Health Guide
Drug Guide

Bronchodilator, adrenergic (Inhalation route)

Brand Names:

Dosage Forms:

Uses of This Medicine:

Adrenergic bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) of the lungs. Some of these medicines are used to treat the symptoms of asthma, chronic bronchitis, emphysema, and other lung diseases, while others are used to prevent the symptoms.

Salmeterol is a long-acting bronchodilator that is used with anti-inflammatory medication to prevent asthma attacks. Salmeterol is different from the other adrenergic bronchodilators because it does not act quickly enough to relieve an asthma attack that has already started.

Some of these medicines are also breathed in through the mouth to prevent bronchospasm (wheezing or difficulty in breathing) caused by exercise. Also, epinephrine may be used in the treatment of croup.

All of these medicines, except some epinephrine preparations, are available only with your doctor's prescription. Although some of the epinephrine preparations are available without a prescription, your doctor may have special instructions on the proper dose of epinephrine for your medical condition.

This medicine is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, some of the adrenergic bronchodilators are used in certain patients with the following medical condition:

Before Using This Medicine:


Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.


Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of these medicines in children. However, isoetharine is not recommended for use in children.

Older adults

For albuterol, bitolterol, epinephrine, fenoterol, isoetharine, isoproterenol, metaproterenol, pirbuterol, procaterol, and terbutaline :

For salmeterol:


For albuterol, bitolterol, formoterol, metaproterenol, and salmeterol:

For epinephrine:

For fenoterol, isoproterenol, pirbuterol, procaterol, and terbutaline:

For isoetharine:


It is not known whether these medicines pass into the breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are using these medicines and who wish to breast-feed should discuss this with their doctor.

Other medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

Proper Use of This Medicine:

These medicines come with patient directions. Read them carefully before using the medicine. If you do not understand the directions or if you are not sure how to use the medicine, ask your health care professional to show you what to do. Also, ask your health care professional to check regularly how you use the medicine to make sure you are using it properly.

Use this medicine only as directed. Do not use more of it and do not use it more often than recommended on the label, unless otherwise directed by your doctor. Using the medicine more often may increase the chance of serious unwanted effects. Deaths have occurred when too much inhalation bronchodilator medicine was used.

Keep the spray away from your eyes because it may cause irritation.

Salmeterol and formoterol are used to prevent asthma attacks. They are not used to relieve an attack that has already started. For relief of an asthma attack that has already started, you should use another medicine (not formoterol) that starts working faster than salmeterol does. If you do not have another medicine to use for an attack or if you have any questions about this, check with your doctor. Because the effects of salmeterol and formoterol usually last about 12 hours, doses should never be taken more than two times a day or less than 12 hours apart.

Salmeterol and formoterol are not substitutes for your oral or inhaled corticosteroid medicine. If you begin taking salmeterol or formoterol, the dosage of your corticosteroid medicine should not be changed or stopped even if you begin to feel better. If you have any questions about this, check with your doctor.

Some epinephrine preparations are available without a doctor's prescription. However, do not use this medicine unless you are seeing a doctor about asthma. Do not use this medicine if you have been hospitalized for asthma treatment or if you are taking a prescription medicine for asthma, unless you have been told to do so by a doctor.

When you use the inhaler for the first time, or if you have not used it in a while, the inhaler may not deliver the right amount of medicine with the first puff. Therefore, before using the inhaler, you may have to test or prime it.

Your doctor, nurse, or pharmacist may want you to use a spacer or holding chamber with the inhaler. A spacer helps get the medicine into the lungs and reduces the amount of medicine that stays in your mouth and throat.

To use a spacer with the inhaler:

For patients using the powder for inhalation dosage form:

For patients using the inhalation solution dosage form :


The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

Bitolterol was withdrawn from the U.S. market by Elan Pharmaceuticals in November 2001.

Canadian product information states that formoterol is used in children 6 years of age and older.

Missed dose

Call your doctor or pharmacist for instructions.

For formoterol:

For all other adrenergic bronchodilators:


Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Store canister with the nozzle end down.

Do not puncture, break, or burn the inhalation aerosol container, even if it is empty.

Precautions While Using This Medicine:

It is important that your doctor check your progress at regular intervals to make sure that your medicine is working properly.

If you still have trouble breathing after using one of these medicines, or if your condition becomes worse, check with your doctor at once.

You may also be taking an anti-inflammatory medicine for asthma along with this medicine. Do not stop taking the anti-inflammatory medicine even if your asthma seems better, unless you are told to do so by your doctor.

For patients using salmeterol or formoterol, check with your doctor:

For patients using any of these medicines except salmeterol and formoterol, check with your doctor:

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Dizziness, severe
feeling of choking, irritation, or swelling in throat
flushing or redness of skin
increased shortness of breath
skin rash
swelling of face, lips, or eyelids
tightness in chest or wheezing, troubled breathing
Incidence not known (for salmeterol)
Difficulty breathing
noisy breathing

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Fast heartbeat
Less common
Coughing or other bronchial irritation
dizziness or light-headedness
dryness or irritation of mouth or throat
Chest discomfort or pain
drowsiness or weakness
irregular heartbeat
irritation of throat or mouth
muscle cramps or twitching
nausea and/or vomiting
trouble in sleeping

Not all of the side effects listed above have been reported for each of these medicines, but they have been reported for at least one of them. All of the adrenergic bronchodilators are similar, so any of the above side effects may occur with any of these medicines.

While you are using an adrenergic bronchodilator, you may notice an unusual or unpleasant taste. This may be expected and will go away when you stop using the medicine.

Isoproterenol may cause the saliva to turn pinkish to red. This is to be expected while you are taking this medicine.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Last Updated: 6/12/2013

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