Oral
Acute bronchospasm
Adult: 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.
Child: 2-6 yr 1-2 mg; >6-12 yr 2 mg; >12 yr Same as adult dose. Doses to be given 3 or 4 times daily.
Elderly: 2 mg 3 or 4 times daily.
Inhalation
Acute bronchospasm
Adult: As metered-dose aerosol or dry powd inhaler (90 or 100 mcg/actuation): 1 or 2 inhalations up to 4 times daily. Max: 800 mcg daily.
Child: 6-12 yr 1 inhalation, may be increased to 2 inhalations as necessary. Max: 400 mcg daily.
Reconstitution: Dilute 0.5 mL of soln to a total of 3 mL w/ NaCl 0.9% to prepare a 2.5 mg dose.
Inhalation
Acute severe asthma
Adult: As metered-dose inhaler (100 mcg/actuation) via spacer device: Initially, 4 inhalations, then a further 2 inhalations every 2 min according to response. Max: 10 inhalations.
Parenteral
Severe bronchospasm
Adult: IM/SC: 500 mcg (8 mcg/kg) and repeated every 4 hours as required.
Child: ≥12 yr Same as adult dose.
Intravenous
Uncomplicated premature labour
Adult: 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. Maintain rate for 1 hr after contractions have stopped, then gradually reduce rate by 50% at intervals of 6 hr. Usual dose: 10-45 mcg/min. Max duration: 48 hr. Doses are given preferably w/ the aid of a syringe pump.
Reconstitution: Dilute 10 mL of soln w/ 40 mL of dextrose 5% to provide a 200 mcg/mL soln for use in syringe pump, alternatively, dilute 10 mL of soln w/ 490 mL of dextrose 5% for use in other infusion methods.
Inhalation
Severe bronchospasm
Adult: Via nebuliser: 2.5-5 mg, up to 4 times daily, alternatively, may be given continuously at a rate of 1-2 mg/hr.
Child: ≥4 yr Same as adult dose.
Reconstitution: Dilute 0.5 mL of soln to a total of 3 mL w/ NaCl 0.9% to prepare a 2.5 mg dose.
Intravenous
Severe bronchospasm
Adult: As 50 mcg/mL soln: 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.
Child: ≥12 yr Same as adult dose.
Reconstitution: Dilute 5 mL of soln w/ 500 mL NaCl or dextrose inj or other suitable diluents to provide a 10 mcg/mL soln.
Inhalation
Prophylaxis of exercise-induced bronchospasm
Adult: As metered-dose aerosol or dry powd inhaler (90 or 100 mcg/actuation): 2 inhalations 10-15 min prior to exercise.
Child: 6-12 yr 1 inhalation 10-15 min prior to exercise.
Reconstitution: Dilute 0.5 mL of soln to a total of 3 mL w/ NaCl 0.9% to prepare a 2.5 mg dose.
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IV (in the treatment of premature labour): Pre-existing or risk factors for ischaemic heart disease, gestational age <22 wk, conditions in which prolongation of pregnancy is hazardous (e.g. severe toxaemia, intrauterine infection, vag bleeding resulting from placenta praevia, eclampsia or severe preeclampsia, placental abruption, cord compression; use in threatened abortion.
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Hyperthyroidism, myocardial insufficiency, arrhythmias, susceptibility to QT-interval prolongation, HTN, DM, glaucoma, hypokalaemia, seizure disorder. Renal impairment. Elderly. Pregnancy and lactation. Monitoring Parameters Monitor BP, heart rate, electrolyte and fluid balance; glucose, lactate and K levels.
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Tremor, nervousness, nausea and vomiting, tachycardia, palpitations, chest pain, shakiness, dizziness, headache, insomnia, inhalation site sensation, hyperactivity, HTN, hypotension, increased sweating, allergic reactions, DM, muscle cramps, flu-like syndrome, conjunctivitis, UTI, hypokalaemia,. Rarely, erythema multiforme, Stevens-Johnson syndrome.
Potentially Fatal: Paradoxical bronchospasm.
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Symptoms: Tachycardia, CNS stimulation, tremor, hypokalaemia, hyperglycaemia, lactic acidosis, nausea, vomiting. Management: Symptomatic and supportive treatment. May administer activated charcoal. β-blocking agents (e.g. metoprolol) may be given but w/ extreme caution in asthmatic patients.
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Increased risk of hypokalaemia w/ K depleting agents (e.g. corticosteroid, diuretics, xanthines, digoxin). Increased uterine inertia w/ halogenated anaesth (IV). Increased risk of pulmonary oedema w/ corticosteroids. May antagonise the effect of anti-diabetics. Effects may be altered by guanethidine, reserpine, methyldopa, TCAs and MAOIs. Increased risk of CV effects w/ other sympathomimetic agents. Antagonistic effect w/ β-blockers.
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Salbutamol activates adenyl cyclase, the enzyme that stimulates the production of cyclic adenosine-3', 5'-monophosphate (cAMP). Increased cAMP leads to activation of protein kinase A, which inhibits phosphorylation of myosin and lowers intracellular ionic Ca concentrations, resulting in smooth muscle relaxation.
Onset: W/in 5 min (inhalation); w/in 30 min (oral).
Duration: Approx 3-6 hr (inhalation); up to 6 hr (oral).
Absorption: Readily absorbed from the GI tract.
Metabolism: Undergoes metabolism in the liver and in the gut wall.
Excretion: Via urine (as metabolites and unchanged drug); faeces (small amounts).
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Inhalation: Store between 15-30°C. Protect from light. Intravenous: Store between 15-30°C. Protect from light. Oral: Store between 15-30°C. Protect from light. Parenteral: Store between 15-30°C. Protect from light.
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R03AC02 - salbutamol ; Belongs to the class of adrenergic inhalants, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
R03CC02 - salbutamol ; Belongs to the class of adrenergics for systemic use, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
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