

            • buprenorphine subdermal implant

              buprenorphine subdermal implant and albuterol both increase QTc interval. Use Caution/Monitor.

            • buprenorphine transdermal

              buprenorphine transdermal and albuterol both increase QTc interval. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              buprenorphine, long-acting injection and albuterol both increase QTc interval. Use Caution/Monitor.

            • butabarbital

              butabarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butalbital

              butalbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butorphanol

              butorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • caffeine

              albuterol and caffeine both decrease sedation. Use Caution/Monitor.

            • carbenoxolone

              albuterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carvedilol

              carvedilol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              carvedilol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • celecoxib

              celecoxib increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • celiprolol

              celiprolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              celiprolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chloroquine

              albuterol and chloroquine both increase QTc interval. Use Caution/Monitor.

            • chlorothiazide

              albuterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and chlorpromazine both increase QTc interval. Use Caution/Monitor.

            • chlorthalidone

              albuterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • cinnarizine

              cinnarizine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ciprofloxacin

              albuterol and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • citalopram

              albuterol and citalopram both increase QTc interval. Use Caution/Monitor.

            • clarithromycin

              albuterol and clarithromycin both increase QTc interval. Use Caution/Monitor.

            • clemastine

              clemastine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clomipramine

              clomipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clonazepam

              clonazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clorazepate

              clorazepate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              clozapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and clozapine both increase QTc interval. Use Caution/Monitor.

            • cobicistat

              cobicistat increases levels of budesonide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • codeine

              codeine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • crizotinib

              albuterol and crizotinib both increase QTc interval. Use Caution/Monitor.

            • cyclizine

              cyclizine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • cyclopenthiazide

              albuterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dasatinib

              albuterol and dasatinib both increase QTc interval. Use Caution/Monitor.

            • deflazacort

              albuterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • degarelix

              albuterol and degarelix both increase QTc interval. Use Caution/Monitor.

            • desipramine

              desipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and desipramine both increase QTc interval. Use Caution/Monitor.

            • deutetrabenazine

              albuterol and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

            • dexchlorpheniramine

              dexchlorpheniramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexfenfluramine

              albuterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.

              albuterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmethylphenidate

              albuterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.

              albuterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextroamphetamine

              albuterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextromoramide

              dextromoramide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diamorphine

              diamorphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide and albuterol both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, albuterol. Either increases levels of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • diclofenac

              diclofenac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diethylpropion

              albuterol and diethylpropion both decrease sedation. Use Caution/Monitor.

              albuterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diflunisal

              diflunisal increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • digoxin

              digoxin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dipipanone

              dipipanone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • disopyramide

              albuterol and disopyramide both increase QTc interval. Use Caution/Monitor.

            • dobutamine

              albuterol and dobutamine both decrease serum potassium. Use Caution/Monitor.

              albuterol and dobutamine both decrease sedation. Use Caution/Monitor.

              albuterol and dobutamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dolasetron

              albuterol and dolasetron both increase QTc interval. Use Caution/Monitor.

            • donepezil

              donepezil and albuterol both increase QTc interval. Use Caution/Monitor.

            • dopamine

              albuterol and dopamine both decrease sedation. Use Caution/Monitor.

              albuterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopexamine

              albuterol and dopexamine both decrease serum potassium. Use Caution/Monitor.

              albuterol and dopexamine both decrease sedation. Use Caution/Monitor.

              albuterol and dopexamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              dopexamine, albuterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • doxepin

              doxepin increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              doxepin and albuterol both increase QTc interval. Use Caution/Monitor.

            • droperidol

              droperidol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and droperidol both increase QTc interval. Use Caution/Monitor.

            • drospirenone

              drospirenone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • efavirenz

              efavirenz and albuterol both increase QTc interval. Use Caution/Monitor.

            • encorafenib

              albuterol and encorafenib both increase QTc interval. Use Caution/Monitor.

            • entrectinib

              albuterol and entrectinib both increase QTc interval. Use Caution/Monitor.

            • ephedrine

              albuterol and ephedrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and ephedrine both decrease sedation. Use Caution/Monitor.

              albuterol and ephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine

              albuterol and epinephrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and epinephrine both decrease sedation. Use Caution/Monitor.

              albuterol and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              albuterol and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.

              albuterol and epinephrine racemic both decrease sedation. Use Caution/Monitor.

              albuterol and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • eribulin

              albuterol and eribulin both increase QTc interval. Use Caution/Monitor.

            • erythromycin base

              albuterol and erythromycin base both increase QTc interval. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              albuterol and erythromycin ethylsuccinate both increase QTc interval. Use Caution/Monitor.

            • erythromycin lactobionate

              albuterol and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

            • erythromycin stearate

              albuterol and erythromycin stearate both increase QTc interval. Use Caution/Monitor.

            • escitalopram

              albuterol and escitalopram both increase QTc interval. Use Caution/Monitor.

            • esmolol

              esmolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              esmolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • estazolam

              estazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ethacrynic acid

              albuterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

            • ethanol

              ethanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • etodolac

              etodolac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fenfluramine

              albuterol and fenfluramine both decrease sedation. Use Caution/Monitor.

              albuterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • fenoprofen

              fenoprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fexinidazole

              albuterol and fexinidazole both increase QTc interval. Use Caution/Monitor.

            • fingolimod

              fingolimod and albuterol both increase QTc interval. Use Caution/Monitor.

            • flecainide

              albuterol and flecainide both increase QTc interval. Use Caution/Monitor.

            • fluconazole

              albuterol and fluconazole both increase QTc interval. Use Caution/Monitor.

            • fluoxetine

              albuterol and fluoxetine both increase QTc interval. Use Caution/Monitor.

            • fluphenazine

              fluphenazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and fluphenazine both increase QTc interval. Use Caution/Monitor.

            • flurazepam

              flurazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurbiprofen

              flurbiprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • formoterol

              albuterol and formoterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and formoterol both decrease sedation. Use Caution/Monitor.

              albuterol and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • foscarnet

              albuterol and foscarnet both increase QTc interval. Use Caution/Monitor.

            • fostemsavir

              albuterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • furosemide

              albuterol and furosemide both decrease serum potassium. Use Caution/Monitor.

            • gemifloxacin

              albuterol and gemifloxacin both increase QTc interval. Use Caution/Monitor.

            • gemtuzumab

              albuterol and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • gentamicin

              albuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

            • gilteritinib

              albuterol and gilteritinib both increase QTc interval. Use Caution/Monitor.

            • glasdegib

              albuterol and glasdegib both increase QTc interval. Use Caution/Monitor.

            • goserelin

              albuterol and goserelin both increase QTc interval. Use Caution/Monitor.

            • granisetron

              albuterol and granisetron both increase QTc interval. Use Caution/Monitor.

            • green tea

              green tea increases effects of albuterol by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

            • haloperidol

              haloperidol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and haloperidol both increase QTc interval. Use Caution/Monitor.

            • histrelin

              albuterol and histrelin both increase QTc interval. Use Caution/Monitor.

            • hydrochlorothiazide

              albuterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • hydromorphone

              hydromorphone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and hydroxyzine both increase QTc interval. Use Caution/Monitor.

            • ibuprofen

              ibuprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen IV

              ibuprofen IV increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibutilide

              albuterol and ibutilide both increase QTc interval. Use Caution/Monitor.

            • iloperidone

              iloperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and iloperidone both increase QTc interval. Use Caution/Monitor.

            • imipramine

              imipramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • indapamide

              albuterol and indapamide both decrease serum potassium. Use Caution/Monitor.

            • indomethacin

              indomethacin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • inotuzumab

              albuterol and inotuzumab both increase QTc interval. Use Caution/Monitor.

            • irbesartan

              irbesartan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • isoflurane

              albuterol and isoflurane both increase QTc interval. Use Caution/Monitor.

            • isoproterenol

              albuterol and isoproterenol both decrease serum potassium. Use Caution/Monitor.

              albuterol and isoproterenol both decrease sedation. Use Caution/Monitor.

              albuterol and isoproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • itraconazole

              albuterol and itraconazole both increase QTc interval. Use Caution/Monitor.

            • ivosidenib

              albuterol and ivosidenib both increase QTc interval. Use Caution/Monitor.

            • ketoprofen

              ketoprofen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac

              ketorolac increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac intranasal

              ketorolac intranasal increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • ketotifen, ophthalmic

              ketotifen, ophthalmic increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • labetalol

              labetalol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              labetalol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • lapatinib

              albuterol and lapatinib both increase QTc interval. Use Caution/Monitor.

            • lefamulin

              albuterol and lefamulin both increase QTc interval. Use Caution/Monitor.

            • lenvatinib

              albuterol and lenvatinib both increase QTc interval. Use Caution/Monitor.

            • leuprolide

              albuterol and leuprolide both increase QTc interval. Use Caution/Monitor.

            • levalbuterol

              albuterol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and levalbuterol both decrease sedation. Use Caution/Monitor.

              albuterol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • levofloxacin

              albuterol and levofloxacin both increase QTc interval. Use Caution/Monitor.

            • levorphanol

              levorphanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lisdexamfetamine

              albuterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.

              albuterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • lithium

              albuterol and lithium both increase QTc interval. Use Caution/Monitor.

            • lofepramine

              lofepramine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofexidine

              lofexidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and lofexidine both increase QTc interval. Use Caution/Monitor.

            • loperamide

              albuterol and loperamide both increase QTc interval. Use Caution/Monitor.

            • loprazolam

              loprazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lorazepam

              lorazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lormetazepam

              lormetazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lornoxicam

              lornoxicam increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              loxapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • maprotiline

              maprotiline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and maprotiline both increase QTc interval. Use Caution/Monitor.

            • marijuana

              marijuana increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meclofenamate

              meclofenamate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefenamic acid

              mefenamic acid increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefloquine

              albuterol and mefloquine both increase QTc interval. Use Caution/Monitor.

            • melatonin

              melatonin increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meloxicam

              meloxicam increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meperidine

              meperidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meprobamate

              meprobamate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaproterenol

              albuterol and metaproterenol both decrease serum potassium. Use Caution/Monitor.

              albuterol and metaproterenol both decrease sedation. Use Caution/Monitor.

              albuterol and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methadone

              methadone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and methadone both increase QTc interval. Use Caution/Monitor.

            • methamphetamine

              albuterol and methamphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methyclothiazide

              albuterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              albuterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.

              albuterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methylphenidate

              albuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • metolazone

              albuterol and metolazone both decrease serum potassium. Use Caution/Monitor.

            • metoprolol

              metoprolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              metoprolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • midazolam

              midazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midodrine

              albuterol and midodrine both decrease sedation. Use Caution/Monitor.

              albuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • mifepristone

              albuterol and mifepristone both increase QTc interval. Use Caution/Monitor.

            • mirtazapine

              mirtazapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and mirtazapine both increase QTc interval. Use Caution/Monitor.

            • modafinil

              albuterol and modafinil both decrease sedation. Use Caution/Monitor.

            • morphine

              morphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • motherwort

              motherwort increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • moxifloxacin

              albuterol and moxifloxacin both increase QTc interval. Use Caution/Monitor.

            • moxonidine

              moxonidine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabilone

              nabilone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabumetone

              nabumetone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nadolol

              nadolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nadolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • nalbuphine

              nalbuphine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • naproxen

              naproxen increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nebivolol

              nebivolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nebivolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • nilotinib

              albuterol and nilotinib both increase QTc interval. Use Caution/Monitor.

            • norepinephrine

              albuterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and norepinephrine both decrease sedation. Use Caution/Monitor.

              albuterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • nortriptyline

              nortriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • octreotide

              albuterol and octreotide both increase QTc interval. Use Caution/Monitor.

            • ofloxacin

              albuterol and ofloxacin both increase QTc interval. Use Caution/Monitor.

            • olanzapine

              olanzapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances

            • olodaterol inhaled

              albuterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

              albuterol and olodaterol inhaled both increase QTc interval. Use Caution/Monitor.

            • ondansetron

              albuterol and ondansetron both increase QTc interval. Use Caution/Monitor.

            • opium tincture

              opium tincture increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • osilodrostat

              osilodrostat and albuterol both increase QTc interval. Use Caution/Monitor.

              albuterol and osilodrostat both increase QTc interval. Use Caution/Monitor. Dose dependent QT prolongation - avoid drugs known to prolong the QT interval

            • osimertinib

              albuterol and osimertinib both increase QTc interval. Use Caution/Monitor.

            • oxaliplatin

              oxaliplatin will increase the level or effect of albuterol by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

              albuterol and oxaliplatin both increase QTc interval. Use Caution/Monitor.

            • oxaprozin

              oxaprozin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxazepam

              oxazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxycodone

              oxycodone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxymorphone

              oxymorphone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ozanimod

              albuterol and ozanimod both increase QTc interval. Use Caution/Monitor.

            • paliperidone

              paliperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and paliperidone both increase QTc interval. Use Caution/Monitor.

            • panobinostat

              albuterol and panobinostat both increase QTc interval. Use Caution/Monitor.

            • papaveretum

              papaveretum increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • papaverine

              papaverine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • parecoxib

              parecoxib increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pasireotide

              albuterol and pasireotide both increase QTc interval. Use Caution/Monitor.

            • pazopanib

              albuterol and pazopanib both increase QTc interval. Use Caution/Monitor.

            • penbutolol

              penbutolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              penbutolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pentamidine

              albuterol and pentamidine both increase QTc interval. Use Caution/Monitor.

            • pentazocine

              pentazocine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pentobarbital

              pentobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • perphenazine

              perphenazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phendimetrazine

              albuterol and phendimetrazine both decrease sedation. Use Caution/Monitor.

              albuterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenobarbital

              phenobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenoxybenzamine

              phenoxybenzamine, albuterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phentermine

              albuterol and phentermine both decrease sedation. Use Caution/Monitor.

              albuterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine

              albuterol and phenylephrine both decrease sedation. Use Caution/Monitor.

              albuterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • phenylephrine PO

              albuterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.

              albuterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • pholcodine

              pholcodine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimavanserin

              albuterol and pimavanserin both increase QTc interval. Use Caution/Monitor.

            • pimozide

              pimozide increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pindolol

              pindolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pindolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • pirbuterol

              albuterol and pirbuterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and pirbuterol both decrease sedation. Use Caution/Monitor.

              albuterol and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • piroxicam

              piroxicam increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pitolisant

              albuterol and pitolisant both increase QTc interval. Use Caution/Monitor.

            • ponesimod

              albuterol and ponesimod both increase QTc interval. Use Caution/Monitor.

            • posaconazole

              albuterol and posaconazole both increase QTc interval. Use Caution/Monitor.

            • potassium acid phosphate

              potassium acid phosphate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium chloride

              potassium chloride increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • primaquine

              albuterol and primaquine both increase QTc interval. Use Caution/Monitor.

            • primidone

              primidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • procainamide

              albuterol and procainamide both increase QTc interval. Use Caution/Monitor.

            • procarbazine

              procarbazine increases effects of albuterol by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode.

            • prochlorperazine

              prochlorperazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • promethazine

              promethazine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • propafenone

              albuterol and propafenone both increase QTc interval. Use Caution/Monitor.

            • propranolol

              propranolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              propranolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

            • propylhexedrine

              albuterol and propylhexedrine both decrease sedation. Use Caution/Monitor.

              albuterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • protriptyline

              protriptyline increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and protriptyline both increase QTc interval. Use Caution/Monitor.

            • pseudoephedrine

              albuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • quazepam

              quazepam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quetiapine

              quetiapine increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and quetiapine both increase QTc interval. Use Caution/Monitor.

            • quinidine

              albuterol and quinidine both increase QTc interval. Use Caution/Monitor.

            • quinine

              albuterol and quinine both increase QTc interval. Use Caution/Monitor.

            • ranolazine

              albuterol and ranolazine both increase QTc interval. Use Caution/Monitor.

            • ribociclib

              albuterol and ribociclib both increase QTc interval. Use Caution/Monitor.

            • rilpivirine

              albuterol and rilpivirine both increase QTc interval. Use Caution/Monitor.

            • risperidone

              risperidone increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              albuterol and risperidone both increase QTc interval. Use Caution/Monitor.

            • romidepsin

              albuterol and romidepsin both increase QTc interval. Use Caution/Monitor.

            • sacubitril/valsartan

              sacubitril/valsartan increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salicylates (non-asa)

              salicylates (non-asa) increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salmeterol

              albuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.

              albuterol and salmeterol both decrease sedation. Use Caution/Monitor.

              albuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • salsalate

              salsalate increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • saquinavir

              albuterol and saquinavir both increase QTc interval. Use Caution/Monitor.

            • scullcap

              scullcap increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • secobarbital

              secobarbital increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • selpercatinib

              albuterol and selpercatinib both increase QTc interval. Use Caution/Monitor.

            • serdexmethylphenidate/dexmethylphenidate

              albuterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • sertraline

              albuterol and sertraline both increase QTc interval. Use Caution/Monitor.

            • sevoflurane

              albuterol and sevoflurane both increase QTc interval. Use Caution/Monitor.

            • shepherd's purse

              shepherd's purse increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • siponimod

              albuterol and siponimod both increase QTc interval. Use Caution/Monitor.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              albuterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • solifenacin

              albuterol and solifenacin both increase QTc interval. Use Caution/Monitor.

            • solriamfetol

              albuterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • sorafenib

              albuterol and sorafenib both increase QTc interval. Use Caution/Monitor.

            • sotalol

              sotalol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              albuterol and sotalol both increase QTc interval. Use Caution/Monitor.

            • spironolactone

              spironolactone increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • stiripentol

              stiripentol will increase the level or effect of budesonide inhaled by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

            • succinylcholine

              succinylcholine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            Minor (15)

            • bendroflumethiazide

              albuterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • bumetanide

              albuterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorothiazide

              albuterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorthalidone

              albuterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • cyclopenthiazide

              albuterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • ethacrynic acid

              albuterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • eucalyptus

              eucalyptus increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • furosemide

              albuterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • hydrochlorothiazide

              albuterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • indapamide

              albuterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • methyclothiazide

              albuterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • metolazone

              albuterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • noni juice

              noni juice increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • sage

              sage increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • torsemide

              albuterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

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            Adverse Effects

            1-10%

            Headache (4.3%)

            Oral candidiasis (1.3%)

            Cough (1%)

            Postmarketing Reports

            Cardiovascular disorders: Myocardial ischemia, tremor, tachycardia, palpitations, extrasystoles, arrhythmias (eg, atrial fibrillation, supraventricular tachycardia), syncope, hypertension, peripheral vasodilatation

            Endocrine disorders: Signs or symptoms of systemic glucocorticoid effect (eg, hypofunction of the adrenal gland and reduction of growth rate)

            Eye disorders: Cataracts, glaucoma, increased intraocular pressure

            Immune system disorders: Immediate and delayed hypersensitivity reactions (eg, anaphylactic reaction, angioedema, bronchospasm, rash, contact dermatitis and urticaria)

            General disorders: Fever, weight gain, taste perversion, flu syndrome

            Gastrointestinal disorders: Nausea, vomiting, dyspepsia, diarrhea

            Infections: Sinusitis, pharyngitis, respiratory tract infection, nasopharyngitis, gastroenteritis, otitis media, laryngitis

            Metabolic disorders: Hypokalemia, metabolic acidosis

            Musculoskeletal disorders: Hypertonia, musculoskeletal pain, myalgia, asthenia, arthralgia, muscle cramps, fracture

            Neurological or psychiatric system disorders: Migraine, dizziness, central nervous system stimulation, insomnia, hyperactivity, psychiatric symptoms (eg, psychosis, depression, aggressive reactions, irritability, nervousness, restlessness, behavioral disturbances and anxiety)

            Respiratory, thoracic, and mediastinal disorders: Rhinitis, nasal congestion, throat irritation, oropharyngeal edema, upper respiratory inflammation, drying or irritation of the oropharynx

            Skin and subcutaneous tissue disorders: Skin bruising, ecchymosis

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            Warnings

            Contraindications

            Hypersensitivity to albuterol, budesonide, or any of the excipients

            Cautions

            Hypersensitivity reactions (eg, anaphylaxis, angioedema, bronchospasm, oropharyngeal edema, rash, urticaria) reported; discontinue if such reactions occur

            Use sympathomimetic amines cautiously in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus and in patients who are unusually responsive to sympathomimetic amines

            Beta-adrenergic agonists may cause hypokalemia in some patients, possibly through intracellular shunting, and thereby potential for adverse cardiovascular effects may occur; decreased serum potassium is usually transeint, not requiring supplementation

            Orally inhaled corticosteroids may reduce growth velocity when administered to pediatric patients; safety and effectiveness of albuterol/budesonide have not been established in pediatric patients, and is not indicated for use in this population

            Deterioration of asthma

            • Asthma may deteriorate acutely over several hours or chronically over several days or longer
            • If symptoms continue after using albuterol/budesonide or requires more doses than usual, evaluate patient and treatment regimen

            Paradoxical bronchospasm

            • Treatment may produce paradoxical bronchospasm, which may be life threatening
            • If paradoxical bronchospasm occurs following, discontinue immediately, and initiate alternant therapy
            • Paradoxical bronchospasm, when associated with inhaled formulations, frequently occurs with the first use of a new canister

            Cardiovascular effects

            • Beta2-adrenergic agonists can produce clinically significant cardiovascular (CV) effects (eg, increased pulse rate, blood pressure), ECG changes (flattening of T wave, QT prolongation, ST-segment depression), and/or other symptoms
            • If such effects occur, albuterol/budesonide may need to be discontinued
            • Caution in patients with CV disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension

            Maximum daily dose

            • Exceeding maximum dose may result in overdose
            • Clinically significant CV effects and fatalities reported in association with excessive use of inhaled sympathomimetic drugs

            Immunosuppression and risk of infections

            • Unknown, how the dose, route, and duration of corticosteroid administration affect risk of developing a disseminated infection
            • Patients taking immunosuppressants are more susceptible to infection; chicken pox and measles, for example, can have a more serious or even fatal course in susceptible patients using corticosteroids
            • Review patient's immunization history and administer necessary vaccinations
            • Immune globulins (eg, VZIG, IG) may be needed if exposure occurs and active infection occurs; consider antiviral agents if chickenpox develops
            • Inhaled corticosteroids should be used with caution, if at all, in patients with active or quiescent TB infection of the respiratory tract; untreated systemic fungal, bacterial, viral, or parasitic infections; or ocular herpes simplex

            Oropharyngeal candidiasis

            • Inhaled corticosteroid (ICS) may increase risk for localized infections of the mouth and pharynx with Candida albicans
            • Advise patient to rinse their mouth with water, if available, without swallowing following administration to help reduce risk
            • If oropharyngeal candidiasis develops, treat with appropriate local or systemic (ie, oral) antifungal therapy while treatment with albuterol/budesonide continues
            • For some patients, albuterol/budesonide treatment may need to be interrupted

            Hypercorticism and adrenal suppression

            • Orally inhaled budesonide often helps control asthma symptoms with less suppression of hypothalamic-pituitary-adrenal (HPA) function than therapeutically equivalent oral doses of prednisone
            • Since budesonide is absorbed into the circulation and can be systemically active at higher doses, the beneficial effects in minimizing HPA dysfunction may be expected only when recommended dosages are not exceeded

            Reduced bone mineral density

            • Decreases in bone mineral density (BMD) observed with long-term administration of ICS
            • Clinical significance of small changes in BMD with regard to long-term consequences (eg, fracture) is unknown
            • Patients with major risk factors for decreased bone mineral content (eg, prolonged immobilization, family history of osteoporosis, post-menopausal status, tobacco use, advanced age, poor nutrition, or chronic use of drugs that can reduce bone mass [eg, anticonvulsants, oral corticosteroids]) should be monitored and treated with established standards of care

            Glaucoma and cataracts

            • Glaucoma, increased intraocular pressure, and cataracts reported following the long-term administration of ICS
            • Consider referral to an ophthalmologist in patients who develop ocular symptoms

            Drug interaction overview

            • Budesonide is a CYP3A4 substrate (major)
            • Strong CYP3A4 inhibitors
              • Caution
              • Strong CYP3A4 inhibitors may increase adverse effects owing to increased budesonide systemic exposure
            • Other short-acting bronchodilators
              • Use judiciously to prevent beta-agonist overdose
              • Additive effects of albuterol with other bronchodilators may occur
            • Beta-blockers
              • Caution
              • Beta-adrenergic receptor blocking agents not only block the pulmonary effect of beta-agonists (eg, albuterol, but may also produce severe bronchospasm in patients with asthma
              • Therefore, patients with asthma should not normally be treated with beta-blockers
              • However, under certain circumstances (eg, prophylaxis after MI), no acceptable alternatives may be available in these patients
              • In this setting, consider cardioselective beta-blockers, although they should be administered with caution
            • Diuretics
              • Caution; consider monitoring potassium levels
              • ECG changes and/or hypokalemia resulting from nonpotassium sparing diuretics (eg, loop or thiazide diuretics) can be acutely worsened by beta-agonists, especially if beta-agonist dose exceeded
            • Digoxin
              • Monitor serum digoxin levels if coadministered
              • Mean decreases in serum digoxin levels of 16% and 22% demonstrated after single-dose IV and oral albuterol, respectively, to normal volunteers who had received digoxin for 10 days
              • Clinical significance of these findings for patients with obstructive airway disease who are receiving albuterol and digoxin on a chronic basis is unclear
            • MAOIs or TCAs
              • Caution
              • Monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants (TCAs) may enhance adverse effects of beta2-agonists
              • Administer albuterol/budesonide with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents
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            Pregnancy & Lactation

            Pregnancy

            Albuterol or budesonide: Available data from epidemiological studies and postmarketing case reports of pregnancy outcomes following inhaled albuterol or inhaled budesonide use do not consistently demonstrate a risk of major birth defects or miscarriage

            Pregnancy Exposure Registry

            • Registry monitors pregnancy outcomes in women exposed to asthma medications during pregnancy
            • For more information, contact the MotherToBaby Pregnancy Studies conducted by the Organization of Teratology Information Specialists at 1-877-311-8972 or visit https://mothertobaby.org/ongoing-study/asthma/

            Clinical considerations

            • In females with poorly or moderately controlled asthma, risk is increased for several perinatal adverse outcomes (eg, preeclampsia in the mother; prematurity, low birth weight, and small for gestational age in the neonate)
            • Closely monitor pregnant women with asthma and adjust medication as necessary to maintain optimal asthma control

            Labor or delivery

            • Because of the potential for beta-agonist interference with uterine contractility, use of during labor should be restricted to those patients in whom the benefits clearly outweigh the risk
            • Serious adverse reactions, including pulmonary edema, reported during or following treatment of premature labor with beta2-agonists, including albuterol

            Lactation

            Data are unavailable on the effects of albuterol/budesonide on breastfed children or on milk production

            Budesonide, like other inhaled corticosteroids, is present in human milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Albuterol: Short-acting beta2-adrenergic bronchodilator; increases cyclic AMP which leads to protein kinase A activation, which inhibits myosin phosphorylation and lowers intracellular ionic calcium concentrations; these actions result in bronchial smooth muscle relaxation

            Budesonide: Anti-inflammatory corticosteroid; has potent glucocorticoid activity and weak mineralocorticoid activity; inflammation is an important component in the pathogenesis of asthma

            Absorption

            Albuterol (healthy subjects)

            • Peak plasma time: 1 hr
            • Peak plasma concentration: 472.2 pg/mL

            Budesonide (healthy subjects)

            • Peak plasma time: 0.33 hr
            • Peak plasma concentration: 272.8 pg/mL

            Distribution

            Albuterol (healthy subjects)

            • Vd: 565.7 L

            Budesonide (healthy subjects)

            • Protein bound: 85-90%
            • Vd: 1002 L

            Metabolism

            Albuterol: Primarily metabolized by SULTIA3 (sulfotransferase)

            Budesonide: Rapidly and extensively metabolized by CYP3A4 to metabolites with <1% activity of that of the parent compound

            Elimination

            Excretion

            • Albuterol: Primarily renal excretion
            • Budesonide: Urine ~60% as metabolites
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            Administration

            Inhaler Priming and Care

            Write “use by date” (12 months after opening foil pouch) on actuator label using permanent ink

            Rinse white actuator weekly and let dry

            Priming inhaler

            • Primer inhaler before first use
            • Remove mouthpiece cover, shake, and spray test puff into air facing away from user; repeat for a total of 4 test puffs

            Re-priming inhaler

            • Re-prime if not used for >7 days, if inhaler dropped, or after rinsing white actuator
            • Remove mouthpiece cover, shake and spray test puff; repeat for a total of 2 test puffs

            Oral Inhalation

            Shake inhaler and remove cap

            Breathe out fully

            Place mouthpiece into mouth and close lips around mouthpiece

            Start to breathe in deeply and slowly while spraying 1 puff; continue breathing as tolerated

            Remove mouthpiece and hold breath for as long as you can (up to 10 seconds)

            Repeat above steps for 2nd inhalation

            Rinse mouth with water (if available) after inhalation to decrease risk of oral/laryngeal fungal infection (thrush)

            Canister has attached dose indicator showing how many inhalations remain

            Storage

            Store at room temperature at 68-77ºF (20-25ºC)

            Keep in dry (nonhumid) place away from heat and sunlight

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            Images

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
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            Code Definition
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.