Albuterol sulfate (Ventolin) is an antiasthmatic that 

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.

Generic Name & Brand Names

albuterol sulfate
(al byoo’ ter ole)
AccuNeb, Novo-Salmol (CAN), Proventil, Proventil HFA, Salbutamol (CAN), Ventodisk
(CAN), Ventolin HFA

Pregnancy Category C

Drug classes
 Sympathomimetic
 Beta 2-selective adrenergic agonist
 Bronchodilator
 Antasthmatic

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

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.
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.
o 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.
o 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.
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 or tid by nebulization.

 15 kg: 2.5 mg bid or tid by nebulization.
Inhalation capsules

 > 4 yr: One 200 mcg capsule inhaled q 4–6 hr.

o Prevention of exercise-induced asthma: One 200 mcg capsule inhaled
15 min before exercise.

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 in mouth
 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

Contraindications and cautions

  Contraindicated with hypersensitivity to albuterol; tachyarrhythmias, tachycardia
caused bydigitalis intoxication; general anesthesia with halogenated
hydrocarbons or cyclopropane (these sensitize the myocardium to
catecholamines); unstable vasomotor system disorders; hypertension; coronary
insufficiency, CAD; history of CVA; 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; laborand 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).

Nursing considerations

Assessment
 History: Hypersensitivity to albuterol; tachyarrhythmias, tachycardia caused
by digitalisintoxication; general anesthesia with halogenated hydrocarbons or
cyclopropane; unstable vasomotor system disorders; hypertension; coronary
insufficiency, CAD; history of CVA; COPD patients who have developed
degenerative heart disease; diabetes mellitus; hyperthyroidism; history of seizure
disorders; psychoneurotic individuals; lactation
 Physical: Weight; skin color, T, 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.
 You may experience these side effects: Dizziness, drowsiness, fatigue, headache
(use caution if driving or performing tasks that require alertness); nausea,
vomiting, change in taste (eat frequent small meals); rapid heart rate, anxiety,
sweating, flushing, insomnia.
 Report chest pain, dizziness, insomnia, weakness, tremors or irregular heartbeat,
difficulty breathing, productive cough, failure to respond to usual dosage