albuterol sulfate

albuterol sulfate (salbutamol sulfate)

AccuNeb, Asmol (CA), Gen-Salbutamol (CA), Novo-Salmol (CA), Proventil HFA, Ventolin HFA, Vospire-ER

Pharmacologic class: Sympathomimetic (beta₂-adrenergic agonist)

Therapeutic class: Bronchodilator, antiasthmatic

Pregnancy risk category C

Action

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

Availability

Aerosol: 90 mcg/actuation

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.

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

Dosage adjustment

• Sensitivity to beta-adrenergic stimulants
• Elderly patients

Off-label uses

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

Contraindications

• Hypersensitivity to drug

Precautions

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

Administration

• 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.

Route	Onset	Peak	Duration
P.O.	15-30 min	2-3 hr	6-12 hr
P.O. (extended)	30 min	2-3 hr	12 hr

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

Interactions

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.
☞ 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.