SALBUTAMOL (SYSTEMIC)

GENERIC NAME: Albuterol

PHARMACOLOGICAL CLASS: B2 adrenergic receptor agonist
ATC CODE: R03AC02
PRACTICE INSIGHTS:

Increased risk of hypokalaemia using with depleting agents (e.g. corticosteroid, diuretics, xanthines,
digoxin).

DOSE
ADULT:
Brochospasm
Inhalation

Metered-dose inhaler: 2 puffs (180 or 216 mcg) 15 minutes before exercise.

Inhalation capsules: 200 mcg inhaled 15 minutes before exercise

Intravenous

250 mcg (4 mcg/kg) injected slowly. May be repeated if necessary. As 10

mcg/mL soln: Usual rate of 3-20 mcg/min (0.3-2 mL/min), adjusted according to
patient needs. Higher doses may be used in resp failure.

Oral

2-4 mg 3 or 4 times daily, up to 8 mg 3 or 4 times daily as required in some

patients. As modified-release tab: 8 mg bid

Chronic Obstructive Pulmonary disease

Metered-dose inhaler: 2 puffs every 4 to 6 hours as needed.

Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary
Nebulizer: 2.5 mg every 6 to 8 hours as needed. (2.5 to 5 mg once followed
by 2.5 mg every 20 minutes for acute bronchospasm).

Asthma acute

Metered-dose inhaler:2 puffs every 4-6hrs as needed

Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.

May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.

Nebulizer: 2.5 mg every 6 to 8 hours as needed. (2.5 to 5 mg once followed by

2.5 mg every 20 minutes for acute bronchospasm).

Asthma - Maintenance

Metered-dose inhaler: 2 puffs every 4 to 6 hours. More frequent administration

or a large number of inhalations is not recommended.

Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.

May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.

Tablets: 2 to 4 mg orally 3 to 4 times a day. May increase stepwise to a

maximum of 8 mg orally 4 times a day.

Extended-release tablets: 4 to 8 mg orally every 8 hours. May increase to a

maximum of 16 mg orally twice a day.

Syrup: 2 to 4 mg orally 3 to 4 times a day. Doses > 4 mg should be given 4

times a day. May increase up to 8 mg orally 4 times a day.

Uncomplicated premature labour

For arrest of preterm labour between 22 and 37 wk of gestation: Initially, 10

mcg/min, increasing gradually at 10-min intervals until there is response;
increase infusion rate slowly thereafter until contractions cease.

Max duration: 48 hr. Doses are given preferably w/ the aid of a syringe pump.

PEDIATRIC:
Asthma acute
Less than 1 year:
Nebulizer: 0.05 to 0.15 mg/kg/dose every 4 to 6 hours with subsequent doses titrated
based on clinical response.
1 year to 4 years:
Nebulizer: 1.25 to 2.5 mg every 4 to 6 hours with subsequent doses titrated based on
clinical response.
5 years or older:
Metered-dose inhaler (HFA): 2 puffs (216 mcg) every 4 to 6 hours as needed.
Inhalation capsules: 200 mcg inhaled every 4 to 6 hours.
May increase to 400 mcg inhaled every 4 to 6 hours, if necessary.
5 years to 11 years:
Nebulizer: 2.5 mg every 4 to 6 hours with subsequent doses titrated based on clinical
response.

12 years or older:
Nebulizer: 2.5 to 5 mg every 6 hours as needed.
Metered dose inhaler (non-HFA): 2 puffs every (180 mcg) every 4 to 6 hours.
Asthma - Maintenance
Over 4 years:
Metered-dose inhaler (HFA): 2 puffs (216 mcg)15 minutes before exercise.
Inhalation capsules: 200 mcg inhaled 15 minutes before exercise.
12 years or older:
Metered-dose inhaler (non-HFA): 2 puffs (180 mcg) 15 minutes before exercise.
DOSE ADJUSTMENT
Hepatic impairment

Safety and efficacy is not established

Renal impairment

Safety and efficacy is not established

INDICATIONS (OPTIONAL):

Exercise induced Brochospasm

PREGNANCY & LACTATION:

Category C
Excretion in breast milk unknown/not recommended

MODE OF ACTION: Salbutamol stimulates 2 adrenergic receptors in bronchial

smooth muscle of the lung which leads to the activation of enzyme adenyl cyclase
that form cyclic AMP (adenosine-mono-phosphate) from ATP (adenosine-triphosphate). This high level of cyclic AMP relaxes bronchial smooth muscle and
decreases airway resistance by lowering intracellular ionic calcium concentrations.
High level of cyclic AMP are also inhibits the release of bronchoconstrictor mediators
such as histamine, leukotreine from the mast cells in the airway.
ADVERSE DRUG REACTIONS:
>10%
Nervousness in children aged 2-6 years, tremor ,insomnia in children aged 6-12 years
receiving 4-12 mg every 12hr
1-10%
Fever,bronchospasm,,vomiting ,headache ,dizziness ,cough ,allergic reactions,otitis
media ,epistaxis in children ,increased appetite ,urinary tract infection ,dry mouth
,eructation or flatulence ,increased sweating ,pain,dyspepsia,hyperactivity

,chills,lymphadenopathy ,ocular pruritus ,sweating ,conjunctivitis in children aged 2-6

years ,dysphonia ,flu syndromenervousness.
<1%
Epigastric pain,epistaxis in adults,hyperactivity in children

DRUG INTERACTIONS:
CONTRAINDICATIONS & WARNINGS:

Contraindicated in
o Person with history of hypersensitivity reactions
o Urticaria
o Angioderma
o Pre existing cardiac tachyarrhythmia
Caution in
o Cardiovascular disorders, especially coronary insufficiency, cardiac
arrhythmias, and hypertension

DIETARY & GENERAL CONSIDERATIONS:

Warn patient to avoid alcohol

Should be used during pregnancy only if absolutely essential

MONITORING PARAMETERS:

Monitor:
o CBC with differential, Vitals
o Pulmonary function
o Glucose, lactate and K levels.
o Signs/symptoms of ASTHMA