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Pronunciation
(al BYOO ter ole)
Generic Available (U.S.)
Yes
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease; prevention of exercise-induced bronchospasm
Pregnancy Risk Factor
C
Pregnancy Considerations
Albuterol crosses the placenta; tocolytic effects, fetal tachycardia, fetal hypoglycemia secondary to maternal hyperglycemia with oral or intravenous routes reported. Available evidence suggests safe use as an inhalation during pregnancy, and albuterol is the preferred short-acting beta agonist for use in asthma according to the NHLBI 2007 Guidelines for the Diagnosis and Management of Asthma.
Lactation
Excretion in breast milk unknown/use caution
Contraindications
Hypersensitivity to albuterol or any component of the formulation
Injection formulation (Canadian labeling; product not available in U.S.): Hypersensitivity to albuterol or any component of the formulation; tachyarrhythmias; risk of abortion during first or second trimester
Warnings/Precautions
Concerns related to adverse effects:
• Bronchospasm: Rarely, paradoxical bronchospasm may occur with use of inhaled bronchodilating agents; this should be distinguished from inadequate response.
• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm) have been reported.
Disease-related concerns:
• Asthma: Appropriate use: Optimize anti-inflammatory treatment before initiating maintenance treatment with albuterol. Do not use as a component of chronic therapy without an anti-inflammatory agent. Only the mildest forms of asthma (Step 1 and/or exercise-induced) would not require concurrent use based upon asthma guidelines.
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (arrhythmia or hypertension or HF); beta-agonists may cause elevation in blood pressure, heart rate and result in CNS stimulation/excitation. Beta2-agonists may also increase risk of arrhythmias.
• Diabetes: Use with caution in patients with diabetes mellitus; beta2-agonists may increase serum glucose.
• Glaucoma: Use with caution in patients with glaucoma; may elevate intraocular pressure.
• Hyperthyroidism: Use with caution in hyperthyroidism; may stimulate thyroid activity.
• Hypokalemia: Use with caution in patients with hypokalemia; beta2-agonists may decrease serum potassium.
• Seizures: Use with caution in patients with seizure disorders; beta-agonists may result in CNS stimulation/excitation.
Special populations:
• Pediatrics: Face masks should be used in children <4 years of age.
Other warnings/precautions:
• Appropriate use: Do not exceed recommended dose; serious adverse events, including fatalities, have been associated with excessive use of inhaled sympathomimetics.
• Patient information: Patients must be instructed to seek medical attention in cases where acute symptoms are not relieved or a previous level of response is diminished. The need to increase frequency of use may indicate deterioration of asthma, and treatment must not be delayed. A spacer device or valved holding chamber is recommended when using a metered-dose inhaler.
Adverse Reactions
Incidence of adverse effects is dependent upon age of patient, dose, and route of administration.
Cardiovascular: Angina, atrial fibrillation, arrhythmias, chest discomfort, chest pain, extrasystoles, flushing, hyper-/hypotension, palpitation, supraventricular tachycardia, tachycardia
Central nervous system: CNS stimulation, dizziness, drowsiness, headache, insomnia, irritability, lightheadedness, migraine, nervousness, nightmares, restlessness, seizure
Dermatologic: Angioedema, rash, urticaria
Endocrine & metabolic: Hyperglycemia, hypokalemia, lactic acidosis
Gastrointestinal: Diarrhea, dry mouth, dyspepsia, gastroenteritis, nausea, unusual taste, vomiting
Genitourinary: Micturition difficulty
Local: Injection: Pain, stinging
Neuromuscular & skeletal: Muscle cramps, musculoskeletal pain, tremor, weakness
Otic: Otitis media, vertigo
Respiratory: Asthma exacerbation, bronchospasm, cough, epistaxis, laryngitis, oropharyngeal drying/irritation, oropharyngeal edema, pharyngitis, rhinitis, upper respiratory inflammation, viral respiratory infection
Miscellaneous: Allergic reaction, anaphylaxis, diaphoresis, lymphadenopathy
Postmarketing and/or case reports: Anxiety, glossitis, hoarseness, metabolic acidosis, myocardial ischemia, pulmonary edema, throat irritation, tongue ulceration
Metabolism/Transport Effects
None known.
Drug Interactions
Alpha-/Beta-Blockers: May diminish the therapeutic effect of Beta2-Agonists. Risk D: Consider therapy modification
Atomoxetine: May enhance the tachycardic effect of Beta2-Agonists. Risk C: Monitor therapy
Beta-Blockers (Beta1 Selective): May diminish the bronchodilatory effect of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Risk C: Monitor therapy
Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Beta2-Agonists. Risk X: Avoid combination
Betahistine: May diminish the therapeutic effect of Beta2-Agonists. Risk C: Monitor therapy
Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination
Loop Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy
MAO Inhibitors: May enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Thiazide Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Thiazide Diuretics. Risk C: Monitor therapy
Tricyclic Antidepressants: May enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Food: Avoid or limit caffeine (may cause CNS stimulation).
Herb/Nutraceutical: Avoid ephedra, yohimbe (may cause CNS stimulation). Avoid St John's wort (may decrease the levels/effects of albuterol).
Storage
HFA aerosols: Store at 15°C to 25°C (59°F to 77°F).
Ventolin® HFA: Discard when counter reads 000 or 12 months after removal from protective pouch, whichever comes first. Store with mouthpiece down.
Infusion solution (Canadian labeling; product not available in U.S.): Ventolin® I.V.: Store at 15°C to 30°C (59°F to 86°F). Protect from light. After dilution, discard unused portion after 24 hours.
Solution for nebulization (0.5%): Store at 2°C to 25°C (36°F to 77°F).
AccuNeb®: Store at 2°C to 25°C (36°F to 77°F). Do not use if solution changes color or becomes cloudy. Use within 1 week of opening foil pouch.
Syrup: Store at 20°C to 25°C (68°F to 77°F).
Tablet: Store at 20°C to 25°C (68°F to 77°F).
Tablet, extended release: Store at 20°C to 25°C (68°F to 77°F)
Reconstitution
Solution for nebulization: To prepare a 2.5 mg dose, dilute 0.5 mL of solution to a total of 3 mL with normal saline; also compatible with cromolyn or ipratropium nebulizer solutions.
Compatibility
Intravenous solution: Stable in water for injection, NS, D5W, and D5NS when mixed in PC bags or glass bottles. Avoid addition of other medications to infusion solution.
Solution for nebulization: Compatible with cromolyn sodium, budesonide inhalation suspension, ipratropium solution for nebulization
Mechanism of Action
Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on heart rate
Pharmacodynamics/Kinetics
Onset of action: Peak effect:
Nebulization/oral inhalation: 0.5-2 hours
CFC-propelled albuterol: 10 minutes
Ventolin® HFA: 25 minutes
Oral: 2-3 hours
Duration: Nebulization/oral inhalation: 3-4 hours; Oral: 4-6 hours
Metabolism: Hepatic to an inactive sulfate
Half-life elimination: Inhalation: 3.8 hours; Oral: 3.7-5 hours
Excretion: Urine (30% as unchanged drug)
Dosage
Oral:
Children: Bronchospasm:
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)
Extended release: 4 mg every 12 hours; maximum dose not to exceed 24 mg/day (divided doses)
Children >12 years and Adults: Bronchospasm (treatment): 2-4 mg/dose 3-4 times/day; maximum dose not to exceed 32 mg/day (divided doses)
Extended release: 8 mg every 12 hours; maximum dose not to exceed 32 mg/day (divided doses). A 4 mg dose every 12 hours may be sufficient in some patients, such as adults of low body weight.
Elderly: Bronchospasm (treatment): 2 mg 3-4 times/day; maximum: 8 mg 4 times/day
Metered-dose inhaler (90 mcg/puff):
Children ≤4 years (NIH Guidelines, 2007):
Quick relief: 2 puffs every 4-6 hours as needed
Exacerbation of asthma (acute, severe): 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed
Exercise-induced bronchospasm (prevention): 1-2 puffs 5 minutes prior to exercise
Children 5-11 years (NIH Guidelines, 2007):
Bronchospasm, quick relief: 2 puffs every 4-6 hours as needed
Exacerbation of asthma (acute, severe): 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed
Exercise-induced bronchospasm (prevention): 2 puffs 5-30 minutes prior to exercise
Children ≥12 years and Adults:
Bronchospasm, quick relief (NIH Guidelines, 2007): 2 puffs every 4-6 hours as needed
Exacerbation of asthma (acute, severe) (NIH Guidelines, 2007): 4-8 puffs every 20 minutes for up to 4 hours, then every 1-4 hours as needed
Exercise-induced bronchospasm (prevention) (NIH Guidelines, 2007): 2 puffs 5-30 minutes prior to exercise
Solution for nebulization:
Children 2-12 years (AccuNeb®): Bronchospasm: 0.63-1.25 mg 3-4 times daily as needed
Children ≤4 years (NIH Guidelines, 2007):
Quick relief: 0.63-2.5 mg every 4-6 hours as needed
Exacerbation of asthma (acute, severe): 0.15 mg/kg (minimum: 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg (maximum: 10 mg) every 1-4 hours as needed or 0.5 mg/kg/hour by continuous nebulization
Children 5-11 years (NIH Guidelines, 2007):
Quick relief: 1.25-5 mg every 4-8 hours as needed
Exacerbation of asthma (acute, severe): 0.15 mg/kg (minimum: 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg (maximum: 10 mg) every 1-4 hours as needed or 0.5 mg/kg/hour by continuous nebulization
Children ≥12 years and Adults:
Bronchospasm: 2.5 mg 3-4 times daily as needed
Quick relief (NIH Guidelines, 2007): 1.25-5 mg every 4-8 hours as needed
Exacerbation of asthma (acute, severe) (NIH Guidelines, 2007): 2.5-5 mg every 20 minutes for 3 doses then 2.5-10 mg every 1-4 hours as needed, or 10-15 mg/hour by continuous nebulization
I.V. continuous infusion: Adults (Canadian labeling; product not available in U.S.): Severe bronchospasm and status asthmaticus: Initial: 5 mcg/minute; may increase up to 10-20 mcg/minute at 15- to 30-minute intervals if needed
Dosage adjustment in renal impairment: Use with caution in patients with renal impairment. No dosage adjustment required (including patients on hemodialysis, peritoneal dialysis, or CRRT; Aronoff, 2007).
Administration: Oral
Do not crush or chew extended release tablets.
Administration: I.V.
Infusion solution (Canadian labeling; product not available in U.S.): Do not inject undiluted. Reduce concentration by at least 50% before infusing. Administer as a continuous infusion via infusion pump.
Administration: Inhalation
Metered-dose inhaler: Shake well before use; prime prior to first use, and whenever inhaler has not been used for >2 weeks or when it has been dropped, by releasing 3-4 test sprays into the air (away from face). HFA inhalers should be cleaned with warm water at least once per week; allow to air dry completely prior to use. A spacer device or valved holding chamber is recommended for use with metered-dose inhalers.
Solution for nebulization: Concentrated solution should be diluted prior to use. Blow-by administration is not recommended, use a mask device if patient unable to hold mouthpiece in mouth for administration.
Monitoring Parameters
FEV1, peak flow, and/or other pulmonary function tests; blood pressure, heart rate; CNS stimulation; serum glucose, serum potassium; asthma symptoms; arterial or capillary blood gases (if patients condition warrants)
Test Interactions
Increased renin (S), increased aldosterone (S)
Dietary Considerations
Oral forms should be taken with water 1 hour before or 2 hours after meals.
Patient Education
Maintain adequate hydration, unless instructed to restrict fluid intake. You may experience nervousness, dizziness, dry mouth, unpleasant taste, or stomach upset. Report unresolved GI upset, dizziness, chest pain or palpitations, nervousness or insomnia, muscle cramping or tremor, or respiratory difficulty.
Self-administered inhalation: Shake canister before using. Sit when using medication. Close eyes when administering albuterol to avoid spraying into eyes. Exhale slowly and completely through nose; inhale deeply through mouth while administering aerosol. Hold breath for 5-10 seconds after inhalation. Wait at least 1 full minute between inhalations. Wash mouthpiece between use. If more than one inhalation medication is used, use albuterol first and wait 5 minutes between medications. Prime inhaler prior to first use, and whenever the inhaler has not been used for more than 2 weeks.
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. Breathe calmly and deeply until no more mist is formed in nebulizer (about 5 minutes).
Geriatric Considerations
Because of its minimal effect on beta1-receptors and its relatively long duration of action, albuterol is a rational choice in elderly when a beta-agonist is indicated. Elderly patients may find it beneficial to utilize a spacer device when using a metered dose inhaler. Oral use should be avoided due to adverse effects.
Additional Information
The 2007 National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma do not recommend the use of oral systemic albuterol as a quick-relief medication and do not recommend regularly scheduled daily, chronic use of inhaled beta-agonists for long-term control of asthma.
Anesthesia and Critical Care Concerns/Other Considerations
Clinical Pearls/Comments: High-dose inhaled beta-agonists may be used as part of a treatment regimen for the management of acute hyperkalemia by stimulating the sodium potassium (K) ATPase pump causing an intracellular shift of potassium. The hypokalemic effects typically have an onset of 30 minutes and may last several hours; however, the intracellular shift is temporary thus requiring the removal (ion-exchange resins or hemodialysis) of potassium from the body.
Cardiovascular Considerations
Beta-agonists will induce increases in heart rate. This should be considered in patients with resting tachycardia. Because of the frequent coexistence of chronic obstructive lung disease and coronary artery disease, many patients are on simultaneous therapy with beta-agonists and beta-blockade. This combination should, for obvious reasons, be avoided. Frequent use of inhaled beta-agonists when used in patients with atrial fibrillation may counteract pharmacologic interventions directed at rate control.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation)
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May produce CNS stimulation resulting in anxiety, tremor, and insomnia
Mental Health: Effects on Psychiatric Treatment
Effect of propranolol may be reduced; cardiovascular effects (tachycardia, palpitations) may be increased with MAO inhibitors, TCAs, and amphetamines
Nursing: Physical Assessment/Monitoring
For inpatient care, monitor vital signs at beginning of therapy and periodically throughout. Evaluate effectiveness of therapy (relief of airway obstruction).
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol, for oral inhalation:
ProAir® HFA: 90 mcg/inhalation (8.5 g) [chlorofluorocarbon free; 200 metered actuations]
Proventil® HFA: 90 mcg/inhalation (6.7 g) [chlorofluorocarbon free; 200 metered actuations]
Ventolin® HFA: 90 mcg/inhalation (18 g) [chlorofluorocarbon free; 200 metered actuations]
Ventolin® HFA: 90 mcg/inhalation (8 g) [chlorofluorocarbon free; 60 metered actuations]
Solution, for nebulization: 0.083% [2.5 mg/3 mL] (25s, 30s, 60s); 0.5% [100 mg/20 mL] (1s)
Solution, for nebulization [preservative free]: 0.021% [0.63 mg/3 mL] (25s); 0.042% [1.25 mg/3 mL] (25s, 30s); 0.083% [2.5 mg/3 mL] (3 mL, 25s, 30s, 60s); 0.5% [2.5 mg/0.5 mL] (30s)
AccuNeb®: 0.021% [0.63 mg/3 mL] (25s); 0.042% [1.25 mg/3 mL] (25s)
Syrup, oral: 2 mg/5 mL (473 mL)
Tablet, oral: 2 mg, 4 mg
Tablet, extended release, oral: 4 mg, 8 mg
VoSpire ER®: 4 mg, 8 mg
Pricing: U.S. (www.drugstore.com)
Aerosol solution (ProAir HFA)
108 (90 Base) mcg/ACT (8.5): $44.99
Aerosol solution (Proventil HFA)
108 (90 Base) mcg/ACT (6.7): $55.99
Aerosol solution (Ventolin HFA)
108 (90 Base) mcg/ACT (18): $45.99
Nebulization (AccuNeb)
0.63 mg/3 mL (75): $56.99
1.25 mg/3 mL (75): $53.82
Nebulization (Albuterol Sulfate)
0.63 mg/3 mL (75): $43.99
1.25 mg/3 mL (3): $12.99
(2.5 MG/3ML) 0.083% (75): $18.99
(5 MG/ML) 0.5% (20): $22.99
Syrup (Albuterol Sulfate)
2 mg/5 mL (120): $14.99
Tablet, 12-hour (VoSpire ER)
4 mg (30): $78.75
8 mg (60): $256.00
Tablets (Albuterol Sulfate)
2 mg (90): $20.99
4 mg (100): $31.99
References
Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007.
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.
Expert Panel Report 3, “Guidelines for the Diagnosis and Management of Asthma,” Clinical Practice Guidelines, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 08-4051, prepublication 2007. Available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
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):666-9.
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.
Mahajan M, Tucker J, and Dolgin J, “Protocol for Management of Accidental Pediatric Albuterol Ingestions,” Vet Hum Toxicol, 1994, 36:361.
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.
Marik P, Hogan J, and Krikorian J, “A Comparison of Bronchodilator Therapy Delivered by Nebulization and Metered-Dose Inhaler in Mechanically Ventilated Patients,” Chest, 1999, 115(6):1653-7.
National Asthma Education and Prevention Program, “Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics - 2002,” J Allergy Clin Immunol, 2002, 110(5 Suppl):141-219.
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.
International Brand Names
Lexi-Comp.com
Last full review/revision January 2012
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