i was just wondering if there was anything you can do to reduce the 'shakes' ou get from salbutamol? i only use the inhaler - but lots of it and the shakes are there all the time but over the last day or so have got worse (and i have been using silghtly less salbutamol!) any ideas??
thanks katie
xxx
Withdrawl symptoms?
hi
shakes are very common to have with ventolin/ salbutamol. I am not sure what causes it but maybe one of the drs on the site may know. I have a constant tremor now from salbutamol and bricanyl. Con always says itis a side effect but would be interested to know what it is that causes the shakes?
sorry cant be of more help
olive
One of the positive effects of short acting relievers like ventolin is to relax the smooth muscle surrounding the bronchioles in our lungs, with a subsequent widening of the airways Hence the reason why most people should notice an immediate relief of breathing problems, when experiencing hyper-responsiveness of the airways due to an external trigger like HDM’s pollens, moulds, pets or other triggers like viruses etc.
However we all have smooth muscle in other parts of the body. But not all muscle fibres within smooth muscle tissue are alike in structure or function. Very simplistically there are basically two different sorts of muscle fibres, type one slow twitch and type two fast twitch. There are many more type two fibres - ‘fast twitch’ in the muscles of the arm.
Fast twitch muscle fibres are far more sensitive to metabolic processes such as the sort demonstrated by ventolin on smooth muscle tissue in the lungs. However we don’t need the relaxant effect on muscles in the arms because they – the muscles – are not contracted. Unfortunately ventolin and similar drugs cause these muscle fibres to contract very quickly which translates into fine muscular tremors and that well known difficulty of being unable to write in a straight line or use cutlery better than the average two year old.
On a positive note these tremors only last as long as this sort of muscle fibre – fast twitch – can contract for a certain length of time. Type two muscle fibres don’t need oxygen to work – anaerobic- even though they can create a huge amount of force – the unwanted shakes. But the effects should only last for a limited time.
In other words fast twitch muscle fibres fire quickly but tire quickly. Bit like sprinters, who all have far more fast twitch muscle fibres than slow twitch muscle fibres.
External factors such as higher temperatures cause even greater dilation of the blood vessels and an increase in metabolic processes, so you may notice that ‘the shakes’ are worse if you feel very warm.
*Sadly* I've noticed that alcohol - even a small amount - compounds the shakes.
SOB.
Mia
Katielou, as far as I am aware, there is nothing that can be done to reduce the shakes from salbutamol, although they do often get better with time as your body gets more used to the drug. The only real way to reduce the shakes is to reduce the amount of salbutamol you are taking - if you are taking a lot, it may be worth visiting your GP or asthma nurse for a review to see if your preventer medication can be increased.
The tremor is basically an exaggeration of the 'physiological' (ie normal) postural skeletal muscle tremor that everyone gets, but that is usually invisible in most people. Salbutamol excentuates this normal tremor, and the combination of salbutamol and theophylline or aminophylline will excentuate it even more. This excentuation occurs because there are beta-2 receptors on the skeletal muscles of your arms and legs (as well as in the heart, which is partly why you get a fast heart rate) as well as the beta-2 receptors on the smooth muscle of your airways.
I can't explain why you are getting more shakes from less salbutamol - 'withdrawal symptoms' certainly shouldn't be an issue or produce this sort of effect - but there are many things that can affect the amount that the salbutamol will make you shake - from air temperature, to blood sugar, minor variations in your potassium levels, and 'nerves'. The more you become aware of and anxious about the shakes, the more you will shake - not an easy one to get around, but relaxing, taking deep breaths, and trying to ignore the shakes may help.
I usually (being fairly used to salbutamol these days) don't get much in the way of shakes from using my inhaler - it normally takes a neb or two to make me shake. However, when I was doing a clinical postgraduate exam a couple of years ago (basically examining ten patients and trying to diagnose them with two consultants watching my every move) I had a few puffs of my inhaler on the way around and was a jibbering, shaking wreck! (Mind you, I may have been anyway, with or without salbutamol).
If your tremor is severe, there are organisations that can make practical suggestions that can help you get around it - tremor.org.uk is an excellent website, and essentialtremor.org is also useful, although bear in mind that this website is primarily for essential tremor, which is slightly different from an exaggerated physiological tremor, and some of the drugs that are given in essential tremor cannot be used in asthma (such as beta blockers) or would not be effective.
If things like writing and eating are difficult, weighted wrist bands, and larger pens and cutlery, may be useful. They can be obtained through an Occupational Therapist, or via the websites above.
Sorry not to have been more practical help, but be assured, at least, that this is a very common side effect.
Take care
Em H
How To Tell If Ventolin Inhaler Is Running Out?
biological not working
Upper airway obstruction on spirometry?
Has the storm/change in weather impacted on you? 
Montelukast Withdrawal
