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See more conditions. Drugs and Supplements Albuterol Inhalation Route. Products and services. Typical dose: 2. Typical dose range: 0. If the child weighs at least 15 kg: 2.
If the child weighs at least 15 kg: May give 2. In some patients, 90 mcg 1 actuation every 4 hours may be sufficient. Children weighing at least 15 kg can receive up to 2. Start with a 2 mg dose in the geriatric adult. If adequate response not obtained, dose may be increased gradually with caution, up to 8 mg PO 4 times daily. Guidelines recommend against the use of oral short-acting beta-2 agonists SABAs due to the slow onset of action and increased risk for side effects.
Use inhaled SABAs for acute bronchospasm; do not use oral agents. If adequate response not obtained, dose may be increased gradually with caution to 8 mg PO 4 times daily. If an adequate response is not obtained, dose may be increased gradually with caution. If an adequate response is not obtained, may gradually increase, up to 0. Safety and efficacy have not been established; not FDA-approved; 0. Start with 2 mg per dose in the geriatric patient. Start with 4 mg per dose in the geriatric patient.
A controller agent e. Optimal dosing for acute COPD exacerbation is not established; adjust dose according to clinical symptoms or the development of adverse effects; higher or more frequent dosing may be needed.
No significant differences in FEV1 have been demonstrated between metered-dose inhalers with or without a spacer and nebulizers for SABAs in clinical trials; nebulizers may be more convenient for patients who are more acutely ill. Optimal dosing for a COPD exacerbation is not established; adjust dose according to clinical symptoms or the development of adverse effects. A nebulized albuterol dose of 5 mg every 4 hours has been used, as well as a regimen of 2.
Short-acting beta-2 agonists SABAs are preferred therapy for the treatment of acute COPD exacerbation, used with or without a short-acting anticholinergic. No significant differences in FEV1 have been demonstrated between metered-dose inhalers with or without a spacer and nebulizers for SABAs in clinical trials; nebulizers may be more convenient for patients that are more acutely ill. Geriatric patients should receive 2 mg PO every 6 to 8 hours initially.
Use not recommended by guidelines; inhaled bronchodilators are preferred. Single doses of 10 to 20 mg have been administered. However, it is a temporary adjunctive measure. Adjuvant or alternative therapy is warranted for patients experiencing electrocardiographic ECG changes or significantly elevated serum potassium concentrations.
Doses were repeated every 2 hours as needed. Although not specifically studied in this population, nebulized albuterol 2. Smaller doses for younger infants may be necessary. Adjuvant or alternative therapy is warranted for patients experiencing electrocardiographic changes or significantly elevated serum potassium concentrations.
Adjuvant or alternative therapy is warranted for patients experiencing electrocardiographic ECG changes or significantly elevated serum potassium concentrations e. While significantly less common, weight-based dosing of 0. Published reports describe a wide range of effective doses; 0. The optimal frequency of administration has not been clearly defined in the neonatal population.
Of note, significantly larger doses of albuterol are used in nebulization when compared to administration with metered-dose inhalers MDIs due to the inefficiency of nebulized drug delivery. Frequency of administration has not been clearly defined in the neonatal population. Of note, MDIs with inline spacers have demonstrated superior drug delivery when compared to jet nebulizers in simulated neonatal lung models.
Limited data. Major cardiovascular side effects did not occur; heart and respiratory rate increases were deemed clinically unimportant by investigators. Higher maximum dosages for inhalation products have been recommended in NAEPP guidelines for acute exacerbations of asthma. Safety and efficacy have not been established; nebulizer inhalation maximum dependent on patient response and formulation used.
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed. Specific guidelines for dosage adjustments in renal impairment are not available. Caution may be warranted during the administration of high doses in patients with renal impairment, as renal clearance is reduced. Immediate release tablets: Administer orally on a regular dosage schedule as directed by prescriber.
Extended-release tablets: Swallow whole, do not chew or crush the extended-release tablets. Aerosol inhalation e. Make sure the canister is firmly seated in the plastic mouthpiece adapter before each use.
Shake the inhaler well. Prime the inhaler before the first use by spraying four times into the air, away from the eyes and face. When the inhaler has not been used for a prolonged period or it has been dropped, prime by spraying two to four 2 to 4 times into the air away from the face, according to the specific inhaler type.
If a face mask is used, allow 3 to 5 inhalations per actuation. General administration instructions: Shake the inhaler well before each use. Take the cap off the mouthpiece. Hold the inhaler as directed for the inhaler type. The patient will breathe out through the mouth and push as much air from the lungs as the patient can.
Put the mouthpiece in the mouth and have patient close their lips around it. Push the top of the canister all the way down while the patient breathes in deeply and slowly through the mouth. Right after the spray comes out, release the canister. After the patient has breathed in all the way, take the inhaler out of the mouth. The patient should hold breath as long as they can, up to 10 seconds, then breathe normally.
If prescribed more sprays, wait 1 minute and shake the inhaler again. Repeat inhaler steps. Put the cap back on the mouthpiece after use. Following administration, instruct patient to rinse the mouth with water to minimize dry mouth. To avoid the spread of infection, do not use the inhaler for more than one person. Clean the plastic mouthpiece of the inhaler at least once a week; some manufacturers advocate daily cleaning. After removing the medication canister wash the mouthpiece in warm running water.
Do not allow the medication canister to get wet. Shake excess water from the mouthpiece and verify that all medication build-up has been rinsed away. Allow the mouthpiece to air-dry before next use e.
Ventolin HFA expires 12 months after medication removal from the foil pouch. Nebulizers can transmit respiratory viral particles. For infants and children up to 3 years of age, a pressurized MDI plus spacer with face mask is recommended; a nebulizer with a face mask is an alternative.
For children 4 to 5 years old, a pressurized MDI plus spacer is recommended; a pressurized MDI plus spacer with face mask or a nebulizer with a face mask is an alternative.
In children 2 years and older with acute asthma, the use of an MDI plus valved holding chamber VHC is as effective as nebulized therapy when appropriate administration technique is used.
The method of delivery does not result in a significant difference in hospital admission rates in children seen in the emergency department or equivalent community setting. Additionally, the length of stay in the emergency department is shorter when a VHC was used. Before using for the first time, check the dose counter window to ensure that the inhaler is full and the number "" is in the window.
The dose counter will count down each time the mouthpiece cap is opened and closed. The dose counter only displays even numbers example: , , , etc. Hold the inhaler upright while opening the cap fully. When the cap is opened, a dose of albuterol will be activated for delivery of the medicine. Make sure a "click" sound is heard; if not, the inhaler may not be activated to give a dose of medicine.
The cap should not be opened unless the patient is ready to take a dose; opening and closing the cap without inhaling a dose will waste the medicine and may damage the inhaler.
The patient should breathe out through the mouth and push as much air from the lungs as they can. Be careful that the patient does not breathe out into the inhaler mouthpiece. Put the mouthpiece in the mouth and have the patient close their lips around it.
The patient should breathe in deeply through the mouth until their lungs feel completely full of air. Ensure that the vent above the mouthpiece is not blocked by the patient's lips or fingers. The patient should hold their breath for about 10 seconds or as long as they comfortably can. Remove the inhaler from the mouth. Check the dose counter on the back of the inhaler to make sure the dose was received.
Close the cap over the mouthpiece after each use of the inhaler; make sure the cap closes firmly into place. To inhale another dose, close the cap and then repeat inhaler steps.
The inhaler contains a powder and must be kept clean and dry at all times. Do not wash or put any part of the inhaler in water. If the mouthpiece needs cleaning, gently wipe it with a dry cloth or tissue.
When there are "20" doses left, the dose counter will change to red; refill the prescription or contact the doctor for another prescription. ProAir Digihaler contains a built-in electronic module which detects, records, and stores data on inhaler events, including peak inspiratory flow rate.
A mobile app is required for data transmission but is not required for the administration of albuterol to the patient. Throw away the inhaler 13 months after removing it from the foil pouch for the first time, when the dose counter displays "0", or after the expiration date on the package, whichever comes first. Deliver solution by nebulization over 5 to 15 minutes. The choice of using a mouthpiece versus a face mask must be made based on the skills and understanding of each individual patient.
Using the 'blow-by' technique i. Some nebulizer solutions state a grace period of 1 week is allowed after removal from the foil pouch. Paradoxical bronchospasm can occur after treatment with albuterol and can be life-threatening. If this occurs, albuterol should be discontinued immediately and supportive care provided as necessary. Additionally, increased albuterol use may indicate asthma destabilization.
Asthma may deteriorate acutely over a period of hours or chronically over several days or weeks. If deterioration of asthma occurs during therapy with albuterol, appropriate evaluation of the patient and the treatment strategy is warranted, giving special consideration to corticosteroid therapy.
Albuterol has no anti-inflammatory activity and is not a substitute for inhaled or oral corticosteroid therapy. The use of beta-agonists alone may not be adequate to control asthma in many patients. Early consideration should be given to adding anti-inflammatory agents e. Corticosteroids should not be stopped or reduced when albuterol therapy is instituted. Do not exceed recommended dosages of beta-agonists; fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs in patients with asthma.
The exact cause of death is unknown, but cardiac arrest after an unexpected development of a severe acute asthmatic crisis and subsequent hypoxia is suspected. Albuterol is contraindicated in patients with albuterol hypersensitivity, levalbuterol hypersensitivity, or hypersensitivity to any component of the specific dosage formulation.
Albuterol inhalation powder i. Like other beta-agonists, albuterol can produce paradoxical bronchospasm, which may be life-threatening. If paradoxical bronchospasm occurs, albuterol should be discontinued immediately and alternative therapy instituted. It should be recognized that paradoxical bronchospasm, when associated with inhaled formulations, frequently occurs with the first use of a new canister or vial. Albuterol, like other sympathomimetic amines, should be used cautiously in patients with a history of seizures or seizure disorder, hyperthyroidism, pheochromocytoma, or unusual responsiveness to other sympathomimetic amines.
Pheochromocytoma may increase the risk of prolonging the QT interval when using albuterol. Monitor heart rate and blood pressure in patients receiving high doses of albuterol for acute asthma exacerbations; cardiovascular adverse effects are more likely to occur when aggressive doses are used. Use albuterol with caution in patients with cardiovascular disorders, including ischemic cardiac disease coronary artery disease , hypertension, cardiac arrhythmias, tachycardia, or QT prolongation.
Beta-agonists should be avoided in patients with congenital long QT syndrome due to the risk of torsade de pointes and QT prolongation. Use albuterol with caution in patients with conditions that may increase the risk of QT prolongation including bradycardia, AV block, heart failure, stress-related cardiomyopathy, myocardial infarction, stroke, hypomagnesemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances.
Females, people 65 years and older, patients with sleep deprivation, pheochromocytoma, sickle cell disease, hypothyroidism, hyperparathyroidism, hypothermia, systemic inflammation e. Significant changes in systolic and diastolic blood pressures and heart rate could be expected to occur in some patients after use of any beta-adrenergic bronchodilator. As with other beta-adrenergic agonist medications, albuterol may produce significant hypokalemia in some patients, possibly through intracellular shunting, which has the potential to produce adverse cardiovascular effects.
The decrease is usually transient, not requiring supplementation. Correct pre-existing hypokalemia before beta-agonist administration; hypokalemia may increase the risk of prolonging the QT interval when using albuterol. Use albuterol with caution in patients with diabetes mellitus. Large doses of intravenous racemic albuterol have been reported to aggravate preexisting diabetes mellitus and diabetic ketoacidosis. Also, patients with diabetic ketoacidosis DKA typically have a severe electrolyte imbalance.
Serum potassium concentrations must be closely monitored during the treatment of DKA and albuterol may contribute to changes in serum potassium concentrations. There are no randomized clinical studies of use of albuterol during pregnancy. Available data from published epidemiological studies and postmarketing case reports of pregnancy outcomes following inhaled albuterol use do not consistently demonstrate a risk of major birth defects or miscarriage.
Poorly controlled or moderately controlled asthma represents risks in pregnant women; there is an increased risk of preeclampsia in the mother and prematurity, low birth weight, and small for gestational age in the neonate.
Pregnant women should be closely monitored and medication adjusted as necessary to maintain optimal control. Inhalation therapy is preferred to oral albuterol treatment.
Albuterol is preferred over other SABAs due to extensive safety-related information during pregnancy. However, there is no evidence of fetal injury with the use of other inhaled SABAs, and maintaining a previously established treatment regimen may be more beneficial to the patient. Due to the potential for beta-agonist interference with uterine contractility, the use of albuterol for acute relief of bronchospasm during labor and obstetric delivery should be restricted to those patients in whom the benefits clearly outweigh the risks.
Additionally, albuterol is not approved for the management of pre-term labor; serious adverse events, including pulmonary edema, have been reported after treatment of premature labor with beta-2 agonists. A pregnancy registry is available to monitor pregnancy outcomes in women exposed to asthma medications, including levalbuterol.
According to the National Asthma Education and Prevention Program NAEPP for managing asthma during pregnancy, there is currently no contraindication for the use of short-acting inhaled beta-2 agonists, including albuterol, during breast-feeding.
Inhaled albuterol therapy is preferred over oral treatment. Plasma concentrations of albuterol after inhalation of therapeutic doses are very low in humans and substantially lower than systemically-administered albuterol. If present in breast milk, albuterol has low oral bioavailability in the infant. Reported clinical experience with inhaled albuterol has not identified any differences in safety, efficacy, or clinical responsiveness with geriatric vs.
Geriatric patients may be more sensitive to the side effects of inhaled and systemic beta-agonists, especially tremor and tachycardia. Geriatric patients may be at increased risk for developing a prolonged QT interval when using albuterol. Although not clearly established, airway responsiveness to albuterol may also change with age.
Monitor for adverse effects, as inhaled beta-agonists, such as albuterol, can cause restlessness, increased heart rate, and anxiety. Albuterol should be administered with extreme caution to patients being treated with monoamine oxidase inhibitor therapy MAOI therapy or within 2 weeks of discontinuation of such agents, because the action of albuterol on the vascular system may be potentiated.
Abarelix: Major Since abarelix can cause QT prolongation, abarelix should be used cautiously, if at all, with other drugs that are associated with QT prolongation. Prescribers need to weigh the potential benefits and risks of abarelix use in patients with prolonged QT syndrome or in patients taking other drugs that may prolong the QT interval.
Agents associated with a lower, but possible risk for QT prolongation and torsade de pointes TdP based on varying levels of documentation include the beta-agonists. Acebutolol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Monitor the patients lung and cardiovascular status closely. Beta-agonists and beta-blockers are pharmacologic opposites, and will counteract each other to some extent when given concomitantly, especially when non-cardioselective beta blockers are used.
Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. Beta-agonists can sometimes increase heart rate or have other cardiovascular effects, particularly when used in high doses or if hypokalemia is present.
Acetaminophen; Caffeine: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists. Acetaminophen; Caffeine; Dihydrocodeine: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists.
Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Acetaminophen; Chlorpheniramine; Phenylephrine : Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Acetaminophen; Dextromethorphan; Phenylephrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Acetaminophen; Dextromethorphan; Pseudoephedrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Acetaminophen; Dichloralphenazone; Isometheptene: Major Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Acetaminophen; Guaifenesin; Phenylephrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Acetaminophen; Pseudoephedrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Acetazolamide: Moderate Albuterol may cause additive hypokalemia when coadministered with carbonic anhydrase inhibitors. These combinations can lead to symptomatic hypokalemia and associated ECG changes in some susceptible individuals. Monitoring of potassium levels would be advisable. Acrivastine; Pseudoephedrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Alfuzosin may prolong the QT interval in a dose-dependent manner. Amisulpride causes dose- and concentration- dependent QT prolongation. Beta-agonists may be associated with adverse cardiovascular effects including QT interval prolongation, usually at higher doses, when associated with hypokalemia, or when used with other drugs known to prolong the QT interval.
This risk may be lower with short-acting beta-agonists as compared to long-acting beta-agonists. Amitriptyline: Minor Tricyclic antidepressants TCAs share pharmacologic properties similar to the Class IA antiarrhythmic agents and may prolong the QT interval, particularly in overdose or with higher-dose prescription therapy elevated serum concentrations.
Beta agonists infrequently produce cardiovascular adverse effects, mostly with high doses or in the setting of beta-agonist-induced hypokalemia. Amoxicillin; Clarithromycin; Omeprazole: Minor The coadministration of beta-agonists with clarithromycin may increase the risk for adverse effects, including prolongation of the QT interval. The action of beta-agonists on the cardiovascular system may be potentiated by clarithromycin.
Clarithromycin is a strong CYP3A4 inhibitor and the co-administration of salmeterol or indacaterol with strong CYP3A4 inhibitors can result in elevated concentrations and increased risk for potential cardiovascular adverse effects. Amphetamine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Amphetamine; Dextroamphetamine Salts: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects. Amphetamine; Dextroamphetamine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Anagrelide: Minor Beta-agonists should be administered with caution to patients being treated with drugs known to prolong the QT interval because the action of beta-agonists on the cardiovascular system may be potentiated. Torsades de pointes TdP and ventricular tachycardia have been reported with anagrelide. In addition, dose-related increases in mean QTc and heart rate were observed in healthy subjects. A cardiovascular examination, including an ECG, should be obtained in all patients prior to initiating anagrelide therapy.
Monitor patients during anagrelide therapy for cardiovascular effects and evaluate as necessary. Apomorphine: Minor Beta-agonists should be used cautiously with apomorphine. Dose-related QTc prolongation is associated with therapeutic apomorphine exposure. Aripiprazole: Minor Use caution if administering aripiprazole with other drugs that may cause QT prolongation, including the short-acting beta-agonists SABAs. QT prolongation has occurred during therapeutic use of aripiprazole and following overdose.
Arsenic Trioxide: Minor Beta-agonists should be used cautiously and with close monitoring with arsenic trioxide. Torsade de pointes TdP , QT interval prolongation, and complete atrioventricular block have been reported with arsenic trioxide use. Avoid concomitant use of arsenic trioxide with other drugs that may cause QT interval prolongation; discontinue or select an alternative drug that does not prolong the QT interval prior to starting arsenic trioxide therapy.
If concomitant drug use is unavoidable, frequently monitor electrocardiograms. This risk may be more clinically significant with long-acting beta-agonists i. Beta-agonists should be administered with caution to patients being treated with drugs known to prolong the QT interval because the action of beta-agonists on the cardiovascular system may be potentiated.
Artemether; Lumefantrine: Minor The administration of artemether; lumefantrine is associated with prolongation of the QT interval. Although there are no studies examining the effects of artemether; lumefantrine in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation and should be avoided.
Consider ECG monitoring if other QT prolonging drugs must be used with or after artemether; lumefantrine treatment. Articaine; Epinephrine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Asenapine: Minor Asenapine has been associated with QT prolongation. According to the manufacturer of asenapine, the drug should be avoided in combination with other agents also known to have this effect.
Atenolol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Atenolol; Chlorthalidone: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Atomoxetine: Minor Use caution when using atomoxetine in combination with short-acting beta-agonists as concurrent use may increase the risk of QT prolongation.
QT prolongation has occurred during therapeutic use of atomoxetine and following overdose. This risk may be more clinically significant with long-acting beta-agonistsas compared to short-acting beta-agonists. Azithromycin: Major Avoid coadministration of azithromycin with short-acting beta-agonists due to the increased risk of QT prolongation. If use together is necessary, obtain an ECG at baseline to assess initial QT interval and determine frequency of subsequent ECG monitoring, avoid any non-essential QT prolonging drugs, and correct electrolyte imbalances.
QT prolongation and torsade de pointes TdP have been spontaneously reported during azithromycin postmarketing surveillance. This risk may be more clinically significant with long-acting beta-agonists as compared to short-acting beta-agonists.
Bedaquiline: Minor Due to the potential for QT prolongation and torsade de pointes TdP , caution is advised when administering bedaquiline with beta-agonists. Bedaquiline has been reported to prolong the QT interval. Prior to initiating bedaquiline, obtain serum electrolyte concentrations and a baseline ECG. An ECG should also be performed at least 2, 12, and 24 weeks after starting bedaquiline therapy. Bendroflumethiazide; Nadolol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together.
Benzphetamine: Moderate Caution and close observation should be used when albuterol is used concurrently with other adrenergic sympathomimetics, administered by any route, to avoid potential for increased cardiovascular effects.
Cardiovascular disorders eg, coronary insufficiency, arrhythmias, hypertension. Seizure disorders. Reevaluate periodically. Nursing mothers: not recommended. During or within 2 weeks of MAOIs or tricyclics increased cardiovascular effects ; consider alternative therapy. Oral sympathomimetics: not recommended.
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