Tachycardia as a side effect of albuterol
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Albuterol and Tachycardia: Side Effect Overview
Albuterol, a commonly used beta-2 adrenergic agonist for asthma and other respiratory conditions, is well-documented to cause tachycardia as a side effect. This effect has been observed in both adults and children, as well as in animal studies, and can range from mild increases in heart rate to more serious arrhythmias.
Mechanism and Incidence of Tachycardia with Albuterol
Albuterol stimulates beta-2 adrenergic receptors, which can lead to increased heart rate (tachycardia) and, in some cases, arrhythmias. High serum levels of albuterol, especially with high-dose or continuous nebulization, are associated with significant increases in heart rate. In one study, adult asthmatics receiving high-dose continuous albuterol experienced a mean heart rate increase of 16.3%, and one patient developed supraventricular tachycardia that resolved after stopping the medication . Similar effects have been reported in children, including cases of supraventricular tachycardia following both oral and nebulized albuterol administration 257.
Case Reports and Special Populations
Several case reports highlight the risk of tachycardia and arrhythmias in specific populations. For example, children with underlying cardiac conditions, such as Wolff-Parkinson-White (WPW) syndrome, may be particularly susceptible to albuterol-induced tachyarrhythmias . There are also reports of recalcitrant supraventricular tachycardia in adults due to occult albuterol toxicity, sometimes related to factitious disorder or abuse . In veterinary medicine, albuterol intoxication in dogs has led to paroxysmal ventricular tachycardia and myocardial damage .
Dose-Dependence and Risk Factors
The risk of tachycardia appears to be dose-dependent. In pediatric patients treated for status asthmaticus, both tachycardia and diastolic hypotension were common and correlated with higher albuterol doses. These cardiovascular effects were also associated with biochemical evidence of myocardial injury, especially when tachycardia and hypotension occurred together . Animal studies confirm that tachycardia and transient hypokalemia can occur at doses above the typical clinical range, but significant cardiotoxicity is not expected at standard therapeutic doses in humans .
Clinical Management and Monitoring
Most cases of albuterol-induced tachycardia are self-limited and resolve with discontinuation of the drug. In cases of supraventricular tachycardia, interventions such as vagal maneuvers or adenosine may be required 27. In critically ill adults, standard doses of nebulized albuterol do not typically cause significant tachycardia or arrhythmias, and switching to levalbuterol does not offer a clear advantage in preventing these side effects 89.
Conclusion
Tachycardia is a recognized and dose-dependent side effect of albuterol, occurring in both adults and children. While usually mild, it can occasionally lead to more serious arrhythmias, especially in patients with underlying cardiac conditions or with high-dose exposure. Clinicians should monitor for tachycardia during albuterol therapy, particularly in high-risk populations, and be prepared to manage arrhythmias if they occur 1256710.
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