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.
    • 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.

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.
    • 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 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 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; 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).

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 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.

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