Albuterol (Salbutamol)

(al - B YO U - t e r- o h l)

CLASSIFICATION(S): Sympathomimetic PREGNANCY CATEGORY: C Rx: AccuNeb, ProAir HFA, Proventil, Proventil HFA, Ventolin, Ventolin HFA, VoSpire ER. WRx: Airomir, Gen-Salbutamol Respirator Solution, Gen-Salbutamol Sterinebs P.F., Novo-Salmol Tablets, Nu-Salbutamol Solution, PMS-Salbutamol, Rhoxal-salbutamol, ratio-Salbutamol HFA.
SEE ALSO SYMPATHOMIMETIC DRUGS.

USES Inhalation: (1) Prophylaxis and relief of bronchospasm in reversible obstructive airway disease. (2) Acute attacks of bronchospasm (inhalation solution). (3) Prophylaxis of exercise-induced bronchospasm. Syrup: Relief of bronchospasm in adults and children 2 years and older with reversible obstructive airway disease. Tablets and Extended-Release Tablets: Relief of bronchospasm in adults and children 6 years and older with reversible obstructive airway disease. Investigational: Nebulized albuterol as an adjunct to treat serious acute hyperkalemia in renal failure. ACTION/KINETICS Action Stimulates beta-2 receptors of the bronchi, leading to bronchodilation. Causes less tachycardia and is longer-acting than isoproterenol. Has minimal beta-1 activity. Available as an inhaler that contains no chlorofluorocarbons (Proventil HFA). Pharmacokinetics Onset, PO: 1530 min; inhalation, within 5 min. Peak effect, PO: 23 hr; inhalation, 6090 min (after 2 inhalations). Duration, PO: 48 hr (up to 12

hr for extended-release); inhalation, 36 hr. Metabolites and unchanged drug excreted in urine and feces. CONTRAINDICATIONS Aerosol for prevention of exercise-induced bronchospasm and tablets are not recommended for children less than 12 years of age. Use during lactation. SPECIAL CONCERNS Syrup and solution for inhalation are indicated for children 2 years and older; tablets (including extended-release) are for use in children 6 years of age and over; aerosol for use in children 4 years of age and over (12 years and over for Proventil). AccuNeb has not been studied for treating acute bronchospasms. May delay preterm labor. Large IV doses may aggravate preexisting diabetes mellitus and ketoacidosis. ADDITIONAL SIDE EFFECTS Most Common Headache, N&V, palpitations/tachycardia, tremor, bronchospasm. GI: Diarrhea, dry mouth, appetite loss or stimulation, epigastric pain. CNS: Hyperkinesia, excitement, nervousness, tension, tremor, dizziness, vertigo, weakness, drowsiness, restlessness, headache, insomnia, malaise, emotional lability, fatigue, lightheadedness, nightmares, disturbed sleep, aggressive behavior, irritability. Respiratory: Cough, wheezing, dyspnea, bronchospasm, dry throat, pharyngitis, throat irritation, bronchitis, epistaxis, hoarseness (especially in children), nasal congestion, increase in sputum. CV: Palpitations, tachycardia, BP changes, hypertension, tight chest, chest pain/discomfort, angina. Hypersensitivity (may be immediate): Urticaria, angioedema, rash, bronchospasm. Miscellaneous: Flushing, sweating, bad or unusual taste, change in smell, muscle cramps/spasm, pallor, teeth discoloration, conjunctivitis, dilated pupils, difficult urination, voice changes, oropharyngeal edema. OD OVERDOSE MANAGEMENT
SEE ALSO SYMPATHOMIMETIC DRUGS
IV = Intravenous

C = see color insert

H = Herbal

E = sound alike drug

ALBUTEROL
Adults and children over 14 years of age, usual initial: 24 mg (510 mL) 34 times per day, up to a maximum of 8 mg 4 times per day. In geriatric clients and those sensitive to adrenergic stimulation, restrict initial dose to 2 mg (5 mL) 3 or 4 times per day; adjunct individually thereafter. Children, over 612 years, initial: 2 mg (5 mL) 34 times per day; then, increase as necessary to a maximum of 24 mg/day in divided doses. Children, 26 years, initial: 0.1 mg/kg 3 times per day, not to exceed 2 mg (5 mL) 3 times per day; then, increase as necessary up to 0.2 mg/kg 3 times per day, not to exceed 4 mg (10 mL) 3 times per day. TABLETS Bronchodilation. Adults and children over 12 years of age, initial: 2 or 4 mg 34 times per day; then, increase dose as needed up to a maximum of 8 mg 4 times per day, as tolerated. In geriatric clients or those sensitive to beta agonists, start with 2 mg 34 times per day; increase dose gradually, if needed, to a maximum of 8 mg 34 times per day, not to exceed 32 mg/day in adults and children over 12 years of age. Children, 612 years of age, usual, initial: 2 mg 34 times per day; then, if necessary, increase the dose in a stepwise fashion to a maximum of 24 mg/day in divided doses. VOSPIRE ER TABLETS Bronchodilation. Adults and children over 12 years of age: 8 mg q 12 hr; in some clients (e.g., low adult body weight), 4 mg q 12 hr may be sufficient initially and then increased to 8 mg q 12 hr, depending on the response. The dose can be increased stepwise and cautiously (under provider supervision) to a maximum of 32 mg/day in divided doses q 12 hr. Children, 612 years of age: 4 mg q 12 hr. The dose can be increased stepwise and cautiously (under provider supervision) to a maximum of 24 mg/day in divided doses q 12 hr.

Symptoms: Seizures, anginal pain, hypertension, hypokalemia, tachycardia (rate may increase to 200 beats/min). DRUG INTERACTIONS H Fir needle oil; Pine needle oil / Risk of bronchospasm HOW SUPPLIED Inhalation Aerosol: 90 mcg/inh; Inhalation Solution: 0.021% (0.63 mg/3 mL), 0.042% (1.25 mg/3 mL), 0.083% (2.5 mg/3 mL), 0.5% (1.25 mg/3 mL); Syrup: 2 mg/5 mL; Tablets: 2 mg, 4 mg; Tablets, Extended-Release: 4 mg, 8 mg. DOSAGE INHALATION AEROSOL Bronchodilation. Adults and children over 4 years of age (12 and over for Proventil): 180 mcg (2 inhalations) q 46 hr. In some clients 1 inhalation (90 mcg) q 4 hr may be sufficient. Maintenance (Proventil only): 180 mcg (2 inhalations) 4 times per day. Prophylaxis of exercise-induced bronchospasm. Adults and children over 4 years of age (12 and over for Proventil): 180 mcg (2 inhalations) 15 min before exercise. INHALATION SOLUTION Bronchodilation. Adults and children over 12 years of age: 2.5 mg 34 times per day by nebulization (dilute 0.5 mL of the 0.5% solution with 2.5 mL sterile NSS and deliver over 515 min). Children, 212 years of age (15 kg or over), initial: 2.5 mg (1 UD vial) 34 times per day by nebulization. Children weighing less than 15 kg who require less than the 2.5 mg dose (i.e., less than a full UD vial): Use the 0.5% inhalation solution. Give over about 515 min. ACCUNEB Relief and prophylaxis of bronchospasms. Initial, children 212 years: 1.25 mg or 0.63 mg given 34 times per day, as needed, by nebulization. Do not give more frequently. Administer over about 515 min. SYRUP Bronchodilation.
Bold Italic = life threatening side effect

NURSING CONSIDERATIONS
E Do not confuse albuterol with atenolol (a beta-blocker); Ventolin with BenyW = Available in Canada

= black box warning

ALBUTEROL
lin (expectorant); or Volmax with Flomax (an alpha-adrenergic blocker). ADMINISTRATION/STORAGE 1. The aerosol and inhalation powder are indicated for children 4 years and older (12 years and older for Proventil); the solution for inhalation is indicated for children 2 years and older. 2. Clients maintained on the tablets or syrup may be switched to the extended-release tablets. For example, the administration of one 4 mg extendedrelease tablet q 12 hr is comparable to one 2 mg tablet q 6 hr. 3. When given by nebulization, use either a face mask or mouthpiece. Use compressed air or oxygen with a gas flow of 610 L/min; a single treatment lasts from 5 to 15 min. 4. When given by IPPB, the inspiratory pressure should be from 10 to 20 cm water, with the duration of treatment ranging from 5 to 20 min depending on the client and instrument control. 5. The MDI may also be administered on a mechanical ventilator through an adapter. 6. Take extended-release tablets whole with the aid of liquids; do not chew or crush. The outer coating of Volmax Extended-Release Tablets is not absorbed and is excreted in the feces; empty outer coating may be seen in the stool. 7. Contents of the MDI container are under pressure. Do not store near heat or open flames and do not puncture the container. 8. Proventil HFA and Ventolin HFA contain hydrofluoroalkane as the propellant rather than chlorofluorocarbons. 9. AccuNeb, either 0.63 mg/3 mL or 1.25 mg/3 mL is intended for relief of bronchospasm in children 212 years of age with asthma. AccuNeb has not been studied in the setting of acute attacks of bronchospasms. 10. Store Volmax tablets refrigerated at 28C (3646F). 11. Store canisters from 1530C (5986F). Failure to use within this temperature range may result in improper dosing. For optimum results, bring the canister to room temperature before use. Shake well before using.

ASSESSMENT 1. Obtain history; assess EKG and CNS status. Avoid use with cardiac tachyarrhythmias. 2. Document PFTs, CXR, oxygen sats and lung sounds. Monitor pulmonary status (i.e., breath sounds, VS, peak flow, or ABGs). 3. Assess symptom characteristics, onset, duration, frequency, any precipitating factors. Note anxiety; may contribute to air hunger. 4. Determine if able to self-administer medication. Assess environmental/ home issues. 5. List drugs prescribed; beta blockers may induce severe bronchospasms, digoxin levels may decrease, and diuretic effects (K) may be aggravated by albuterol. 6. Observe for allergic responses. CLIENT/FAMILY TEACHING 1. Take as directed; do not exceed prescribed dose and do not chew or crush capsules. 2. Maintain calm, reassuring approach. Do not leave client/child unattended if acutely short of breath; should improve 3060 min after therapy. 3. Practice how to inhale through nose and exhale with pursed lips or diaphragmatic breathing; prolongs expiration and keeps the airways open longer, thus reducing the work of breathing. 4. Review how to use: Do not put lips around inhaler; go two fingerbreadths away before attempting to activate and inhale. Have client return demonstrate proper technique/use/care, including timing between inhalations. 5. A spacer used with the MDI may enhance drug dispersion. Maintain fluid intake of 2,000 mL/day. Always thoroughly rinse mouth and equipment with water following each use/dose to prevent oral fungal infections. 6. When using inhalers, do not use other albuterol inhalation medication unless specifically prescribed. If a steroid (Vanceril) inhaler is also prescribed, use this 2030 min after albuterol to permit better lung penetration. 7. Establish dosing regimens that fit lifestyle, i.e., 12 puffs q 6 hr or 4 puffs 4
IV = Intravenous

C = see color insert

H = Herbal

E = sound alike drug

ALBUTEROL
9. To check inhaler content, place in glass of water: full inhalers sink, empty inhalers float and half-full inhalers are partially submerged. Check to ensure you do not run out of medication. 10. Keep all F/U to evaluate response to therapy and for adverse SE. OUTCOMES/EVALUATE Improved breathing patterns/airway exchange Prevention/treatment of reversible bronchospasm R/T asthma or obstructive pulmonary diseases

times per day; usual dosing is q 46 hr with an as-needed order, or before exercise. Check peak flows, call if requiring more puffs more frequently than prescribed or if drug dose used previously does not provide relief. Report lack of response, chest pain, dizziness, weakness, heart palpitations, significant drop in peak flow readings, changes in sputum color/amount. 8. Use caution, may cause dizziness/ drowsiness. Keep record of pulse and BP for provider review.

Bold Italic = life threatening side effect

= black box warning

W = Available in Canada