Albuterol

Pronunciation: (al-BYOO-ter-ahl)

Class: Sympathomimetic

Trade Names:

Airet

- Solution for inhalation 0.083% (as sulfate)

Trade Names:

Proventil

- Tablets 2 mg (as sulfate)

- Tablets 4 mg (as sulfate)

- Syrup 2 mg (as sulfate) per 5 mL

- Aerosol Each actuation delivers 90 mcg albuterol

- Solution for inhalation 0.083% (as sulfate)

- Solution for inhalation 0.5% (as sulfate)

Trade Names:

Proventil HFA

- Aerosol Each actuation delivers 90 mcg albuterol (as sulfate)

Trade Names:

Ventolin

- Tablets 2 mg (as sulfate)

- Tablets 4 mg (as sulfate)

- Syrup 2 mg (as sulfate) per 5 mL

- Solution for inhalation 0.5% (as sulfate)

Trade Names:

Ventolin Nebules

- Solution for inhalation 0.083% (as sulfate)

Trade Names:

Ventolin Rotacaps

- Capsules for inhalation 200 mcg microfine (as sulfate)

Airomir (Canada)

Apo-Salvent (Canada)

Apo-Salvent CFC Free (Canada)

Gen-Salbutamol Respirator Solution (Canada)

Gen-Salbutamol Sterinebs P.F. (Canada)

ratio-Salbutamol HFA (Canada)

Sandoz Salbutamol (Canada)

Ventolin Diskus (Canada)

Ventolin Oral Liquid (Canada)


Pharmacology

Produces bronchodilation by relaxing bronchial smooth muscle through beta-2 receptor stimulation.

Pharmacokinetics

Absorption

Tablets

Rapidly absorbed; T max is 2 h; C max is about 18 ng/mL.

Inhalation

Less than 20% absorbed; T max is 0.5 h; C max is 2.1 ng/mL.

Elimination

T ½ is 5 to 6 h. 76% recovered in urine over 3 days with 60% as metabolites; 4% excreted in feces.

Onset

Oral

Within 30 min.

Inhalation

Within 5 min.

Duration

Oral

4 to 8 h.

Inhalation

3 to 6 h.

Indications and Usage

Prevention and treatment of reversible bronchospasm associated with asthma and other obstructive pulmonary diseases.

Unlabeled Uses

Adjunctive treatment of hyperkalemia in patients undergoing dialysis.

Contraindications

Cardiac tachyarrhythmias.

Dosage and Administration

Inhalation Aerosol

Adults and Children at least 4 yr of age (at least 12 yr for Proventil )

1 to 2 inhalations every 4 to 6 h.

Prevention of exercise-induced bronchospasm

2 inhalations 15 min before exercise.

Inhalation Solution

Adults and children older than 2 yr of age

2.5mg/dose 3 to 4times/day by nebulization.

Children 2 to 12 yr of age ( AccuNeb )

1.25 mg or 0.63 mg 3 to 4 times/day by nebulization.

Oral

Adults and Children older than 12 yr of age

PO 2 to 4 mg/dose 3 to 4 times/day. Do not exceed 32 mg/day.

Children 6 to 12 yr of age

PO 2 mg/dose 3 to 4 times/day. Do not exceed 24 mg/day.

Children 2 to 6 yr of age

PO 0.1 to 0.2 mg/kg/dose 3 times/day. Do not exceed 12 mg/day.

Adults and Children older than 12 yr of age, extended-release ( Proventil Repetabs )

PO 4 to 8 mg every 12 h. May be cautiously increased stepwise to a max of 16 mg twice daily (max, 32 mg/day).

Children 6 to 12 yr of age, extended-release ( Proventil Repetabs )

PO 4 every 12 h. May be cautiously increased stepwise to a max of 12 mg twice daily.

Syrup

Adults and Children alder than 12 yr of age

2 or 4mg (1 to 2 tsp) 3 or 4 times/day. Doses of above 4 mg 4 times/day may be appropriate when patient fails to respond.

Children 6 to 12 yr of age

2 mg (1tsp) 3 or 4 times/day. Doses of 2 mg 4times/day may be cautiously increased. Do not exceed 24 mg/day in divided doses.

Children 2 to 6 yr of age

Initiate at 0.1 mg/kg 3 times/day. Dose may be increased 2 mg 3 times/day. Do not exceed 2 mg 3 times/day. Dose may be increased to 0.2 mg/kg 3 times/day, but not to exceed 4 mg 3 times/day.

Elderly and those sensitive to beta-adrenergic stimulation

Restrict initial dose to 2 mg (1 tsp) 3 or 4times/day. Individualize dosage thereafter.

Storage/Stability

Store at room temperature. Refrigeration of syrup improves palatability.

Drug Interactions


Atomoxetine Increased risk of cardiovascular side-effects when parenteral salbutamol given with atomoxetine
Digoxin salbutamol possibly reduces plasma concentration of digoxin
Methyldopa acute hypotension reported when infusion of salbutamol given with methyldopa
Salbutamol belongs to Sympathomimetics, Beta2 and will have the following interactions:

Acetazolamide increased risk of hypokalaemia when high doses of beta2 sympathomimetics given with acetazolamide —for CSM advice (hypokalaemia) see section 3.1.1.1
Corticosteroids increased risk of hypokalaemia when high doses of beta2 sympathomimetics given with corticosteroids —for CSM advice (hypokalaemia) see section 3.1.1.1 Interactions do not generally apply to corticosteroids used for topical action (including inhalation) unless specified
Diuretics, Loop increased risk of hypokalaemia when high doses of beta2 sympathomimetics given with loop diuretics —for CSM advice (hypokalaemia) see section 3.1.1.1
Diuretics, Thiazide and related increased risk of hypokalaemia when high doses of beta2 sympathomimetics given with thiazides and related diuretics —for CSM advice (hypokalaemia) see section 3.1.1.1
Theophylline increased risk of hypokalaemia when high doses of beta2 sympathomimetics given with theophylline —for CSM advice (hypokalaemia) see section 3.1.1.1


Adverse Reactions

Cardiovascular

Palpitations; tachycardia; elevated BP; chest tightness; angina.

CNS

Tremor; dizziness; hyperactivity; nervousness; headache; insomnia; weakness; drowsiness; restlessness.

EENT

Dry mouth; throat irritation.

GI

Nausea; vomiting; heartburn; diarrhea.

Genitourinary

Urinary retention.

Respiratory

Cough; bronchospasm; wheezing; dyspnea.

Miscellaneous

Flushing; sweating; anorexia; unusual sensory changes.

Precautions

Pregnancy

Category C .

Lactation

Unknown.

Children

Albuterol aerosol and inhalation powder in children younger than 4 yr of age and albuterol solution for inhalation in children younger than 2 yr of age not established.

Labor and Delivery

May inhibit uterine contractions.

CV effects

Toxic symptoms may occur in patients with CV disorders.

CNS effects

CNS stimulation may occur; use cautiously in patients with history of seizures or hyperthyroidism.

Diabetes

Dosage adjustment of insulin or oral hypoglycemic agent may be required.

Excessive use

Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use.

Hypokalemia

Decreases in potassium levels have occurred.

Tolerance

If previously effective dose fails to provide relief, therapy may need to be reassessed.
Overdosage

Symptoms

Tremor, palpitations, tachycardia, elevated BP, seizures.

Patient Information

* Tell patient not to chew or crush capsules.
* Teach patient correct method for using metered-dose inhaler. Have patient demonstrate proper technique, including timing between inhalations.
* Instruct patient in home monitoring of pulse and BP.
* Advise patient to maintain fluid intake of 2,000 mL/day and to rinse mouth after each complete dose.
* Instruct patient not to use OTC inhalers without consulting health care provider.
* Instruct patient to contact health care provider if symptoms are not relieved by normal dose.
* Tell patient to report adverse reactions or side effects.