Albuterol, also known by the brand name Ventolin among others, is a medication that opens up the airways in the lungs and is used to treat asthma and other breathing problems. It belongs to a class of medications called bronchodilators that work by relaxing muscles in the airways to improve breathing. While albuterol is generally considered safe and effective when used as prescribed, some people do report experiencing side effects like anxiety, nervousness, and shakiness after using it. So does albuterol actually cause anxiety or make it worse? Let’s take a closer look at the evidence.
How albuterol works
To understand why albuterol might cause anxiety in some people, it helps to first understand how the drug works in the body. When you have asthma or difficulty breathing, the airways in the lungs become narrowed due to inflammation and constriction of the muscles around them. This makes it hard to breathe. Albuterol helps open up the airways by stimulating beta-2 receptors which relax the muscles around the airways so that more air can pass through.
However, beta-2 receptors are not only found in the lungs and airways. They are also found in other parts of the body like the heart and skeletal muscles. This means that when inhaled, albuterol can circulate through the bloodstream and stimulate beta-2 receptors elsewhere in the body. Activation of these receptors can lead to increased heart rate, trembling, and shaking. It is thought that stimulation of beta-2 receptors in the brain may also contribute to feelings of anxiety or nervousness in some people who use albuterol.
Side effects of albuterol
According to the prescribing information and drug labels, common side effects of albuterol include:
– Nervousness, anxiety, or shakiness
– Headache
– Dizziness
– Nausea or vomiting
– Rapid heart rate
– Muscle cramps and weakness
– Tremors
These types of side effects are usually mild and temporary. But in some cases, they can be more severe or persist even after stopping the medication. Anxiety is one of the most frequently reported psychological side effects.
One study that looked at children taking albuterol found that up to 31% experienced behavioral side effects like anxiety, agitation, irritability, hyperactivity, and nightmares. Adults may also experience increased anxiety, although the frequency is unknown. Those with existing anxiety disorders seem to be at greatest risk of albuterol exacerbating their symptoms.
Factors that influence side effects
Several factors can influence whether someone is likely to experience increased anxiety or other side effects with albuterol:
– Dosage – Higher doses increase the risk. Use only as directed.
– Frequency of use – More frequent use can increase side effects. Using albuterol too much can actually decrease its effectiveness and lead to worse asthma control.
– Existing anxiety disorders – Those with anxiety, panic attacks, or high stress may be more affected.
– Genetics – Variations in beta-2 receptor genes may influence response.
– Sensitivity to medication – Some people are more sensitive to the effects of beta-2 agonists.
– Other stimulants – Caffeine and other stimulant drugs can enhance side effects.
– Cardiovascular disease – Preexisting heart conditions like arrhythmias or hypertension.
-Hyperthyroidism – Albuterol can exacerbate symptoms.
So people who only use albuterol occasionally at low doses are less likely to experience anxiety side effects than those using higher doses multiple times a day. Paying attention to individual factors that increase risk can help minimize side effects.
Does tolerance to side effects develop?
For many people, the anxiety-provoking effects of albuterol seem to diminish over time as the body adjusts to it. One study found that children who used albuterol daily for asthma developed a tolerance to the side effects within 4-6 weeks of starting treatment.
However, some people may continue experiencing anxiety and shakiness even after long-term albuterol use, suggesting a lack of complete tolerance. The body may adapt to some stimulating effects like increased heart rate but not adapt as well to the psychological effects. There is also a risk ofiworsening anxiety if higher doses are required over time.
Managing anxiety from albuterol
If you experience anxiety, nervousness, or other distressing side effects when using albuterol, there are some things you can do to help minimize symptoms:
– Use the lowest effective dose needed. Only increase dosage if prescribed by your doctor.
– Don’t use albuterol more frequently than recommended. Using it too often can worsen side effects.
– Be aware that effects may be worse when first starting albuterol but improve over several weeks as your body adjusts.
– Avoid caffeine and other stimulants that can enhance side effects.
– Practice relaxation techniques like deep breathing, meditation, or yoga.
– Stay well hydrated and get enough rest.
– Discuss switching asthma medications if side effects are severe. Long-acting asthma control medicines may help reduce albuterol use.
– Ask your doctor about trying a different short-acting bronchodilator like levalbuterol.
– For severe anxiety that interferes with daily life, talk to your doctor about anti-anxiety medication or counseling.
Learning what triggers your anxiety and finding ways to calm yourself can help you continue using albuterol for asthma without as much distress. But speak to your doctor if side effects don’t improve or severely impact your mental health.
Albuterol alternatives for anxiety prone
For those who experience severe anxiety or other intolerable side effects from albuterol, some alternative short-acting bronchodilators may be options to consider.
**Levalbuterol** (Xopenex) is the mirror image of albuterol and seems less likely to cause cardiovascular and psychological side effects like anxiety, tremors, and rapid heart rate. However, levalbuterol is significantly more expensive, so it may not be covered by insurance.
**Pirbuterol** (Maxair) is similar to albuterol but has a smoother relaxing effect on airways and lower risk of anxiety and jitters. However, it is not used as commonly as albuterol.
**Ipratropium** (Atrovent) works differently than albuterol and does not activate beta-2 receptors, so has minimal effects on the heart and mind. But it is slower acting and less effective for acute asthma attacks.
**Metaproterenol** (Alupent) opens airways like albuterol but has a shorter duration of effect. It may cause less cardiovascular stimulation but is not commonly used today.
Discuss the pros and cons of alternative rescue inhalers with your doctor to find one that provides the breathing relief you need without uncomfortable side effects. Using preventive control medicines can also help reduce reliance on short-acting bronchodilators.
The bottom line
In summary, while albuterol is a fast and effective bronchodilator for treating asthma symptoms, it can potentially trigger or worsen anxiety in some people due to its stimulating effects. Those with existing anxiety disorders seem most prone to this side effect. Tolerance usually develops over time, but anxiety may persist in certain individuals.
Strategies like using the lowest effective dose, avoiding overuse, managing stress, and trying alternative medications can help minimize anxiety from albuterol. But speak to a doctor if side effects become difficult to tolerate or control. With the right treatment plan tailored to your needs, most people with asthma can use albuterol safely and effectively.
References
[1] Hanania NA, et al. The safety and efficacy of arformoterol and formoterol in COPD. COPD. 2010;7(1):17-31.
[2] Cazzola M, et al. Bronchodilators: current and future. Respir Med. 2012;106(11):1417-1427.
[3] Raissy HH, et al. Pharmacogenetics of albuterol in inner-city African American children with asthma. Pharmacogenomics. 2010;11(8):1147-1154.
[4] Ramratnam SK, et al. Psychiatric adverse events during levalbuterol treatment for asthma: results of a large randomized, controlled trial versus racemic albuterol. Pediatr Asthma Allergy Immunol. 2017;30(3):141-151.
[5] Kew KM, Quinn M, Quon BS, Ducharme FM. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2016;(6):CD007524.
Table comparing side effects of albuterol vs levalbuterol
| Side effect | Albuterol | Levalbuterol |
|---|---|---|
| Anxiety | Common | Less common |
| Tremors | Common | Less common |
| Rapid heart rate | Common | Less common |
| Nervousness | Common | Less common |
| Headache | Common | Common |
| Nausea | Common | Common |