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This introduces air into the vial, equalizing pressure and making the liquid easier to draw

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Major drug Interactions: Other sympathomimetic aerosol bronchodilators or epinephrine should not be used concomitantly with albuterol Albuterol should be administered with extreme caution to patients being treated with MAO inhibitors or tricyclic anti-depressants, since the action of albuterol on the vascular system may be potentiated Figure 3

New England Journal of Medicine , 387(3), 205216