Albuterol 0.021%(0.63mg/3ml) 25x3ml

• Beta-blockers (e.g., propranolol, carvedilol): May block the bronchodilatory effect of albuterol and produce severe bronchospasm in asthmatic patients. Avoid concomitant use.
• Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants (TCAs): May potentiate the vascular effects of albuterol, leading to severe cardiovascular adverse effects. Use with extreme caution or avoid within 14 days of MAOI/TCA discontinuation.

• Diuretics (e.g., loop or thiazide diuretics): May exacerbate ECG changes and/or hypokalemia associated with beta-agonists, especially at higher doses. Monitor potassium levels.
• Digoxin: Albuterol may decrease serum digoxin levels. Monitor digoxin levels.
• Other sympathomimetic agents (e.g., epinephrine, pseudoephedrine): Concomitant use may potentiate cardiovascular adverse effects. Use with caution.

• Worsening shortness of breath
• Increased wheezing
• Chest tightness
• Increased cough
• Need for more frequent use of rescue inhaler
• Palpitations
• Tremor
• Nervousness

Albuterol is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Studies in animals have shown adverse effects, but there are no adequate and well-controlled studies in pregnant women. Clinical experience suggests it is generally safe when used as directed for asthma control, which is crucial during pregnancy.

Albuterol is excreted in human milk. However, due to its short half-life and low oral bioavailability, systemic exposure to the infant is expected to be low. The American Academy of Pediatrics considers albuterol compatible with breastfeeding. Use with caution and monitor the infant for adverse effects (e.g., irritability, tremor).

Albuterol is widely used and effective in pediatric patients for the treatment of bronchospasm associated with asthma and other reversible obstructive airway diseases. Dosing is weight- or age-based. The 0.021% (0.63mg/3ml) concentration may be particularly useful for very young children or for continuous nebulization protocols where lower doses are required.

Use with caution in elderly patients, as they may be more susceptible to the cardiovascular effects of sympathomimetic amines (e.g., tachycardia, palpitations, hypertension). Consider starting with lower doses and titrating up based on response and tolerability. Monitor for cardiac adverse effects and hypokalemia.

• Albuterol is a rescue medication; it should not be used for daily maintenance unless specifically prescribed for exercise-induced bronchospasm or as part of a specific continuous nebulization regimen.
• Increased use of albuterol (e.g., more than 2 days a week for symptom control, not including exercise-induced bronchospasm) indicates worsening asthma control and necessitates re-evaluation of the patient's maintenance therapy (e.g., inhaled corticosteroids).
• Paradoxical bronchospasm can occur with inhaled albuterol, though rare. If it occurs, discontinue immediately and institute alternative therapy.
• Patients should be educated on the proper technique for using their nebulizer to ensure optimal drug delivery.
• Hypokalemia can occur, especially with high doses or concomitant use of diuretics. Monitor potassium levels in at-risk patients.
• The 0.021% (0.63mg/3ml) concentration is a lower dose than the standard 2.5mg/3ml (0.083%) and is often used for continuous nebulization or in specific pediatric protocols, rather than as a typical single dose for acute exacerbations in adults.

• Other Short-Acting Beta-Agonists (SABAs): Levalbuterol (Xopenex) - R-isomer of albuterol, potentially fewer side effects.
• Long-Acting Beta-Agonists (LABAs): Salmeterol, Formoterol (used for maintenance, never monotherapy in asthma).
• Inhaled Corticosteroids (ICS): Budesonide, Fluticasone (first-line for asthma maintenance).
• Systemic Corticosteroids: Prednisone, Methylprednisolone (for acute severe exacerbations).
• Anticholinergics: Ipratropium (for COPD, sometimes adjunct in asthma).