Can You Use Primatene And Albuterol Together?
In our latest question and answer, the pharmacist discusses if it is safe to use albuterol inhalers with Primatene (inhaled epinephrine).
I wanted to ask if I can take epinephrine intermittently with my albuterol inhaler. I have been experiencing some shortness of breath as a side effect of Wellbutrin. I am on 300 mg. I also take 60 mg of Cymbalta. Sometimes I use Pepcid AC to relieve itchiness. I read that there is an interaction between epinephrine and albuterol. What would you recommend? My psychiatrist was unable to answer. Thank you.
May 20, 2022- Primatene and albuterol work the same way to open airways, so using them together or within a few hours increases the risk of side effects like increased heart rate, tremor, and anxiety.
- If you need to use both medications, space them at least 4 to 6 hours apart since albuterol lasts longer than Primatene.
- Frequent use of either inhaler suggests your asthma may need better control with longer-acting preventative medications, so talk to your doctor.
Hello!
In your question, you mention wanting to know if you can use epinephrine along with your albuterol inhaler, so I am assuming you mean inhaled epinephrine (i.e. Epinephrine Oral Inhalation, Primatene Mist).
You shouldn't be using them at the same time, or within a few hours of each other, as they essentially work the same way to treat asthma symptoms like shortness of breath.
Since inhaled albuterol and epinephrine work the same way, they have similar side effects. Using both together can, therefore, increase the risk of these side effects occurring, and their severity.
How Both Drugs Work To Treat Asthma Symptoms
Both albuterol and epinephrine are classified as 'sympathomimetics'.
While epinephrine (another word for 'adrenaline') has much broader actions overall than albuterol, they both work the same way to help us breathe better and that is by stimulating beta-2 receptors, which are found in the smooth muscle in our airways.
Stimulating beta-2 receptors relaxes smooth muscle, opening our airway, and making it easier to breathe.
Stimulation of these receptors also stops the release of certain molecules from our mast cells (the same cells that release histamine), further decreasing inflammation and airway constriction.
Using albuterol and epinephrine together would really be just using two drugs that work by the same mechanism to treat your shortness of breath.
Side Effects
Since inhaled albuterol and epinephrine work the same way, they will share many of the same side effects.
Using both together, or within a short period of time, can cause:
- Increased heart rate
- Nausea
- Headache
- Nervousness
- Anxiety
- Tremor
If any of these side effects occur, they would be relatively short-lived as both drugs don't last more than a few hours but, again, using albuterol and epinephrine together increases the risk they will happen.
Separating The Drugs
Both drugs are short-acting, but albuterol (the active ingredient in several brand-name inhalers such as Proair, Ventolin, and Proventil) still tends to last longer than inhaled epinephrine (the active ingredient in Primatene).
Each dose of albuterol lasts around 4 to 6 hours while each dose of epinephrine lasts for slightly shorter in most individuals.
Again, they shouldn't be used together, but they could safely be used if you separate dosing by at least 4 to 6 hours.
Final Words
If you find yourself needing to use a short-acting inhaler like albuterol or Primatene often, you should talk to your doctor.
Your asthma may not be well controlled, and other, longer-acting preventative medications are probably better long-term options.
Thanks again for your question!
References & sources
Glossary — Terms in This Answer
- Sympathomimetics
- Drugs that work by mimicking the effects of the sympathetic nervous system to produce effects similar to adrenaline.
- Beta-2 receptors
- Specific binding sites found on airway smooth muscle that, when activated, cause the muscles to relax and open the airways.
- Smooth muscle
- A type of muscle that lines the airways and blood vessels and is not under conscious control.
- Mast cells
- Immune cells that release inflammatory molecules like histamine in response to allergens or irritants.
- Histamine
- A chemical messenger released by mast cells that causes inflammation and airway constriction during allergic or asthmatic reactions.
- Short-acting
- Refers to medications that work quickly but only provide relief for a few hours rather than all day.
- Airway constriction
- Tightening or narrowing of the passages through which air travels to the lungs.
- Preventative medications
- Long-acting drugs taken regularly to prevent asthma symptoms from occurring rather than only treating symptoms after they start.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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