Increasing use of beta-2 agonist may be a sign of worsening asthma. Under these conditions a reassessment of the patient's therapy plan may be required and concomitant glucocorticosteroid therapy should be considered.
As there may be adverse effects associated with excessive dosing, the dosage or frequency of administration should only be increased on medical advice.
Nebules: VENTOLIN Nebules are to be used with a nebuliser, under the direction of a physician.
The solution must not be injected, or swallowed.
Clinical efficacy of nebulised salbutamol in infants under 18 months is uncertain. As transient hypoxaemia may occur, supplement oxygen therapy should be considered.
Adults and Children: A suitable starting dose of salbutamol by wet inhalation is 2.5 mg. This may be increased to 5 mg. Treatment may be repeated four times daily. In adults higher dosing, up to 40 mg per day, can be given under strict medical supervision in hospital for the treatment of severe airway obstruction.
Salbutamol has a duration of 4-6 hours in most patients.
VENTOLIN Nebules are intended to be used undiluted. However, if prolonged delivery time is desirable (more than 10 minutes) dilution using sterile normal saline as a diluent may be required.
Accuhaler: VENTOLIN ACCUHALER is for inhalation use only. VENTOLIN ACCUHALER is suitable for many patients including those who cannot use a metered-dose inhaler successfully.
Adults (including the elderly): For the relief of acute bronchospasm, 200mcg as a single dose. The maximum daily dose is 200mcg four times a day.
To prevent allergen- or exercise-induced asthma, 200mcg should be taken 10-15 minutes before challenge.
Children: The recommended dose for relief of acute bronchospasm or before allergen exposure or exercise is 200mcg. The maximum daily dose is 200mcg four times daily.
On demand use of VENTOLIN ACCUHALER should not exceed four times daily. Reliance on such frequent supplementary use, or a sudden increase in dose, indicates poorly controlled or deteriorating asthma (see Precautions).
Inhaler: Ventolin inhaler is for oral inhalation use only. A spacer device may be used in patients who find it difficult to synchronise aerosol actuation with inspiration of breath.
Adults (including the Elderly): For the relief of acute asthma symptoms including bronchospasm, one inhalation (100 mcg) may be administered as a single minimum starting dose. This may be increased to two inhalations if necessary. To prevent allergen- or exercise-induced symptoms, two inhalations should be taken 10-5 minutes before challenge.
For chronic therapy, two inhalations up to four times a day.
Children: For the relief of acute asthma symptoms including bronchospasm, or before allergen exposure or exercise, one inhalation, or two if necessary.
For chronic therapy, two inhalations up to four times a day.
Babies and young children may benefit from use of a spacer device.
On-demand use of VENTOLIN Inhaler should not exceed 8 inhalations in any 24 hours.
Solution for Intravenous Infusion: VENTOLIN parenteral preparations are to be used under the direction of a physician.
In severe bronchospasm and status asthmaticus: Adults: A suitable solution for infusion providing 10 mcg salbutamol / ml is prepared by diluting 5ml of VENTOLIN Solution for Intravenous Infusion to 500ml with an infusion solution such as sodium chloride and dextrose injection BP. Other suitable diluents are Water for Injections BP, Sodium Chloride Injection BP or Dextrose Injection BP.
Infusion rates providing 3 to 20 mcg salbutamol / min (0.3 to 2 ml/min of the previously mentioned infusion solution) are usually adequate. Higher doses have been used with success in patients with respiratory failure.
Paediatric Population: The safety and efficacy of VENTOLIN Solution for Intravenous Infusion in children under the age of 12 has not been established. From the available data no recommendation on posology can be made.
Children aged 12 years and over: Dose as per adult population.
In the short term management of uncomplicated premature labour: Treatment with VENTOLIN Solution for Intravenous Infusion should only be initiated by obstetricians/ physicians experienced in the use of tocolytic agents. It should be carried out in facilities adequately equipped to perform continuous monitoring of maternal and foetus health status.
Duration of treatment should not exceed 48 hours as data show that the main effect of tocolytic therapy is a delay in delivery of up to 48 hours; no statistically significant effect on perinatal mortality or morbidity has been observed in randomized, controlled trials. This short term delay may be used to implement other measures known to improve perinatal health.
VENTOLIN Solution for Intravenous Infusion should be administered as early as possible after the diagnosis of premature labour, and after evaluation of the patient to eliminate any contra-indications to the use of salbutamol (see Contraindications). This should include an adequate assessment of the patient's cardiovascular status with supervision of cardiorepiratory function and ECG monitoring throughout treatment (see Precautions).
Special caution for infusion: The dose must be individually titrated with reference to suppression of contractions, increase in pulse rate and changes in blood pressure, which are limiting factors. These parameters should be carefully monitored during treatment. A maximum maternal heart rate of 120 beats per min should not be exceeded.
Careful control of the level of hydration is essential to avoid the risk of maternal pulmonary oedema (see Precautions). The volume of fluid in which the drug is administered should thus be kept to a minimum. A controlled infusion device should be used, preferably a syringe pump.
Infusion rates providing 10-45 mcg salbutamol / min are generally adequate to control uterine contractions. A starting rate of 10 mcg / min is recommended, increasing the rate at 10-minute intervals until there is evidence of patient response shown by diminution in strength, frequency or duration of contractions. Thereafter, the infusion rate may be increased slowly until contractions cease. Careful attention should be given to cardio-respiratory function and fluid balance monitored. Once uterine contractions have ceased the infusion rate should be maintained at the same level for one hour and then reduced by 50% decrements at six-hourly intervals. If labour progresses despite treatment the infusion should be stopped.
Dilution: The recommended diluent is 5% Dextrose (see Contraindications).
For use in a syringe pump: Prepare a solution providing 200 mcg salbutamol / ml by diluting 10 ml VENTOLIN Solution for Intravenous Infusion with 40 ml diluents. An infusion rate of 10 to 45 mcg / min is equivalent to 0.05 to 0.225 ml / min of this solution.
Other infusion methods: Prepare a solution providing 20 mcg salbutamol / min by diluting 10 ml VENTOLIN Solution for Intravenous Infusion with 490 ml diluents. An infusion rate of 10 to 45 mcg / min is equivalent to 0.5 to 2.25 ml / min of this solution.