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.
Beta-adrenergic blockers: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Betaxolol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together.
Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Brimonidine; Timolol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Brompheniramine; Carbetapentane; 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.
Brompheniramine; 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.
Brompheniramine; Hydrocodone; 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.
Brompheniramine; 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.
Brompheniramine; 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. Brompheniramine; Pseudoephedrine; Dextromethorphan: 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.
Bumetanide: Moderate Loop diuretics may potentiate hypokalemia and ECG changes seen with beta agonists. Hypokalemia due to beta agonists appears to be dose related and is more likely with high dose therapy.
Caution is advised when loop diuretics are coadministered with high doses of beta agonists; potassium levels may need to be monitored. Buprenorphine: Minor Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes TdP. FDA-approved labeling for some buprenorphine products recommend avoiding use with Class 1A and Class III antiarrhythmic medications while other labels recommend avoiding use with any drug that has the potential to prolong the QT interval.
Buprenorphine; Naloxone: Minor Buprenorphine has been associated with QT prolongation and has a possible risk of torsade de pointes TdP. Butalbital; Acetaminophen; Caffeine: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists.
Butalbital; Acetaminophen; Caffeine; Codeine: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists. Cabotegravir; Rilpivirine: Minor Caution is advised when administering rilpivirine with short-acting beta-agonists as concurrent use may increase the risk of QT prolongation. Caffeine: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists. Caffeine; Sodium Benzoate: Moderate Caffeine may enhance the cardiac inotropic effects of beta-agonists.
Carbetapentane; 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. Carbetapentane; Diphenhydramine; 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.
Carbetapentane; 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.
Carbetapentane; 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. Carbetapentane; Phenylephrine; Pyrilamine: 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.
Carbetapentane; 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.
Carbinoxamine; 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. Carbinoxamine; Hydrocodone; 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.
Carbinoxamine; Hydrocodone; 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.
Carbinoxamine; 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. Carbinoxamine; 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.
Carbonic anhydrase inhibitors: Moderate Albuterol may cause additive hypokalemia when coadministered with carbonic anhydrase inhibitors. Carteolol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together.
Carvedilol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Ceritinib: Minor Periodically monitor electrolytes and ECGs in patients receiving concomitant treatment with ceritinib and long-acting beta-agonists; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Ceritinib causes concentration-dependent prolongation of the QT interval.
Cetirizine; 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.
Chlophedianol; Dexchlorpheniramine; 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. Chlophedianol; 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.
Chlordiazepoxide; 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. Chloroquine: Major Avoid coadministration of chloroquine with short-acting beta-agonists due to the increased risk of QT prolongation.
Chloroquine is associated with an increased risk of QT prolongation and torsade de pointes TdP ; the risk of QT prolongation is increased with higher chloroquine doses.
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. 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.
Chlorpheniramine; Dihydrocodeine; 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. Chlorpheniramine; Dihydrocodeine; 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.
Chlorpheniramine; Guaifenesin; Hydrocodone; 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. Chlorpheniramine; Hydrocodone; 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.
Chlorpheniramine; Hydrocodone; 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.
Chlorpheniramine; Ibuprofen; 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.
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.
Chlorpheniramine; 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. This risk is generally higher at elevated drugs concentrations of phenothiazines. Chlorpromazine is specifically associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine.
Agents that prolong the QT interval could lead to torsade de pointes when combined with a phenothiazine, and therefore are generally not recommended for combined use. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with chlorpromazine include the beta-agonists.
Ciprofloxacin: Minor Rare cases of QT prolongation and torsade de pointe TdP have been reported with ciprofloxacin during post-marketing surveillance.
Ciprofloxacin should be used with caution in patients receiving drugs that prolong the QT interval. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with ciprofloxacin include the beta-agonists. Cisapride: Contraindicated QT prolongation and ventricular arrhythmias, including torsade de pointes TdP and death, have been reported with cisapride. Because of the potential for TdP, use of other drugs that might increase the QT interval is contraindicated with cisapride.
Citalopram: Minor Citalopram causes dose-dependent QT interval prolongation. According to the manufacturer, concurrent use of citalopram with other drugs that prolong the QT interval is not recommended. If concurrent therapy is considered essential, ECG monitoring is recommended.
Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with citalopram include the beta-agonists. Clarithromycin: Minor The coadministration of beta-agonists with clarithromycin may increase the risk for adverse effects, including prolongation of the QT interval. QT prolongation and torsade de pointes have been reported in patients receiving clofazimine in combination with QT prolonging medications. Clomipramine: 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.
Clozapine: Minor Treatment with clozapine has been associated with QT prolongation, torsade de pointes TdP , cardiac arrest, and sudden death. The manufacturer of clozapine recommends caution during concurrent use with medications known to cause QT prolongation. Drugs with a possible risk for QT prolongation that should be used cautiously and with close monitoring with clozapine include the beta-agonists. Cocaine: Moderate Additive effects and increased toxicity might be observed when using cocaine with beta-agonists, which are sympathomimetic agents.
The combined use of these agents may have the potential for additive adrenergic stimulation and side effects, such as nervousness, insomnia, palpitations, or adverse cardiovascular effects. Codeine; 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.
Codeine; Phenylephrine; Promethazine: 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. Use cautiously with promethazine, which has been reported to cause QT prolongation. Crizotinib: Minor Monitor ECGs for QT prolongation and monitor electrolytes in patients receiving crizotinib concomitantly with short-acting beta-agonists.
An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary for crizotinib patients if QT prolongation occurs. Crizotinib has been associated with concentration-dependent QT prolongation. Dasatinib: Minor Use dasatinib with caution in combination with beta-agonists as concurrent use may increase the risk of QT prolongation. In vitro studies have shown that dasatinib has the potential to prolong the QT interval. Degarelix: Minor Consider whether the benefits of androgen deprivation therapy outweigh the potential risks in patients receiving short-acting beta-agonists as concurrent use may increase the risk of QT prolongation.
Androgen deprivation therapy i. Desipramine: 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. Desloratadine; 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.
Deutetrabenazine: Minor The risk of QT prolongation may be increased with coadministration of deutetrabenazine and short-acting beta-agonists. Deutetrabenazine may prolong the QT interval, but the degree of QT prolongation is not clinically significant when deutetrabenazine is administered within the recommended dosage range. Dexbrompheniramine; 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.
Dexchlorpheniramine; 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.
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.
Dextromethorphan; Diphenhydramine; 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. 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.
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. Dextromethorphan; Quinidine: Minor Beta-agonists should be used cautiously with quinidine.
Quinidine administration is associated with QT prolongation and torsades de pointes TdP. Beta-agonists should be administered with extreme 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. Dichlorphenamide: Moderate Use dichlorphenamide and albuterol together with caution. Metabolic acidosis has been reported with dichlorphenamide and albuterol aerosol and inhalation solution.
Concurrent use may increase the severity of metabolic acidosis. Measure sodium bicarbonate concentrations at baseline and periodically during dichlorphenamide treatment.
If metabolic acidosis occurs or persists, consider reducing the dose or discontinuing dichlorphenamide therapy. Diethylpropion: 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.
The clinical significance of these findings for patients with obstructive airway disease who are receiving albuterol or levalbuterol and digoxin on a chronic basis is unclear. The manufacturer of digoxin recommends measuring serum digoxin concentrations prior to initiation of albuterol or levalbuterol. Dihydrocodeine; 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.
Diphenhydramine; Hydrocodone; 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. Diphenhydramine; 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.
Disopyramide: Minor Beta-agonists should be used cautiously and with close monitoring with disopyramide. Disopyramide administration is associated with QT prolongation and torsade de pointes TdP.
Dobutamine: 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.
Dofetilide: Minor Coadministration of dofetilide and short-acting beta-agonists may increase the risk of QT prolongation. Dolasetron: Minor Administer dolasetron with caution in combination with short-acting beta-agonists as concurrent use may increase the risk of QT prolongation. Dolutegravir; Rilpivirine: Minor Caution is advised when administering rilpivirine with short-acting beta-agonists as concurrent use may increase the risk of QT prolongation.
Donepezil: Minor Use donepezil with caution in combination with short-acting beta-agonists as concurrent use may increase the risk of QT prolongation. Case reports indicate that QT prolongation and torsade de pointes TdP can occur during donepezil therapy. Donepezil; Memantine: Minor Use donepezil with caution in combination with short-acting beta-agonists as concurrent use may increase the risk of QT prolongation.
Dopamine: 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. Dorzolamide; Timolol: Moderate Use of a betaselective cardioselective beta blocker is recommended whenever possible when this combination of drugs must be used together. Doxapram: 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.
Doxepin: 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. Dronedarone: Contraindicated Dronedarone administration is associated with a dose-related increase in the QTc interval. The increase in QTc is approximately 10 milliseconds at doses of mg twice daily the FDA-approved dose and up to 25 milliseconds at doses of mg twice daily.
For more information, ask your healthcare provider or pharmacist You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www. Are you a healthcare professional? YES NO. Monitor digoxin. Caution with non-potassium sparing diuretics eg, loop or thiazide ; monitor. Headache, tachycardia, pain, dizziness, pharyngitis, rhinitis; hypokalemia, paradoxical bronchospasm, cardiovascular effects, immediate hypersensitivity reactions eg, rash, urticaria, angioedema.
Adverse Reactions: Headache, tachycardia, pain, dizziness, pharyngitis, rhinitis; hypokalemia, paradoxical bronchospasm, cardiovascular effects, immediate hypersensitivity reactions eg, rash, urticaria, angioedema. How Supplied: Inhalation aerosol w. Enter Zip Code GoodRx.
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