Albuterol

 Risk Factor: CM
 Class: AUTONOMICS / Sympathomimetics (Adrenergics)

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Albuterol is a b-sympathomimetic used to prevent premature labor (see also Terbutaline and Ritodrine) (1,2,3,4,5,6,7,8,9,10,11 and 12). In twins, however, a double-blind, controlled study involving 144 women (74 treated with albuterol and 70 treated with placebo) observed no difference between the groups in the length of gestation, birth weight, or fetal outcome, except fewer infants in the albuterol group had respiratory distress syndrome (13).

In an in vitro experiment using perfused human placentas, 2.8% of infused drug crossed to the fetal side, but the method only used about 5% of the exchange area of the total placenta (14). Maternal serum concentrations during IV and oral albuterol therapy have been reported (15).

Reproduction studies in mice observed an increase in the incidence of cleft palate at a SC dose of 0.25 mg/kg (0.4 times the maximum recommended human oral dose [MRHD]) and higher (16). Cranioschisis was observed in 37% of the fetuses from pregnant rabbits treated with a 50 mg/kg dose of albuterol (78 times the MRHD) (16).

No published reports linking the use of albuterol to human congenital anomalies have been located, but the majority of reports do not involve 1st trimester exposures. However, in a surveillance study of Michigan Medicaid recipients conducted between 1985 and 1992 involving 229,101 completed pregnancies, 1,090 newborns had been exposed to albuterol during the 1st trimester (F. Rosa, personal communication, FDA, 1993). A total of 48 (4.4%) major birth defects were observed (43 expected). Specific data were available for six defect categories, including (observed/expected) 9/11 cardiovascular defects, 2/2 oral clefts, 2/0.6 spina bifida, 1/2 limb reduction defects, 0/3 hypospadias, and 6/3 polydactyly. Only with the latter defect is there a suggestion of a possible association, but other factors, including the mother's disease, concurrent drug use, and chance, may be involved.

A brief 1980 report described a patient who was treated with a continuous IV infusion of albuterol for 17 weeks via a catheter placed in the right subclavian vein (10,17,18). A normal male infant was delivered within a few hours of stopping the drug. A 1982 report described the use of albuterol in two women with incompetent cervix from the 14th week of gestation to near term (19). Both patients were delivered of normal infants.

Adverse reactions observed in the fetus and mother after albuterol treatment are secondary to the cardiovascular and metabolic effects of the drug. Albuterol may cause maternal and fetal tachycardia with fetal rates exceeding 160 beats/minute (1,2 and 3,12,20). Major decreases in maternal blood pressure have been reported with both systolic and diastolic pressures dropping more than 30 mm Hg (2,4,6). Fetal distress after maternal hypotension was not mentioned. One study observed a maximum decrease in diastolic pressure of 24 mm Hg (34% decrease) but a rise in systolic pressure (20). Other maternal adverse effects associated with albuterol have been acute congestive heart failure, pulmonary edema, and death (21,22,23,24,25,26,27,28 and 29).

Like all b-mimetics, albuterol may cause transient fetal and maternal hyperglycemia followed by an increase in serum insulin (4,30,31,32 and 33). Cord blood levels of insulin are about twice those of untreated control infants and are not dependent on the duration of exposure, gestational age, or birth weight (32,33). These effects are more pronounced in diabetic patients, especially in juvenile diabetics, with the occurrence of significant increases in glycogenolysis and lipolysis (20,34,35). Maternal blood glucose should be closely monitored and neonatal hypoglycemia prevented with adequate doses of glucose.

A group of 20 women in premature labor, treated with oral albuterol (4 mg every 4 hours for several weeks), was matched with a control group of women who were not in premature labor (36). The mean gestational ages at delivery for the treated and nontreated patients were 36.4 and 37.0 weeks, respectively. No significant differences were found between the groups for cord blood concentrations of insulin, triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH). However, growth hormone levels were significantly higher in the treated group than in control patients (36.5 vs. 17.4 ng/mL, respectively, p<0.001). The investigators did not determine the reason for the elevated growth hormone level but speculated that it could be caused by either the use of betamethasone for fetal lung maturation in some women of the albuterol group (and resulting fluctuations in fetal blood glucose and insulin levels), or direct adrenergic stimulation of the fetal pituitary (36). Of interest, of the 12 women who received betamethasone, cord blood growth hormone levels in 11 were compared with those of 8 untreated control women. Although the levels in the treated patients were higher (39.5 vs. 31.4 ng/mL), the difference was not significant.

Albuterol decreases the incidence of neonatal respiratory distress syndrome similar to the way that other b-mimetics do (13,37,38). Long-term evaluation of infants exposed to in utero b-mimetics has been reported, but not specifically for albuterol (39,40). No harmful effects were observed in these infants. However, a brief 1994 Reference described the use of b-sympathomimetics (albuterol, N=1; ritodrine N=7) in eight infants from a group of 16 with retinopathy of prematurity (41). In a matched control group with retinopathy, only 1 of 16 infants was exposed to ritodrine (p<0.008). The authors speculated that the b-sympathomimetics had compromised retinal perfusion in utero leading to ischemia and eventually to the ophthalmic complication (41).

The effects of inhaled albuterol on maternal and fetal hemodynamics were first published as an abstract (42) and then as a full report (43). Twelve pregnant asthmatic women between 33 and 39 weeks' gestation received two deep inhalations of a 0.05% solution as recommended by the manufacturer. No effects on the mean maternal, uterine, or fetal hemodynamics were observed.

In contrast to the above, a 1997 case report described fetal tachycardia from the inadvertent administration of a double dose of inhaled albuterol over 24 hours (44). The 34-year-old woman at 33 weeks' gestation received a metered-dose inhaler (two 90-g actuations every 46 hours; 5 doses over 24 hours) and albuterol nebulizer treatment (2.5 mg) every 4 hours (5 doses over 24 hours). Three hours after the last dose, fetal tachycardia (>200 beats/minute) was detected (maternal heart rate was 90100 beats/minute). Atrial flutter of 420 beats/minute was detected by fetal echocardiography with a predominate 2:1 conduction. Eight hours later, spontaneous conversion to a normal rate occurred. A normal infant was delivered at term and did well during the 4 days of hospitalization.

Breast Feeding Summary

No reports describing the use of albuterol during human lactation or measuring the amount, if any, of the drug excreted in milk have been located. Other drugs in the class (e.g., terbutaline) are considered compatible with breast feeding and albuterol, most likely, is also compatible.

References

1. Liggins GC, Vaughan GS. Intravenous infusion of salbutamol in the management of premature labor. J Obstet Gynaecol Br Commonw 1973;80:2933.
2. Korda AR, Lynerum RC, Jones WR. The treatment of premature labor with intravenous administered salbutamol. Med J Aust 1974;1:7446.
3. Hastwell G. Salbutamol aerosol in premature labour. Lancet 1975;2:12123.
4. Hastwell GB, Halloway CP, Taylor TLO. A study of 208 patients in premature labor treated with orally administered salbutamol. Med J Aust 1978;1:4659.
5. Hastwell G, Lambert BE. A comparison of salbutamol and ritodrine when used to inhibit premature labour complicated by ante-partum haemorrhage. Curr Med Res Opin 1979;5:7859.
6. Ng KH, Sen DK. Hypotension with intravenous salbutamol in premature labour. Br Med J 1974;3:257.
7. Pincus R. Salbutamol infusion for premature labour - the Australian trials experience. Aust NZ Obstet Gynaecol 1981;21:14.
8. Gummerus M. The management of premature labor with salbutamol. Acta Obstet Gynecol Scand 1981;60:3757.
9. Crowhurst JA. Salbutamol, obstetrics and anaesthesia: a review and case discussion. Anaesth Intensive Care 1980;8:3943.
10. Lind T, Godfrey KA, Gerrard J, Bryson MR. Continuous salbutamol infusion over 17 weeks to pre-empt premature labour. Lancet 1980;2:11656.
11. Kuhn RJP, Speirs AL, Pepperell RJ, Eggers TR, Doyle LW, Hutchison A. Betamethasone, albuterol, and threatened premature delivery: benefits and risks. Study of 469 pregnancies. Obstet Gynecol 1982;60:4038.
12. Eggers TR, Doyle LW, Pepperell RJ. Premature labour. Med J Aust 1979;1:2136.
13. Felicity Ashworth M, Spooner SF, Verkuyl DAA, Waterman R, Ashurst HM. Failure to prevent preterm labour and delivery in twin pregnancy using prophylactic oral salbutamol. Br J Obstet Gynaecol 1990;97:87882.
14. Sodha RJ, Schneider H. Transplacental transfer of b-adrenergic drugs studied by an in vitro perfusion method of an isolated human placental lobule. Am J Obstet Gynecol 1983;147:30310.
15. Haukkamaa M, Gummerus M, Kleimola T. Serum salbutamol concentrations during oral and intravenous treatment in pregnant women. Br J Obstet Gynaecol 1985;92:12303.
16. Product information. Proventil. Schering Corporation, 2000.
17. Boylan P, ODiscoll K. Long-term salbutamol or successful Shirodkar suture? Lancet 1980;2:1374.
18. Addis GJ. Long-term salbutamol infusion to prevent premature labor. Lancet 1981;1:423.
19. Edmonds DK, Letchworth AT. Prophylactic oral salbutamol to prevent premature labour. Lancet 1982;1:13101.
20. Wager J, Fredholm B, Lunell NO, Persson B. Metabolic and circulatory effects of intravenous and oral salbutamol in late pregnancy in diabetic and non-diabetic women. Acta Obstet Gynecol Scand 1982;Suppl 108:416.
21. Whitehead MI, Mander AM, Hertogs K, Williams RM, Pettingale KW. Acute congestive cardiac failure in a hypertensive woman receiving salbutamol for premature labour. Br Med J 1980;280:12212.
22. Poole-Wilson PA. Cardiac failure in a hypertensive woman receiving salbutamol for premature labour. Br Med J 1980;281:226.
23. Fogarty AJ. Cardiac failure in a hypertensive woman receiving salbutamol for premature labour. Br Med J 1980;281:226.
24. Davies PDO. Cardiac failure in a hypertensive woman receiving salbutamol for premature labour. Br Med J 1980;281:2267.
25. Robertson M, Davies AE. Cardiac failure in a hypertensive woman receiving salbutamol for premature labour. Br Med J 1980;281:227.
26. Crowley P. Cardiac failure in a hypertensive woman receiving salbutamol for premature labour. Br Med J 1980;281:227.
27. Whitehead MI, Mander AM, Pettingale KW. Cardiac failure in a hypertensive woman receiving salbutamol for premature labour (reply). Br Med J 1980;281:227.
28. Davies AE, Robertson MJS. Pulmonary oedema after the administration of intravenous salbutamol and ergometrine-case report. Br J Obstet Gynaecol 1980;87:53941.
29. Milliez, Blot Ph, Sureau C. A case report of maternal death associated with betamimetics and betamethasone administration in premature labor. Eur J Obstet Gynaecol Reprod Biol 1980;11: 95100.
30. Thomas DJB, Dove AF, Alberti KGMM. Metabolic effects of salbutamol infusion during premature labour. Br J Obstet Gynaecol 1977;84:4979.
31. Wager J, Lunell NO, Nadal M, Ostman J. Glucose tolerance following oral salbutamol treatment in late pregnancy. Acta Obstet Gynecol Scand 1981;60:2914.
32. Lunell NO, Joelsson I, Larsson A, Persson B. The immediate effect of a B-adrenergic agonist (salbutamol) on carbohydrate and lipid metabolism during the third trimester of pregnancy. Acta Obstet Gynecol Scand 1977;56:4758.
33. Procianoy RS, Pinheiro CEA. Neonatal hyperinsulinism after short-term maternal beta sympathomimetic therapy. J Pediatr 1982;101:6124.
34. Barnett AH, Stubbs SM, Mander AM. Management of premature labour in diabetic pregnancy. Diabetologia 1980;188:3658.
35. Wager J, Fredholm BB, Lunell NO, Persson B. Metabolic and circulatory effects of oral salbutamol in the third trimester of pregnancy in diabetic and non-diabetic women. Br J Obstet Gynaecol 1981;88:35261.
36. Desgranges M-F, Moutquin J-M, Peloquin A. Effects of maternal oral salbutamol therapy on neonatal endocrine status at birth. Obstet Gynecol 1987;69:5824.
37. Hastwell GB. Apgar scores, respiratory distress syndrome and salbutamol. Med J Aust 1980;1:1745.
38. Hastwell G. Salbutamol and respiratory distress syndrome. Lancet 1977;2:354.
39. Wallace RL, Caldwell DL, Ansbacher R, Otterson WN. Inhibition of premature labor by terbutaline. Obstet Gynecol 1978;51:38792.
40. Freysz H, Willard D, Lehr A, Messer J, Boog G. A long term evaluation of infants who received a beta-mimetic drug while in utero. J Perinat Med 1977;5:949.
41. Michie CA, Braithwaite S, Schulenberg E, Harvey D. Do maternal b-sympathomimetics influence the development of retinopathy in the premature infant? Arch Dis Child 1994;71:F149.
42. Rayburn WF, Atkinson BD, Gilbert KA, Turnbull GL. Acute effects of inhaled albuterol (Proventil) on fetal hemodynamics (abstract). Teratology 1994;49:370.
43. Rayburn WF, Atkinson BD, Gilbert K, Turnbull GL. Short-term effects of inhaled albuterol on maternal and fetal circulations. Am J Obstet Gynecol 1994;171:7703.
44. Baker ER, Flanagan MF. Fetal atrial flutter associated with maternal beta-sympathomimetic drug exposure. Obstet Gynecol 1997;89:861.
    
    

Questions and Answers

advair and albuterol while pregnant?

I have severe bronchial ashthma. I am on advair and albuterol and a couple of other meds. The others I can do without, but I am 6 weeks pregnant. I am concerned with these 2 meds.

The Food and Drug Administration has issued warnings regarding the popular asthma inhaler Advair Diskus used by millions of Americans. The Advair inhaler is linked to serious side effects including severe asthma-attacks and sudden death among patients.



you should ask your doctor about what albuterol and advair will do to babies . Albuterol is in the FDA pregnancy category C. This means that it is not known whether it will harm an unborn baby. Do not take albuterol without first talking to your doctor if you are pregnant or could become pregnant during treatment.
nobrfeed It is not known whether albuterol passes into breast milk. Do not take albuterol without first talking to your doctor if you are breast-feeding a baby.

Is using albuterol in nebulizer safe when your pregnant?

The doctor in the er, and my ob said it's ok, but i read on-line that it's category c which isn't that great? I also have been using the inhaler, they say all of it is ok. I'm just really nervous, so has anyone ever taken any of these while pregnant? Please give me your opininion i just been having really bad asthma and i'm 21 weeks pregnant. Thanks!

I am 14 wks pregnant and also have asthsma. Go ahead and do your nebulizer treatment. When controlled, asthma during pregnancy is okay, but if you are having trouble breathing the lack of oxygen to the fetus will do more harm than the meds. Its better for you and your baby to take your asthma meds as needed. Breathing is good! plus it feels awful to have to struggle to breathe. Don't worry even if you need several treatments in a row. When my mom was preg with my brother she was given multiple treatments (w/abuterol neb) in the hospital. they all assured her it would be fine, and my brother is now a healthy 23 yr old. I use my meds when I need too. Including the nebulizer. Just think of it like, when you can't breathe, your baby can't breathe. The benefits way outweigh any possible risks.

can you use albuterol humidfiers while pregnant?

6 weeks?

You mean albuterol nebulizer treatments? Yes, baby can't breathe if mom can't breathe. Still check with your doctor. I could use them while i was pregnant

Albuterol Inhaler and 11 weeks pregnant?

Im just wanting to know if an albuterol Inhaler for asthma is safe during pregnancy..Some say yes some say no. Is anyone here pregnant and takeing albuterol

Yea I had the same concern now I'm 20 weeks pregnant and everything looks good. My asthma specialist told me that albuterol categorized as C but she also said taking care of my asthma is better than having an asthma attack where it would actually affect the baby.

What I did in the beginning was use saline inhalations 2 to 3 times a day and albuterol inhaler only when needed not straight in a row like Iike before I was pregnant. Till this day I try to stay away from things that trigger my asthma and only take albuterol as needed and rest.Basically what I'm trying to say is that not taking care of your asthma is worse than ignoring it because (you would know) leaving asthma alone will only get worse and worse and you'll end up needing steroids which you wouldn't want to do. I hope I helped you out in some way :)

and don't forget to talk to an asthma specialist he/she can probably help you out.

alternative to albuterol while pregnant?

Is there a safer alternative to albuterol while pregnant?
Don't answer "ask you doc"
I plan to, just wanted to gather info in the mean time.

Albuterol is a Class C drug.

My nurse said if I use it more than 2x a day they would give me something safer. After I got off the phone it dawned on me .....
"SAFER?" If there is something "safer" I want it now.

I don't even take tylenol unless I absolutely need to and every other effort has failed.
However I MUST breathe....so what is "SAFER"??

I am on my third pregnancy. I have asthma and used albuterol every pregnancy. Albuterol is fine to use. I was always told that you shouldn't use it more than 2x a day regardless if you're pregnant or not. If you use it more than 2x then you need something stronger cause its just not cutting it for you....And I've seen tons of doctors and never heard anything about "safer"

Can I take Albuterol while pregnant?

Hi I was diagnosed with binocular asthma at 16 years old.

As long as I did not run I felt fine, well I think my asthma has caught up with me. Help does this sound like asthma?

I get short of breath, like I cant take a good full lung of breath.

I feel like I have mucus in my lungs that I need to clear my throat a lot.

I get dizzy and lightheaded.

I did go to the E.R for short of breath, like 2 weeks ago and they did a EKG and a Xray of my lungs, I was not short of breath any more when they did this, I was fine but dehydrated they said.

So If I took a puff of a inhaler Albuterol would I be OK?

Oh by the way I am 3 months pregnant.

I also take high blood pressure medication called METHYLDOPA 250 MG 3 times a day. And Zyrtec 1 time a day.
I am going to see my doctor tomorrow.
Please help!

I have had asthma since I was 5 years old. With both of my pregnancies, my doctor had me stay on ALL my asthma medications (albuterol, Advair, Singulair) because he said it would be worse for me to have trouble breathing and not get oxygen to the baby then the side effects of the albuterol would be. However, remember you are always short of breath in pregnancy...sometimes even in the beginning. So, it could be that or something more serious. Don't take ANYTHING until you speak with your doctor. I don't know if you have a specialist you see for your allergies/asthma, but my allergist and my ob/gyn actually communicated and shared files so that my baby and I got the best treatment possible. I have had two healthy boys and took my asthma medication throughout both pregnancies. Only your doctor can prescribe medication and advise you as to what is safe to take and what is not...it is based on each individual case. Good luck...being short of breath while pregnant isn't fun! So, rest as much as you can!

Is it safe for me to use my asthma medicine while pregnant?

Here's the deal, I just found out I am pregnant about a week ago, and I have an appointment to see my doctor on Wednesday. My problem is that I have asthma, and I'm starting to have some tightness in my chest. Normally I would use my inhaler and I'd be alright, but I'm unsure if it's safe for me to use my medicine since I'm pregnant. It's an Albuterol inhaler if that makes any difference.

Does anyone have any similar experiences? Any advice?

i would put a call into the doctors office,if you cant speak with the dr directly there should be a nurse that can deliver the message,if you cant use it he or she will or should be able to call in a prescrip for you...i had a friend who had severe asthma and she needed treatment thru out but not sure what she was on.....goodluck.

Is it possible that my albuterol doesn't work for me anymore after over 20 years?

Just today I took my rescue inhaler and I feel worse. Could it be because I'm pregnant that it's not working or that it's just the baby crushing my lungs or that albuterol doesn't work for me anymore.

My doc gave me a different prescription when I was pg, other than albuterol. If I can find the name, I'll let you know. It wasn't that the albuterol was ineffective, though, it was because the other med was safer for the baby.

Is it safe to take any kind of medicine for a cold while you are pregnant?

I am 13 weeks pregnant and I have a cold. It is hard to deal with because I have bronchitis and asthma so when I have a cold, it makes it even harder to breathe because my nose gets stopped up too. I am allowed to take my albuterol inhaler which helps some but doesnt help my bronchitis. I am wondering if it atleast ok to take some nose spray to clear my nose or something. Does anyone know?

WWW.SAFEFETUS.COM That website will answer all questions about any medicine that you have. By the way, saline solution is ok for your nose!
Very Best Wishes!
Congrats!

Is albuterol or advair safe during pregnancy?

I am 12 weeks pregnant and have asthma. I need to know if anyone has any information regarding using albuterol or advair, or if anyone has any experience using these medications. I read it was bad for the fetus, but has not met anyone who has used them during pregnancy. Any information would be helpfull. Thanks!

I'm the mother of 3 and 20 weeks pregnant w/#4. i am on albuterol and advair as well oral meds for my asthma.

i have PERFECTLY HEALTHY! babies!! not one of them has asthma, or allergies. none of them have any birth defects either, and i did not have any complications to my babies due to my medication use for my asthma. in fact my youngest son is gifted.

some docs will tell you don't take the meds..others will say it's fine.
if i don't take my meds i am in the hospital in a few days, and i would have to stay there.

i have not read any studies that are conclusive about adverse effects of these medication on the baby.

considering how serious asthma can be in later pregnancy (when heaviness in the chest can occur) i would NOT stop taking your meds unless your doc gives you something else.
also be careful after baby is born...the 'heaviness' feeling in the chest can occur as your organs shift back to where they were pre-pregnancy while your uterus retracts to it's pre-pregnancy size...i have had one asthma attack from that.

listen to your body, you know it better than i or your doc even!
I've had asthma since i was 12, I'm 29 now.