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Adrenergic bronchodilator overdose

Adrenergic bronchodilators are inhaled medicines that help open up the airways. They are used to treat asthma and chronic bronchitis. Adrenergic bronchodilator overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medicine. People with underlying cardiovascular disease are at higher risk for heartbeat irregularities when using adrenergic bronchodilators.

This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with has an overdose, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

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Poisonous Ingredient

In large amounts, these medicines can be poisonous:

• Albuterol
• Bitolterol
• Ephedrine
• Epinephrine
• Isoetharine
• Isoproterenol
• Metaproterenol
• Pirbuterol
• Racepinephrine
• Ritodrine
• Terbutaline

Other bronchodilators may also be harmful when taken in large amounts.

Where Found

The substances listed above are found in medicines. Brand names are in parentheses:

• Albuterol (AccuNeb, ProAir, Proventil, Ventolin Vospire)
• Ephedrine
• Epinephrine (Adrenalin, AsthmaHaler, EpiPen Auto-Injector)
• Isoproterenol
• Metaproterenol
• Terbutaline

Other brands of bronchodilators may also be available.

Symptoms

Below are symptoms of an adrenergic bronchodilator overdose in different parts of the body.

AIRWAYS AND LUNGS

• Feeling breathless or short of breath
• Shallow breathing
• Rapid breathing
• No breathing

BLADDER AND KIDNEYS

• No urine output

EYES, EARS, NOSE, AND THROAT

• Blurred vision
• Dilated pupils
• Burning throat

HEART AND BLOOD VESSELS

• Irregular heartbeat
• Heart attack
• Chest pain
• High blood pressure, then low blood pressure
• Rapid heartbeat
• Shock (extremely low blood pressure)

NERVOUS SYSTEM

• Chills
• Coma
• Convulsions (seizures)
• Fever
• Irritability
• Nervousness
• Tingling of hands and feet
• Tremor
• Weakness

SKIN

• Blue lips and fingernails (cyanosis)

STOMACH AND INTESTINES

• Nausea and vomiting

Complications

Adrenergic bronchodilators including albuterol have been found to cause an irregular heartbeat called atrial fibrillation. Rarely, adrenergic bronchodilator overdose can cause a heart attack.

Home Care

Seek medical help right away. Call 911 or the local emergency services number.

Before Calling Emergency

Have this information ready:

• The person's age, weight, and condition
• Name of the product (ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed

Poison Control

The local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

You can also get online poison help now at Poisonhelp.org. Just enter the product, poison, or medicine to get expert help.

What to Expect at the Emergency Room

If you go to the emergency room, take the medicine container with you, if possible.

Your health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure.

If the medicine was swallowed, tests may include:

• Blood and urine tests
• Chest x-ray
• CT scan (advanced imaging) of the brain for neurologic symptoms
• Electrocardiogram (ECG), or heart tracing

Treatment may include:

• Activated charcoal
• Breathing support, including oxygen, through the mouth into the lungs, and breathing machine (ventilator)
• Fluids through a vein (IV)
• Laxative
• Medicines to treat symptoms

Outlook (Prognosis)

Survival past 24 hours is usually a good sign that the person will recover. People who have seizures, breathing difficulties, and heart rhythm disturbances may have the most serious problems after an overdose.

References

Aronson JK. Adrenaline (epinephrine). In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:86-94.

Aronson JK. Salmeterol. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:294-301.

Aronson JK. Ephedra, ephedrine, and pseudoephedrine. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:65-75.

Meehan TJ. Care of the poisoned patient. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 135.

Review Date: 7/1/2025  

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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