Yes

Beta₂ Agonist

Bronchodilator in reversible airway obstruction due to asthma or COPD

C

Clinical effects on the fetus: Crosses the placenta. Tocolytic effects, fetal tachycardia, fetal hypoglycemia secondary to maternal hyperglycemia with oral or intravenous routes reported. Available evidence suggests safe use during pregnancy.

Breast-feeding/lactation: No data on crossing into breast milk or clinical effects on the infant

Hypersensitivity to albuterol, adrenergic amines or any ingredients

Use with caution in patients with hyperthyroidism, diabetes mellitus, or sensitivity to sympathomimetic amines; cardiovascular disorders including coronary insufficiency or hypertension; excessive use may result in tolerance

Because of its minimal effect on beta₁-receptors and its relatively long duration of action, albuterol is a rational choice in the elderly when a beta agonist is indicated. All patients should utilize a spacer device when using a metered dose inhaler. Oral use should be avoided in the elderly due to adverse effects.

>10%:

Cardiovascular: Tachycardia, palpitations, pounding heartbeat

Gastrointestinal: GI upset, nausea

1% to 10%:

Cardiovascular: Flushing of face, hypertension or hypotension

Central nervous system: Nervousness, CNS stimulation, hyperactivity, insomnia, dizziness, lightheadedness, drowsiness, headache

Gastrointestinal: Xerostomia, heartburn, vomiting, unusual taste

Genitourinary: Dysuria

Neuromuscular & skeletal: Muscle cramping, tremor, weakness

Respiratory: Coughing

Miscellaneous: Diaphoresis (increased)

<1%: Chest pain, unusual pallor, loss of appetite, paradoxical bronchospasm

Symptoms of overdose include hypertension, tachycardia, angina, hypokalemia

Hypokalemia and tachyarrhythmias: Prudent use of a cardioselective beta-adrenergic blocker (eg, atenolol or metoprolol); keep in mind the potential for induction of bronchoconstriction in an asthmatic. Dialysis has not been shown to be of value in the treatment of an overdose with this agent.

Decreased effect: Beta-adrenergic blockers (eg, propranolol)

Increased therapeutic effect: Inhaled ipratropium may increase duration of bronchodilation, nifedipine may increase FEV-1

Increased toxicity: Cardiovascular effects are potentiated in patients also receiving MAO inhibitors, tricyclic antidepressants, sympathomimetic agents (eg, amphetamine, dopamine, dobutamine), inhaled anesthetics (eg, enflurane)

Albuterol nebulizer solution is compatible with cromolyn or ipratropium nebulizer solutions

Relaxes bronchial smooth muscle by action on beta₂-receptors with little effect on heart rate

Peak effect: Oral: 2-3 hours; Nebulization/oral inhalation: Within 0.5-2 hours

Duration of action: Oral: 4-6 hours; Nebulization/oral inhalation: 3-4 hours

Metabolism: By the liver to an inactive sulfate, with 28% appearing in the urine as unchanged drug

Half-life: Inhalation: 3.8 hours; Oral: 3.7-5 hours

Elimination: 30% appears in urine as unchanged drug

Oral:

Children:

2-6 years: 0.1-0.2 mg/kg/dose 3 times/day; maximum dose not to exceed 12 mg/day (divided doses)

6-12 years: 2 mg/dose 3-4 times/day; maximum dose not to exceed 24 mg/day (divided doses)

Children >12 years and Adults: 2-4 mg/dose 3-4 times/day; maximum dose not to exceed 32 mg/day (divided doses)

Elderly: 2 mg 3-4 times/day; maximum: 8 mg 4 times/day

Inhalation MDI: 90 mcg/spray:

Children <12 years: 1-2 inhalations 4 times/day using a tube spacer

Children greater than or equal to 12 years and Adults: 1-2 inhalations every 4-6 hours; maximum: 12 inhalations/day

Exercise-induced bronchospasm: 2 inhalations 15 minutes before exercising

Inhalation: Nebulization: 0.01-0.05 mL/kg of 0.5% solution every 4-6 hours; intensive care patients may require more frequent administration; minimum dose: 0.1 mL; maximum dose: 1 mL diluted in 1-2 mL normal saline; continuous nebulized albuterol at 0.3 mg/kg/hour has been used safely in the treatment of severe status asthmaticus in children; continuous nebulized doses of 3 mg/kg/hour ± 2.2 mg/kg/hour in children whose mean age was 20.7 months resulted in no cardiac toxicity; the optimal dosage for continuous nebulization remains to be determined.

Hemodialysis: Not removed

Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics

Limit caffeine intake; should be administered with water 1 hour before or 2 hours after meals

Heart rate, CNS stimulation, asthma symptoms, arterial or capillary blood gases (if patients condition warrants)

renin (S), aldosterone (S)

May produce CNS stimulation resulting in anxiety, tremor, and insomnia

Effect of propranolol may be reduced; cardiovascular effects (tachycardia, palpitations) may be increased with MAOIs, TCAs, and amphetamines

No information available to require special precautions

No effects or complications reported

Use exactly as directed. Do not use more often than recommended. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nervousness, dizziness, or fatigue (use caution when driving or engaging in hazardous activities until response to drug is known); dry mouth, unpleasant taste, stomach upset (frequent small meals, frequent mouth care, chewing gum, or sucking lozenges may help); or difficulty urinating (always void before treatment). Report unresolved GI upset, dizziness or fatigue, vision changes, chest pain or palpitations, persistent inability to void, nervousness or insomnia, muscle cramping or tremor, or unusual cough. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Self-administered nebulizer: Wash hands before and after treatment. Wash and dry nebulizer after each treatment. Twist open the top of one unit dose vial and squeeze contents into nebulizer reservoir. Connect nebulizer reservoir to the mouthpiece or face-mask. Connect nebulizer to compressor. Sit in comfortable, upright position. Place mouthpiece in your mouth or put on face mask and turn on compressor. If face-mask is used, avoid leakage around the mask to avoid mist getting into eyes which may cause vision problems. Breath calmly and deeply until no more mist is formed in nebulizer (about 5 minutes). At this point treatment is finished.

Before using, the inhaler must be shaken well; assess lung sounds, pulse, and blood pressure before administration and during peak of medication; observe patient for wheezing after administration, if this occurs, call physician

Aerosol: 90 mcg/dose (17 g) [200 doses]

Proventil®, Ventolin®: 90 mcg/dose (17 g) [200 doses]

Aerosol, chlorofluorocarbon free (Proventil® HFA): 90 mcg/dose (17 g)

Capsule for oral inhalation (Ventolin® Rotacaps®): 200 mcg [to be used with Rotahaler® inhalation device]

Solution, inhalation: 0.083% (3 mL); 0.5% (20 mL)

Airet®: 0.083%

Proventil®: 0.083% (3 mL); 0.5% (20 mL)

Ventolin®: 0.5% (20 mL)

Syrup, as sulfate: 2 mg/5 mL (480 mL)

Proventil®, Ventolin®: 2 mg/5 mL (480 mL)

Tablet, as sulfate: 2 mg, 4 mg

Proventil®, Ventolin®: 2 mg, 4 mg

Tablet, extended release:

Proventil® Repetabs®: 4 mg

Volmax®: 4 mg, 8 mg

Bartfield JM, Boenau IB, Lozon J, et al, "Comparison of Metered Dose Inhaler and Oral Administration of Albuterol in the Outpatient Treatment of Infants and Children," Am J Emerg Med, 1995, 13(3):375-8.

Cook P, Scarfone RJ, and Cook RT, "Adenosine in the Termination of Albuterol-Induced Supraventricular Tachycardia," Ann Emerg Med, 1994, 24(2):316-9.

Finnerty JP and Howarth PH, "Paradoxical Bronchoconstriction With Nebulized Albuterol But Not With Terbutaline," Am Rev Respir Dis, 1993, 148(2):512-3.

Katz RW, Kelly HW, Crowley MR, et al, "Safety of Continuous Nebulized Albuterol for Bronchospasm in Infants and Children," Pediatrics, 1993, 92(5):666-69.

Leikin JB, Linowiecki KA, Soglin DF, et al, "Hypokalemia After Pediatric Albuterol Overdose: A Case Series," Am J Emerg Med, 1994, 12(1):64-6.

Lin R, Smith AJ, and Hergenroeder P, "High Serum Albuterol Levels and Tachycardia in Adult Asthmatics Treated With High-Dose Continuously Aerosolized Albuterol," Chest, 1993, 103(1):221-5.

Manthous CA, Hall JB, Schmidt GA, et al, "Metered-Dose Inhaler Versus Nebulized Albuterol in Mechanically Ventilated Patients," Am Rev Respir Dis, 1993, 148(6 Pt 1):1567-70.

O'Callaghan C, Milner AD, and Swarbrick A, "Nebulized Salbutamol Does Have a Protective Effect on Airways in Children Under One Year Old," Arch Dis Child, 1988, 63(5):479-83.

Papo MC, Frank J, and Thompson AE, "A Prospective, Randomized Study of Continuous Versus Intermittent Nebulized Albuterol for Severe Status Asthmaticus in Children," Crit Care Med, 1993, 21(10):1479-86.

Rachelefsky GS and Siegel SC, "Asthma in Infants and Children - Treatment of Childhood Asthma: Part II," J Allergy Clin Immunol, 1985, 76(3):409-25.

Schuh S, Parkin P, Rajan A, et al, "High- Versus Low-Dose, Frequently Administered, Nebulized Albuterol in Children With Severe, Acute Asthma," Pediatrics, 1989, 83(4):513-8.

Schuh S, Reider MJ, Canny G, et al, "Nebulized Albuterol in Acute Childhood Asthma: Comparison of Two Doses," Pediatrics, 1990, 86(4):509-13.

Spiller HA, Ramoska EA, Henretig FM, et al, "A Two-Year Retrospective Study of Accidental Pediatric Albuterol Ingestions," Pediatr Emerg Care, 1993, 9(6):338-40.

Udezue E, D'Souza L, and Mahajan M, "Hypokalemia After Normal Doses of Nebulized Albuterol (Salbutamol)," Am J Emerg Med, 1995, 13(2):168-71.

Wiley JF 2nd, Spiller HA, Krenzelok EP, et al, "Unintentional Albuterol Ingestion in Children," Pediatr Emerg Care, 1994, 10(4):193-6.