Nadolol: (Moderate) Use of a beta-1-selective (cardioselective) beta blocker is recommended whenever possible when this combination of drugs must be used together. Food decreases the rate of absorption without altering the extent of bioavailability. Carvedilol: (Moderate) Use of a beta-1-selective (cardioselective) beta blocker is recommended whenever possible when this combination of drugs must be used together. Albuterol crosses the blood-brain barrier and may cross the placenta. Monitor the patients lung and cardiovascular status closely. [28225] [28432] [28457] [31823] [43674] [44010] [49951] [56592] [59350] [64470], Use albuterol with caution in patients with diabetes mellitus. 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. Administer using a calibrated oral measuring device to ensure accurate dosing. Beta-agonists can sometimes increase heart rate or have other cardiovascular effects, particularly when used in high doses or if hypokalemia is present.
Use inhaled SABAs for acute bronchospasm; do not use oral agents.
Furosemide: (Moderate) Loop diuretics may potentiate hypokalemia and ECG changes seen with beta agonists. 4 to 8 mg PO every 12 hours (Maximum: 32 mg/day PO). 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. 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. 4 to 8 mg ER PO every 12 hours. 4 to 10 oral inhalations of 90 mcg/actuation (total: 360 to 900 mcg) every 20 minutes during the first hour for mild to moderate exacerbations. Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. 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. Pemoline: (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. 2.5 mg via nebulizer every 20 minutes for the first hour for acute exacerbation, with reassessment after that (further dosing not specified). Those with more severe asthma (baseline FEV1 less than 60% predicted), may achieve a better initial response with the 1.25 mg dose. [56384]Powder for Inhalation (e.g., ProAir RespiClick, ProAir Digihaler)Instruct patient on proper inhalation technique; see the specific product's "Instructions for Use" from the manufacturer.Before using for the first time, check the dose counter window to ensure that the inhaler is full and the number "200" is in the window. Beta-agonists can sometimes increase heart rate or have other cardiovascular effects, particularly when used in high doses or if hypokalemia is present. Levothyroxine; Liothyronine (Synthetic): (Moderate) Based on the cardiovascular stimulatory effects of beta-agonists and other sympathomimetics, concomitant use with thyroid hormones might enhance the effects on the cardiovascular system. [31823] [33925]Discard medication and inhaler after expired or once the labeled number of inhalations have been used, whichever comes first; some products may have an inhalation counter. Therefore, linezolid has the potential for interaction with adrenergic agents, such as the beta-agonists. 90 to 180 mcg (1 to 2 actuations of 90 mcg/actuation) via the inspiratory limb of the mechanical ventilator circuit appeared to improve pulmonary mechanics in ventilator-dependent neonates.
Halofantrine: (Contraindicated) Halofantrine is considered to have a well-established risk for QT prolongation and torsade de pointes (TdP). Monitor blood pressure and heart rate. The patient should hold breath as long as they can, up to 10 seconds, then breathe normally. Beta-blockers will block the pulmonary effects of inhaled beta-agonists, and in some cases may exacerbate bronchospasm in patients with reactive airways. Specific guidelines for dosage adjustments in renal impairment are not available. Generic:- Protect from light- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F- Store in original package until time of useAccuneb:- After opening the foil pouch, product should be used within 2 weeks- Avoid excessive heat (above 104 degrees F)- Discard product if it contains particulate matter, is cloudy, or discolored- Protect from light- Store between 36 to 77 degrees F- Store unused product in foil pouchProAir digihaler:- Avoid excessive humidity- Store away from excessive heat and cold- Store between 59 to 77 degrees FProair HFA:- Avoid exposure to temperatures above 122 degrees F- Exposure to temperatures above 120 degrees F may cause bursting- For best results, product should be at room temperature before use- Keep away from heat and flame- Protect from direct sunlight- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)- Store away from excessive heat and cold- Store in a cool, well ventilated, dry place- Store in original container- Store inhaler with mouthpiece downProAir RespiClick:- Avoid excessive humidity- Store away from excessive heat and cold- Store between 59 to 77 degrees FProventil:- Avoid exposure to temperatures above 122 degrees F- Exposure to temperatures above 120 degrees F may cause bursting- For best results, product should be at room temperature before use- Keep away from heat and flame- Protect from direct sunlight- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)- Store away from excessive heat and cold- Store in a cool, well ventilated, dry place- Store in original container- Store inhaler with mouthpiece downProventil HFA:- Avoid exposure to temperatures above 122 degrees F- Exposure to temperatures above 120 degrees F may cause bursting- For best results, product should be at room temperature before use- Keep away from heat and flame- Protect from direct sunlight- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)- Store away from excessive heat and cold- Store in a cool, well ventilated, dry place- Store in original container- Store inhaler with mouthpiece downProventil Repetabs:- Keep away from heat and flame- Protect from light- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)- Store in a cool, well ventilated, dry placeRespirol :- Avoid exposure to temperatures above 122 degrees F- Exposure to temperatures above 120 degrees F may cause bursting- For best results, product should be at room temperature before use- Keep away from heat and flame- Protect from direct sunlight- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)- Store away from excessive heat and cold- Store in a cool, well ventilated, dry place- Store in original container- Store inhaler with mouthpiece downVentolin:- Avoid exposure to temperatures above 122 degrees F- Exposure to temperatures above 120 degrees F may cause bursting- For best results, product should be at room temperature before use- Keep away from heat and flame- Protect from direct sunlight- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)- Store away from excessive heat and cold- Store in a cool, well ventilated, dry place- Store in original container- Store inhaler with mouthpiece downVentolin HFA:- Avoid exposure to temperatures above 122 degrees F- Exposure to temperatures above 120 degrees F may cause bursting- For best results, product should be at room temperature before use- Keep away from heat and flame- Protect from direct sunlight- Protect from moisture- Store at controlled room temperature (between 68 and 77 degrees F)- Store away from excessive heat and cold- Store in a cool, well ventilated, dry place- Store in original container- Store inhaler with mouthpiece downVolmax:- Store at controlled room temperature (between 68 and 77 degrees F)VoSpire ER:- Store at controlled room temperature (between 68 and 77 degrees F). Use inhaled SABAs for acute bronchospasm; do not use oral agents. Albuterol is believed to work by activating adenylate cyclase, the enzyme responsible for generating cyclic AMP, an intracellular mediator. 180 mcg (2 actuations of 90 mcg/actuation) via oral inhalation, administered 15 to 30 minutes before exercise. Metoprolol: (Moderate) Use of a beta-1-selective (cardioselective) beta blocker is recommended whenever possible when this combination of drugs must be used together. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: (Moderate) Caffeine may enhance the cardiac inotropic effects of beta-agonists. Start with 2 mg per dose in the geriatric patient. Beta-agonists inhibit the airway response to methacholine. 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. Hypokalemia due to beta agonists appears to be dose related and is more likely with high dose therapy.
Those with more severe asthma (baseline FEV1 less than 60% predicted), weight more than 40 kg, or patients 11 to 12 years of age may achieve a better initial response with the 1.25 mg dose. Monitor the patients lung and cardiovascular status closely. Caution is advised when loop diuretics are coadministered with high doses of beta agonists; potassium levels may need to be monitored. Weigh the risks of coadministration, and where possible, allow a washout period after discontinuation of the MAOI before instituring beta-agonist treatment or vice-versa. The cardiovascular effects of beta-agonists may be potentiated by concomitant use of MAOIs. 
