AboutDr Alan Galbraith Expertise I can answer most questions on drugs, both medical and "recreational". Answers can be given in either technical or layperson terminology. My main areas of interest are psychiatric, gastrointestinal and cardiovascular drugs.
Experience I have been a university lecturer/head of department for almost thirty years, but am now retired. My research interests were alcohol, smoking and cardiovascular disease.
Organizations Institute of Biology, London.
Publications Author of "Fundamentals of Pharmacology" 5th Edition published in November 2007 by Pearson Education, Australia.
My wife suffers from delayed-onset Postural Orthostatic Tachycardia Syndrome with adrenergic excess. (she has had it for 13 years but was misdiagnosed for 12 years as suffering from a Superventricular Tachycardia.
She recently started taking Florinef for the POTS.
She has just been diagnosed with Upper Airway Resistance Syndrome & Restless Leg Syndrome. Is on .5mg nightly Clonazapam to reduce the RLS.
She has suffered for many years with bouts of breathlessness/shortness of breath. These symptoms have steadily worsened over recent months where she is now breathless/short of breath most of the time.
She is on atenolol, a beta blocker, which mitigates her tachy episodes. She has been on various beta blockers for 13 years, since her SVT was diagnosed.
Her MD just prescribed an albuterol inhaler (an beta adrenergic agonist) for her shortness of breath.
The albuterol product information (and multiple online sites - Web MD, etc.) specifically provide a drug interaction warning for albuterol/atenolol because:
1) a beta blocker and a beta agonist are counterveiling medications which will significantly decrease the efficacy of both medications if taken in conjunction.
2) in asthmatics may cause severe, even potentially life threatening, bronchospasm.
Talked to local pharmacist and doctors assistant [all are members of a HMO], both think I'm paranoid and treated me like I was an idiot, and both say there is no problem her taking the albuterol in combination with the atenolol. But, given the cause of her SOB is unknown, that she has documented hyperadrenergic sensitivity, and that the two medications will apparently substantially reduce each others effectiveness, potentially exacerbating her POTS/tachycardia, it does not seem to make much sense to me for her to take this medication?
I would very appreciate the opinion of an outside, unbiased professional.
Mahalo nui loa,
Russell Hart, Ph.D.
Kailua
Hawaii
Answer Dear Russell
I appreciate your concerns and definitely do not think you are paranoid. You are perfectly correct in saying that albuterol and beta-blockers do have adverse interactions and in most instances should not be given concurrenty. However, in some circumstances this combination is necessary if, in the opinion of the prescriber the benefits outweigh that of the problems. This may be the cae with your wife but her doctor and the pharmacist should be informing you of the whys and wherefores of this drug combination. You are after all an educated person and should be treated as such.
I have appended below some information from a professional database showing you basically what I have said already.
The action of albuterol or levalbuterol is antagonized by â-adrenergic blocking agents (e.g., propranolol). â-Adrenergic blocking agents not only block the pulmonary effects of â-agonists, but may produce severe bronchospasm in asthmatic patients; therefore, asthmatic patients should not normally be treated with â-adrenergic blocking agents. However, under certain circumstances (e.g., prophylaxis after myocardial infarction), there may be no acceptable alternatives to the use of â-adrenergic blocking agents in patients with asthma; cardioselective â-adrenergic blocking agents should be used with caution in these patients.
I hope this puts your mind at rest but I would be asking your wife's prescriber again for more information regarding the treatment protocol.
