Salbutamol


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Acute bronchospasm 2-4 mg 3-4 times/day, up to 8 mg 3-4 times/day. As modified-release tab: 8 mg bid. IV Severe bronchospasm 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). Higher doses may be used in resp failure. Uncomplicated premature labour at 22-37 wk of gestation Initial: 10 mcg/min, increasing gradually at 10-min intervals until there is response, then increase rate slowly until contractions cease. Maintain rate for 1 hr after contractions have stopped, then gradually reduce rate by 50% at intervals of 6 hr. Usual: 10-45 mcg/min. Max duration: 48 hr. IM/SC Severe bronchospasm 500 mcg (8 mcg/kg) and repeated 4 hrly as required. Inhalation Acute bronchospasm As metered-dose aerosol or dry powd inhaler: 1 or 2 inhalations up to 4 times/day. Max: 800 mcg/day. Prophylaxis of exercise-induced bronchospasm As metered-dose aerosol or dry powd inhaler: 2 inhalations 10-15 min prior to exercise. Severe bronchospasm Via nebuliser: 2.5-5 mg, up to 4 times/day, or continuously at a rate of 1-2 mg/hr. Acute severe asthma As metered-dose inhaler via spacer device: Initial: 4 inhalations, then a further 2 inhalations every 2 min according to response. Max: 10 inhalations.
Dosage Details
Inhalation/Respiratory
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.

Inhalation/Respiratory
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.

Inhalation/Respiratory
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.

Inhalation/Respiratory
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.

Intravenous
Uncomplicated premature labour
Adult: For arrest of preterm labour between 22 and 37 weeks 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 hour after contractions have stopped, then gradually reduce rate by 50% at intervals of 6 hours. Usual dose: 10-45 mcg/min. Max duration: 48 hours.

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. Higher doses may be used in resp failure.
Child: ≥12 yr Same as adult dose.

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.

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.
Reconstitution
Intravenous:
Bronchospasm: Dilute 5 mL of soln w/ 500 mL NaCl or dextrose inj or other suitable diluents to provide a 10 mcg/mL soln.
Premature labour: 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:
Dilute 0.5 mL of soln to a total of 3 mL w/ NaCl 0.9% to prepare a 2.5 mg dose.
Contraindications
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.
Special Precautions
Hyperthyroidism, myocardial insufficiency, arrhythmias, susceptibility to QT-interval prolongation, HTN, DM, glaucoma, hypokalaemia, seizure disorder. Renal impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
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.
Inhalation/Respiratory/IV/Parenteral/PO: C
MonitoringParameters
Monitor BP, heart rate, electrolyte and fluid balance; glucose, lactate and K levels.
Overdosage
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.
Drug Interactions
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.
Action
Description: 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).
Pharmacokinetics:
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).
Chemical Structure

Chemical Structure Image
Salbutamol

Source: National Center for Biotechnology Information. PubChem Database. Salbutamol, CID=2083, https://pubchem.ncbi.nlm.nih.gov/compound/Salbutamol (accessed on Jan. 21, 2020)

Storage
Store between 15-30°C. Protect from light.
ATC Classification
R03CC02 - salbutamol ; Belongs to the class of adrenergics for systemic use, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
R03AC02 - salbutamol ; Belongs to the class of adrenergic inhalants, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
References
Albuterol Sulfate Solution (Actavis Pharma, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 30/06/2015.

Anon. Albuterol Sulfate, Levalbuterol Hydrochloride, Levalbuterol Tartrate. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 30/06/2015.

Anon. Albuterol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 30/06/2015.

Buckingham R (ed). Salbutamol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 30/06/2015.

Disclaimer: This information is independently developed by MIMS based on Salbutamol from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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