albuterol sulfate

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Related to AccuNeb: Albuterol sulfate

albuterol sulfate (salbutamol sulfate)

AccuNeb, Gen-Salbutamol (CA), Nu-Salbutamol (CA), ProAir HFA, Proventil HFA, Ventolin HFA, Vospire-ER

Pharmacologic class: Sympathomimetic (beta2-adrenergic agonist)

Therapeutic class: Bronchodilator, antiasthmatic

Pregnancy risk category C


Relaxes smooth muscles by stimulating beta2-receptors, thereby causing bronchodilation and vasodilation


Aerosol: 90 mcg/actuation, 108 mcg/inhalation

Oral solution: 2 mg/5 ml

Solution for inhalation: 0.083% (3 ml), 0.5% (0.5 and 20 ml), 0.63 mg/3 ml, 1.25 mg/3 ml

Syrup: 2 mg/5 ml

Tablets: 2 mg, 4 mg

Tablets (extended-release): 4 mg, 8 mg

Indications and dosages

To prevent and relieve bronchospasm in patients with reversible obstructive airway disease

Adults and children ages 12 and older:Tablets-2 to 4 mg P.O. three or four times daily, not to exceed 32 mg daily. Extended-release tablets-4 to 8 mg P.O. q 12 hours, not to exceed 32 mg daily in divided doses. Syrup-2 to 4 mg (1 to 2 tsp or 5 to 10 ml) three or four times daily, not to exceed 8 mg q.i.d.

Aerosol-one to two inhalations q 4 to 6 hours to relieve bronchospasm; two inhalations q.i.d. to prevent bronchospasm. Solution for inhalation-2.5 mg three to four times daily by nebulization, delivered over 5 to 15 minutes.

Children ages 6 to 12:Tablets-2 mg P.O. three or four times daily; maximum daily dosage is 24 mg, given in divided doses. Extended-release tablets-4 mg q 12 hours; maximum daily dosage is 24 mg/kg given in divided doses. Syrup-2 mg (1 tsp or 5 ml) three or four times daily, not to exceed 24 mg.

Adults and children age 4 and older (with ProAir HFA): Two inhalations q 4 to 6 hours to treat acute bronchospasm

Children ages 2 to 12 weighing more than 15 kg (33 lb):Solution for inhalation-2.5 mg three to four times/day by nebulization

Children ages 2 to 6:Syrup-Initially, 0.1 mg/kg P.O. t.i.d., not to exceed 2 mg (1 tsp) t.i.d. Maximum dosage is 4 mg (2 tsp) t.i.d.

To prevent exercise-induced bronchospasm

Adults and children older than age 4 (older than age 12 with Proventil): Two inhalations 15 minutes before exercise

Adults and children age 4 and older (with ProAir HFA): Two inhalations q 15 to 30 minutes before exercise

Dosage adjustment

• Sensitivity to beta-adrenergic stimulants
• Elderly patients

Off-label uses

• Chronic obstructive pulmonary disease
• Hyperkalemia with renal failure
• Preterm labor management


• Hypersensitivity to drug


Use cautiously in:
• cardiac disease, hypertension, diabetes mellitus, glaucoma, seizure disorder, hyperthyroidism, exercise-induced bronchospasm, prostatic hypertrophy
• elderly patients
• pregnant or breastfeeding patients
• children.


• Give extended-release tablets whole; don't crush or mix with food.
• Administer solution for inhalation by nebulization over 5 to 15 minutes, after diluting 0.5 ml of 0.5% solution with 2.5 ml of sterile normal saline solution.
• Know that children weighing less than 15 kg (33 lb) who require less than 2.5 mg/dose should receive 0.5% inhalation solution.

Adverse reactions

CNS: dizziness, excitement, headache, hyperactivity, insomnia

CV: hypertension, palpitations, tachycardia, chest pain

EENT: conjunctivitis, dry and irritated throat, pharyngitis

GI: nausea, vomiting, anorexia, heartburn, GI distress, dry mouth

Metabolic: hypokalemia

Musculoskeletal: muscle cramps

Respiratory: cough, dyspnea, wheezing, paradoxical bronchospasm

Skin: pallor, urticaria, rash, angioedema, flushing, sweating

Other: tooth discoloration, increased appetite, hypersensitivity reaction


Drug-drug.Beta-adrenergic blockers: inhibited albuterol action, possibly causing severe bronchospasm in asthmatic patients

Digoxin: decreased digoxin blood level

MAO inhibitors: increased cardiovascular adverse effects

Oxytoxics: severe hypotension

Potassium-wasting diuretics: ECG changes, hypokalemia

Theophylline: increased risk of theophylline toxicity

Drug-food.Caffeine-containing foods and beverages (such as coffee, tea, chocolate): increased stimulant effect

Drug-herbs.Cola nut, ephedra (ma huang), guarana, yerba maté: increased stimulant effect

Patient monitoring

Stay alert for hypersensitivity reactions and paradoxical bronchospasm. Stop drug immediately if these occur.
• Monitor serum electrolyte levels.

Patient teaching

• Tell patient to swallow extended-release tablets whole and not to mix them with food.
• Follow manufacturer's directions supplied with inhalation drugs.

Teach patient signs and symptoms of hypersensitivity reaction and paradoxical bronchospasm. Tell him to stop taking drug immediately and contact prescriber if these occur.

Instruct patient to notify prescriber immediately if prescribed dosage fails to provide usual relief, because this may indicate seriously worsening asthma.
• Advise patient to limit intake of caffeine-containing foods and beverages and to avoid herbs unless prescriber approves.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to establish effective bedtime routine and to take drug well before bedtime to minimize insomnia.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.

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