Brand Name
Proventil
albuterol sulfate (salbutamol sulphate)
AccuNeb, Airet, Gen-Salbutamol (CAN), Novo-Salmol (CAN), Proair
HFA, Proventil, Proventil HFA, Proventil Repetabs, Proventil Syrup, Ventolin HFA,
Ventolin Syrup, Volmax
Class and Category
Chemical class: Selective beta2-adrenergic agonist,
sympathomimetic
Therapeutic class: Bronchodilator
Pregnancy category: C
Indications and Dosages
To prevent exercise-induced asthma
INHALATION AEROSOL
Adults and children over age 4. 2 inhalations 15 to 30 min
before exercise.
To treat bronchospasm in patients with reversible
obstructive airway disease or acute bronchospastic attack
E.R. TABLETS
Adults and children over age 12. Initial: 4 or 8 mg
every 12 hr. Maximum: 32 mg daily in divided doses every 12 hr.
Children ages 6 to 12. Initial: 4 mg every
12 hr. Maximum: 24 mg daily in divided doses every 12 hr.
REPETABS
Adults and children over age 12. Initial: 4 to 8 mg
every 12 hr. Maximum: 32 mg daily in divided doses every 12 hr.
Children ages 6 to 11. Initial: 4 mg every
12 hr. Maximum: 24 mg daily in divided doses every 12 hr.
SYRUP
Adults and children over age 14. Initial: 2 to 4 mg
(1 to 2 tsp) t.i.d. or q.i.d. Maximum: 32 mg daily in divided doses.
Children ages 6 to 14. Initial: 2 mg (1
tsp) t.i.d. or q.i.d. Maximum: 24 mg daily in divided doses.
Children ages 2 to 6. Initial: 0.1 mg/kg t.i.d.
(not to exceed 2 mg t.i.d.), increased to 0.2 mg/kg t.i.d. (not to exceed 4 mg t.i.d.).
TABLETS
Adults and children over age 12. Initial: 2 or 4 mg
t.i.d. or q.i.d. Maximum: 32 mg daily in divided doses.
Children ages 6 to 12. Initial: 2 mg
t.i.d. or q.i.d. Maximum: 24 mg daily in divided doses.
DOSAGE ADJUSTMENT
For elderly patients, initial dosage reduced to 2 mg (1 tsp) of syrup
t.i.d. or q.i.d. or 2 mg of tablets t.i.d. or q.i.d. (up to 32 mg daily).
INHALATION AEROSOL
Adults and children age 4 and over. 1
inhalation every 4 hr to 2 inhalations every 4 to 6 hr.
INHALATION CAPSULES (ROTOCAPS) Adults and children age 4 and over.
200 mcg inhaled every 4 to 6 hr using inhalation device. Maximum:
400 mcg every 4 to 6 hr.
INHALATION SOLUTION
Adults and children age 12 and over. 2.5 mg
t.i.d. or q.i.d. by nebulization over 5 to 15 min.
Children ages 2 to 12. Initial: 0.1 to 0.15
mg/kg t.i.d. or q.i.d. Maximum: 2.5 mg t.i.d. or q.i.d.
Mechanism
of Action
Albuterol
attaches to beta2 receptors on membrane bronchial cell membranes, which
stimulates the intracellular enzyme adenylate cyclase to convert adenosine
triphosphate (ATP) to cyclic adenosine monophosphate (cAMP). This reaction
decreases intracellular calcium levels. It also increases intracellular levels
of cAMP, as shown. Together, these effects relax bronchial smooth-muscle cells
and inhibit histamine release.
Route Onset
Peak Duration
P.O. (E.R. tab) 30
min 2–3 hr 12 hr
P.O. (syrup) Rapid
2 hr Unknown
P.O. (tab) 30
min 2–3 hr 4–8 hr
Inhalation (aerosol) 5–15 min 50–55 min 3–6 hr
Inhalation (rotocap) 5–15 min
0.5–3 hr 2–6 hr
Inhalation (sol’n) 5–15 min
1–2 hr 3–6 hr
Contraindications
Hypersensitivity to albuterol or its components
Interactions
DRUGS
beta blockers: Inhibited effects of albuterol
bronchodilators (sympathomimetics), such as
theophylline: Possibly adverse CV effects
digoxin: Decreased serum digoxin level
MAO inhibitors, tricyclic antidepressants: Increased
vascular effects of albuterol
methyldopa: Increased vasopressor effect of methyldopa
potassium-lowering drugs: Possibly hypokalemia
potassium-wasting diuretics: Possibly increased hypokalemia
Adverse Reactions
CNS: Anxiety, dizziness, drowsiness, headache, hyperkinesia, insomnia,
irritability, nervousness, tremor, vertigo, weakness
CV: Angina; arrhythmias, including atrial fibrillation, extrasystoles,
supraventricular tachycardia, and tachycardia; chest pain; hypertension;
hypotension; palpitations
EENT: Altered taste, dry mouth and throat, ear pain, glossitis,
hoarseness, oropharyngeal edema, pharyngitis, rhinitis, taste perversion
ENDO: Hyperglycemia
GI: Anorexia, diarrhea, dysphagia, heartburn, nausea, vomiting
GU: UTI
MS: Muscle cramps
RESP: Bronchospasm, cough, dyspnea, paradoxical bronchospasm, pulmonary
edema
SKIN: Diaphoresis, flushing, pallor, pruritus, rash, urticaria
Other: Angioedema, hypokalemia, infection, metabolic acidosis
Nursing Considerations
• Administer pressurized inhalations of albuterol during second
half of inspiration, when airways are open wider and aerosol distribution is
more effective.
WARNING Use cautiously in patients with cardiac
disorders, diabetes mellitus, digitalis intoxication, hypertension,
hyperthyroidism, or history of seizures. Albuterol can worsen these conditions.
•Monitor serum potassium level because albuterol may cause
transient hypokalemia.
• Be aware that drug tolerance can develop with prolonged use.
PATIENT TEACHING
• Teach patient to use inhaler. Tell him to shake canister before
use and to check that a new canister is working by spraying it the appropriate
number of times (once to four times based on manufacturer instructions) into
the air while looking for a fine mist.
• Instruct patient to wash mouthpiece with water once a week and
let it air-dry.
• Advise patient to wait at least 1 minute between inhalations.
• Tell patient to check with his prescriber before using other
inhaled drugs.
•Warn patient not to exceed prescribed dose or frequency. If doses
become less effective, tell patient to contact his prescriber.
• Tell patient to immediately report signs and symptoms of
allergic reaction, such as difficulty swallowing, itching, and rash.
