Can Albuterol Cause Weight Loss? I Use Albuterol in Nebulizer 3x/day Along with Ventolin As Needed

Can Albuterol Cause Weight Loss?

Dear Dr. Mahler: I continue to lose weight. 9 lbs in 6 months, more before that.  No apparent explanation so I am on the hunt to try to figure it out. I can’t get an appt with an endocrinologist for 3 months. Have you heard of people with COPD losing weight from taking a lot of albuterol or just from having diminished lung capacity?
I use Albuterol in the nebulizer 3x day plus several puffs of Ventolin during the day. Along with Albuterol I use Budesonide inhalation 2xday as prescribed. I tried all of the other newer “2 in 1” bronchodilators, but either they didn’t work or I had side effects.
I’d appreciate your thoughts.
Sidney from Tacoma, WA Dear Sidney: I have not come across your question in my practice previously. To provide an answer to your question – Can Albuterol Cause Weight Loss? – I first summarize information about beta receptors in the body. Second, I review how albuterol works. Third, I include information based on a search of the medical literature on PubMed. Beta Receptors There are three types of beta-receptors in the body that work in different ways. Beta1 receptors are located mainly in the heart. When stimulated with a medication, heart rate increases and the heart pumps more blood. Beta2 receptors are located in the breathing tubes and in the blood vessels (arteries) that provide  blood to muscles in the arms and legs. When stimulated with a medication, the muscle that wraps around the breathing tubes relaxes allowing more air to go in and out of the lungs.  This makes it easier to breathe. Beta3 receptors are located in the fat (adipose) tissue of the body. When stimulated, there is break down of fat tissue (called lipolysis). Muscarinic Receptors In addition to beta receptors, there are muscarinic receptors located in the breathing tubes that work in a different way to allow more air to go in and out of the lungs. It is common to prescribe both beta2 and muscarinic antagonists because they dilate the airways be different mechanisms and work better than only one type of bronchodilator. Albuterol Sulfate Albuterol is a short-acting beta2-agonist bronchodilator. What does this mean? Short-acting means that it lasts for 3 – 4 hours, and then wears off. Beta2 means that is attaches to beta2 receptors – located in the breathing tubes and arteries of skeletal muscle –  and has minimal effect on beta1 and beta3 receptors. Bronchodilator means that it relaxes the smooth muscle that wraps around the breathing tubes to open them and make it easier for air to move in and out.
Smooth muscle wraps around the outside of the breathing tubes. This address Can Albuterol Cause Weight loss

View of smooth muscle wrapping around the outside of the breathing tubes

In general, albuterol is used mainly as needed. This means either as rescue for sudden breathing attacks OR before doing an activity that is expected to cause some breathing difficulty. For maintenance therapy, long-acting bronchodilators are used to treat those with COPD because they keep the breathing tubes open from 12 – 24 hours. I assume that you were tried on long-acting bronchodilator medications and either they did not work for you, or you had side effects. Can Albuterol Cause Weight Loss? There is not a lot of medical information to answer your question completely. There is one study published in 1993 in the journal Thorax (Amoroso is first author) which showed a slight increase in metabolism in 10 healthy adults with four puffs of albuterol compared to a placebo over an hour. A review of side effects of albuterol in listed the following side effects: 16 MAJOR side effects with shakiness and trembling as More Common, fast, irregular, pounding heart rate as Less Common, and 13 different reactions as Rare, none of which was weight loss. There were 11 MINOR side effects listed, again none of which included weight loss. My Comments Based on this information and my experience, I consider it very unlikely that your frequent use of albuterol in the nebulizer and by inhaler are causing your weight loss. Ideally, you would try using long-acting bronchodilators so that you would not need to use so much albuterol to breathe. To know for sure about your concern, you would need to reduce albuterol use markedly. Obviously, that would require you to use long-acting bronchodilators to replace short-acting albuterol. Finally, I support your effort to look for another reason for weight loss. I would start with your primary care provider, and then with an endocrinologist as you are planning. Best wishes in finding an answer. Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.