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Albuterol Sulfate

Albuterol Sulfate

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albuterol sulfate
(alb yoo' 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
\u2022
Relief and prevention of bronchospasm in patients with reversible obstructive
airway disease
\u2022
Inhalation: Treatment of acute attacks of bronchospasm
\u2022
Prevention of exercise-induced bronchospasm
\u2022

Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients;
seems to lower potassium concentrations when inhaled by patients on
hemodialysis

Contraindications and cautions
\u2022

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.

\u2022

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\u20142, 4 mg; ER tablets\u20144, 8 mg; syrup\u20142 mg/5 mL; aerosol\u201490 mcg/actuation;
solution for inhalation\u20140.083%, 0.5%, 1.25 mg/3 mL, 0.63 mg/3 mL; capsules for
inhalation\u2014200 mcg

Dosages
ADULTS
Oral

Initially, 2 or 4 mg (1\u20132 tsp syrup) tid\u2013qid 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\u20138 mg q 12 hr (Proventil)

Inhalation

Each actuation of aerosol dispenser delivers 90 mcg albuterol; 2 inhalations q 4\u20136 hr;
some patients may require only 1 inhalation q 4 hr; more frequent administration or larger
number of inhalations not recommended.

\u2022
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\u20136 hr up to two 200 mcg capsules q 4\u20136 hr.
\u2022
Prevention of exercise-induced asthma: One 200 mcg capsule inhaled 15 min
before exercise.
PEDIATRIC PATIENTS
Oral, tablets
\u2022
6\u201312 yr: 2 mg tid\u2013qid. Do not exceed 24 mg/day.
\u2022
> 12 yr: Use adult dosage.
ER tablets
\u2022
6\u201311 yr: 4 mg q 12 hr (Proventil).
\u2022
6\u201312 yr: 4 mg q 12 hr (Volmax).
Oral, syrup
\u2022
< 2 yr: Safety and efficacy not established.
\u2022
2\u20136 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.
\u2022
6\u201314 yr: 2 mg (1 tsp) tid\u2013qid; if necessary, cautiously increase dosage. Do not
exceed 24 mg/day in divided doses.
\u2022
> 14 yr: Use adult dosage.
Inhalation
\u2022
2\u201312 yr: For child 10\u201315 kg, use 1.25 mg; for child > 15 kg, use 2.5 mg.
\u2022
> 12 yr: Use adult dosage.
Solution for inhalation
\u2022
10\u201315 kg: 1.25 mg bid\u2013tid by nebulization.
\u2022
> 15 kg: 2.5 mg bid\u2013tid by nebulization.
Inhalation capsules
\u2022
> 4 yr: One 200 mcg capsule inhaled q 4\u20136 hr.
\u2022
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\u20132.5 hr
4\u20138 hr
Inhalation 5 min
1.5\u20132 hr
3\u20138 hr

Metabolism: Hepatic; T1/2: 2\u20134 hr
Distribution: Crosses placenta; enters breast milk
Excretion:Urin e

Adverse effects
\u2022
CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation,h ype rkinesia,
insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache
\u2022
C V:Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare), anginal pain
\u2022
Dermatologic: Sweating, pallor, flushing
\u2022
GI:Nausea, vomiting, heartburn, unusual or bad taste
\u2022
GU: Increased incidence of leiomyomas of uterus when given in higher than
human doses in preclinical studies
\u2022
Respiratory: Respiratory difficulties, pulmonary edema, coughing,
bronchospasm, paradoxical airway resistance with repeated, excessive use of
inhalation preparations
Interactions
Drug-drug
\u2022
Increased sympathomimetic effects with other sympathomimetic drugs
\u2022
Increased risk of toxicity, especially cardiac, when used with theophylline,
aminophylline, oxtriphylline
\u2022
Decreased bronchodilating effects with beta-adrenergic blockers (eg, propranolol)
\u2022
Decreased effectiveness of insulin, oral hypoglycemic drugs
\u2022
Decreased serum levels and therapeutic effects of digoxin
Nursing considerations
Assessment
\u2022
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

\u2022
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

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