albuterol sulfate

(al byoo' ter ole)

AccuNeb, Novo-Salmol (CAN), Proventil, Proventil HFA, Proventil Repetabs,
Salbutamol (CAN), Ventodisk (CAN), Ventolin, Ventolin HFA, Volmax

Pregnancy Category C

Drug classes
Sympathomimetic drug
Beta2-selective adrenergic agonist
Bronchodilator
Antiasthmatic

Therapeutic actions
In low doses, acts relatively selectively at beta2-adrenergic receptors to cause
bronchodilation and vasodilation; at higher doses, beta2 selectivity is lost, and the drug
acts at beta2 receptors to cause typical sympathomimetic cardiac effects.

Indications
• Relief and prevention of bronchospasm in patients with reversible obstructive
airway disease
• Inhalation: Treatment of acute attacks of bronchospasm
• Prevention of exercise-induced bronchospasm
• Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients;
seems to lower potassium concentrations when inhaled by patients on
hemodialysis

Contraindications and cautions

• Contraindicated with hypersensitivity to albuterol; tachyarrhythmias, tachycardia
caused by digitalis intoxication; general anesthesia with halogenated
hydrocarbons or cyclopropane (these sensitize the myocardium to
catecholamines); unstable vasomotor system disorders; hypertension; coronary
insufficiency, CAD; history of stroke; COPD patients with degenerative heart
disease.
• Use cautiously with diabetes mellitus (large IV doses can aggravate diabetes and
ketoacidosis); hyperthyroidism; history of seizure disorders; psychoneurotic
individuals; labor and delivery (oral use has delayed second stage of labor;
parenteral use of beta2-adrenergic agonists can accelerate fetal heart beat and
cause hypoglycemia, hypokalemia, pulmonary edema in the mother and
hypoglycemia in the neonate); lactation; the elderly (more sensitive to CNS
effects).

Available forms
Tablets—2, 4 mg; ER tablets—4, 8 mg; syrup—2 mg/5 mL; aerosol—90 mcg/actuation;
solution for inhalation—0.083%, 0.5%, 1.25 mg/3 mL, 0.63 mg/3 mL; capsules for
inhalation—200 mcg
Dosages
ADULTS
Oral
Initially, 2 or 4 mg (1–2 tsp syrup) tid–qid PO; may cautiously increase dosage if
necessary to 4 or 8 mg qid, not to exceed 32 mg/day. Extended release tablets: 8 mg q
12 hr (Volmax); 4–8 mg q 12 hr (Proventil)
Inhalation
Each actuation of aerosol dispenser delivers 90 mcg albuterol; 2 inhalations q 4–6 hr;
some patients may require only 1 inhalation q 4 hr; more frequent administration or larger
number of inhalations not recommended.
• Prevention of exercise-induced bronchospasm: 2 inhalations 15 min prior to
exercise.
Solution for inhalation
2.5 mg tid to qid by nebulization.
Inhalation capsules
One 200 mcg capsule q 4–6 hr up to two 200 mcg capsules q 4–6 hr.
• Prevention of exercise-induced asthma: One 200 mcg capsule inhaled 15 min
before exercise.
PEDIATRIC PATIENTS
Oral, tablets
• 6–12 yr: 2 mg tid–qid. Do not exceed 24 mg/day.
• > 12 yr: Use adult dosage.
ER tablets
• 6–11 yr: 4 mg q 12 hr (Proventil).
• 6–12 yr: 4 mg q 12 hr (Volmax).
Oral, syrup
• < 2 yr: Safety and efficacy not established.
• 2–6 yr: Initially, 0.1 mg/kg tid, not to exceed 2 mg (1 tsp) tid; if necessary,
cautiously increase stepwise to 0.2 mg/kg tid. Do not exceed 4 mg (2 tsp) tid.
• 6–14 yr: 2 mg (1 tsp) tid–qid; if necessary, cautiously increase dosage. Do not
exceed 24 mg/day in divided doses.
• > 14 yr: Use adult dosage.
Inhalation
• 2–12 yr: For child 10–15 kg, use 1.25 mg; for child > 15 kg, use 2.5 mg.
• > 12 yr: Use adult dosage.
Solution for inhalation
• 10–15 kg: 1.25 mg bid–tid by nebulization.
• > 15 kg: 2.5 mg bid–tid by nebulization.
Inhalation capsules
• > 4 yr: One 200 mcg capsule inhaled q 4–6 hr.
• Prevention of exercise-induced asthma: One 200 mcg capsule inhaled 15 min
before exercise.
GERIATRIC PATIENTS OR PATIENTS SENSITIVE TO BETA-ADRENERGIC
STIMULATION
Restrict initial dose to 2 mg tid or qid; individualize dosage thereafter. Patients > 60 yr
are more likely to develop adverse effects.

Pharmacokinetics
Route Onset Peak Duration
Oral 30 min 2–2.5 hr 4–8 hr
Inhalation 5 min 1.5–2 hr 3–8 hr

Metabolism: Hepatic; T1/2: 2–4 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesia,
insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache
• CV: Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare), anginal pain
• Dermatologic: Sweating, pallor, flushing
• GI: Nausea, vomiting, heartburn, unusual or bad taste
• GU: Increased incidence of leiomyomas of uterus when given in higher than
human doses in preclinical studies
• Respiratory: Respiratory difficulties, pulmonary edema, coughing,
bronchospasm, paradoxical airway resistance with repeated, excessive use of
inhalation preparations

Interactions
Drug-drug
• Increased sympathomimetic effects with other sympathomimetic drugs
• Increased risk of toxicity, especially cardiac, when used with theophylline,
aminophylline, oxtriphylline
• Decreased bronchodilating effects with beta-adrenergic blockers (eg, propranolol)
• Decreased effectiveness of insulin, oral hypoglycemic drugs
• Decreased serum levels and therapeutic effects of digoxin

Nursing considerations
Assessment
• History: Hypersensitivity to albuterol; tachyarrhythmias, tachycardia caused by
digitalis intoxication; general anesthesia with halogenated hydrocarbons or
cyclopropane; unstable vasomotor system disorders; hypertension; coronary
insufficiency, CAD; history of stroke; COPD patients who have developed
degenerative heart disease; diabetes mellitus; hyperthyroidism; history of seizure
disorders; psychoneurotic individuals; lactation
• Physical: Weight; skin color, temperature, turgor; orientation, reflexes, affect; P,
BP; R, adventitious sounds; blood and urine glucose, serum electrolytes, thyroid
function tests, ECG

Interventions
 • Use minimal doses for minimal periods; drug tolerance can occur with prolonged
use.
• Maintain a beta-adrenergic blocker (cardioselective beta-blocker, such as atenolol,
should be used with respiratory distress) on standby in case cardiac arrhythmias
occur.
• Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL
normal saline; deliver over 5–15 min by nebulization.
• Do not exceed recommended dosage; administer pressurized inhalation drug
forms during second half of inspiration, because the airways are open wider and
the aerosol distribution is more extensive.

Teaching points
• Do not exceed recommended dosage; adverse effects or loss of effectiveness may
result. Read the instructions that come with respiratory inhalant.
• These side effects may occur: Dizziness, drowsiness, fatigue, headache (use
caution if driving or performing tasks that require alertness); nausea, vomiting,
change in taste (eat small, frequent meals); rapid heart rate, anxiety, sweating,
flushing, insomnia.
• Report chest pain, dizziness, insomnia, weakness, tremors or irregular heart beat,
difficulty breathing, productive cough, failure to respond to usual dosage.

Adverse effects in Italic are most common; those in Bold are life-threatening.