Bronchodilators, Adrenergic (Oral/Injection)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For adrenergic bronchodilators taken by mouth or given by injection, the following should be considered:

Allergies - Tell your doctor if you have ever had any unusual or allergic reaction to albuterol, ephedrine, epinephrine, isoproterenol, metaproterenol, or terbutaline. Also, tell your doctor if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy - Some of these medicines can increase blood sugar, blood pressure, and heart rate in the mother, and may increase the heart rate and decrease blood sugar in the infant. Before taking any of these medicines, make sure your doctor knows if you are pregnant or may become pregnant.

Some of these medicines also relax the muscles of the uterus and may delay labor.

• For albuterol : Albuterol has not been studied in pregnant women. Studies in animals have shown that albuterol causes birth defects when given in doses many times the usual human dose.
• For ephedrine : Ephedrine has not been studied in pregnant women or in animals.
• For epinephrine : Epinephrine has been shown to cause birth defects in humans. However, this medicine may be needed during allergic reactions that threaten the mother's life.
• For isoproterenol : Studies on birth defects with isoproterenol have not been done in humans. However, there is some evidence that it causes birth defects in animals.
• For metaproterenol : Metaproterenol has not been studied in pregnant women. However, studies in animals have shown that metaproterenol causes birth defects and death of the animal fetus when given in doses many times the usual human dose.
• For terbutaline : Terbutaline has not been shown to cause birth defects in humans using recommended doses or in animal studies when given in doses many times the usual human dose.

Breast-feeding -

• For albuterol, isoproterenol, and metaproterenol : It is not known whether albuterol, isoproterenol, or metaproterenol passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.
• For ephedrine : Ephedrine passes into breast milk and may cause unwanted side effects in babies of mothers using ephedrine.
• For epinephrine : Epinephrine passes into breast milk and may cause unwanted side effects in babies of mothers using epinephrine.
• For terbutaline : Terbutaline passes into breast milk but has not been shown to cause harmful effects in the infant. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.

Children - There is no specific information comparing use of isoproterenol, metaproterenol, or terbutaline in children with use in other age groups.

Excitement and nervousness may be more common in children 2 to 6 years of age who take albuterol than in adults and older children.

Infants and children may be especially sensitive to the effects of epinephrine.

Older adults - Older adults may be more sensitive to the side effects of these medicines, such as trembling, high blood pressure, or fast or irregular heartbeats.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking adrenergic bronchodilators, it is especially important that your health care professional know if you are taking any of the following:

For all adrenergic bronchodilators
• Amphetamines or
• Appetite suppressants (diet pills) or
• Medicine for colds, sinus problems, or hay fever or other allergies (including nose drops or sprays) or
• Other medicines for asthma or other breathing problems - The chance for side effects may be increased

• Beta-adrenergic blocking agents taken orally or by injection (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin], betaxolol [e.g., Kerlone], bisoprolol [e.g., Zebeta], carteolol [e.g., Cartrol], labetalol [e.g., Normodyne], metoprolol [e.g., Lopressor, Toprol XL], nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Sotacor], timolol [e.g., Blocadren]) - These medicines may prevent the adrenergic bronchodilators from working properly

• Beta-adrenergic blocking agents used in the eye (betaxolol [e.g., Betoptic], levobunolol [e.g., Betagan], metipranolol [e.g., OptiPranolol], timolol [e.g., Timoptic] - Enough of these medicines may be absorbed from the eye into the blood stream to prevent the adrenergic bronchodilators from working properly

• Cocaine - Unwanted effects of both medicines on the heart may be increased

• Digitalis medicines (e.g., Lanoxin) or
• Quinidine (e.g., Quinaglute Dura-Tabs, Quinidex) - The risk of heart rhythm problems may be increased

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) - Taking adrenergic bronchodilators while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may dramatically increase the effects of MAO inhibitors

• Thyroid hormones - The effect of this medicine may be increased

• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Norpramin], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl, Pamelor], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) - The effects of these medicines on the heart and blood vessels may be increased

Other medical problems - The presence of other medical problems may affect the use of these medicines. Make sure you tell your doctor if you have any other medical problems, especially:

• Convulsions (seizures) - These medicines may make this condition worse

• Diabetes mellitus (sugar diabetes) - These medicines may increase blood sugar, which could change the amount of insulin or other diabetes medicine you need

• Enlarged prostate - Ephedrine may make the condition worse

• Gastrointestinal narrowing - Use of the extended-release dosage form of albuterol may result in a blockage in the intestines.

• Glaucoma - Ephedrine or epinephrine may make the condition worse

• High blood pressure or
• Overactive thyroid - Use of ephedrine or epinephrine may cause severe high blood pressure and other side effects may also be increased

• Parkinson's disease - Epinephrine may make stiffness and trembling worse

• Psychiatric problems - Epinephrine may make problems worse

• Reduced blood flow to the brain - Epinephrine further decreases blood flow, which could make the problem worse

• Reduced blood flow to the heart or
• Heart rhythm problems - These medicines may make these conditions worse