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Albuterol

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Albuterol, Ventolin, Proventil, Nebulized Albuterol, Albuterol Nebulizer, Albuterol Neb

  • See Also
  1. Short-acting Beta Agonist
  2. Long Acting Beta Agonist
  3. Nebulized Albuterol
  • Indications
  1. Acute Asthma rescule Inhaler
    1. Short acting agents are for rescue use only
  2. Exercise Induced Bronchospasm (pretreatment prophylaxis)
  3. Hyperkalemia
    1. See Hyperkalemia for dosing
  • Mechanism
  1. Inhaled Bronchodilators target Beta 2 Adrenergic Receptors
  2. Adverse effects (e.g. Tachycardia) are related to Beta 1 Adrenergic Receptor activity
  • Medications
  1. Albuterol Nebulizer Solution
    1. Albuterol solution alone (0.5% solution or 5 mg/ml)
      1. Albuterol available in 0.5 ml vials and 20 ml bottles
      2. Dilute 0.5 ml of 0.5% solution (contains 2.5 mg Albuterol) in 2.5 ml Normal Saline
      3. Final solution concentration 0.083% Albuterol (3 ml)
    2. Albuterol premixed with saline
      1. Available in 3 ml vials containing 0.63 mg, 1.25 mg or 2.5 mg vials (in boxes of 30 to 60 vials)
  2. Albuterol Inhalers (Generic in 2019)
    1. ProAir HFA Albuterol Inhalers
      1. Replaced CFC Inhalers
      2. Generic as of December 2016
      3. Each HFA actuation delivers 108 mcg of Albuterol sulfate (90 mcg of Albuterol base)
    2. ProAir RespiClick (Dry Powder Inhaler or DPI, released 2015)
      1. Requires deep inhalation, but no spacer needed
      2. Approved age 12 years and older
      3. Each DPI actuation delivers 117 mcg of Albuterol sulfate (97 mcg of Albuterol base)
  1. See Hydrofluoroalkane Inhaler (HFA Inhaler) for technique
  2. Rescue Inhaler: 2 puffs every 4 to 6 hours as needed
  3. Exercise Induced Asthma: 2 puffs used 10 to 30 minutes before Exercise
  4. Severe COPD or Asthma Exacerbation
    1. Use 6 to 8 puffs every 1-2 hours (max) OR
    2. Use 2 puffs every 20 minutes as needed for up to 3 doses every 1 to 4 hours
  • Dosing
  • Albuterol Nebulizer
  1. Dilute Albuterol solution (5 mg/ml) in Normal Saline (NS) as described above
  2. Weight <10 kg or age under 12 months (0.15 mg/kg)
    1. Albuterol 1.25 mg (0.25 cc) in 2 cc NS q1-4 hours
  3. Weight 10-35 kg or age 12 months to adult (Typical, standard dose)
    1. Albuterol 2.5 mg (0.5 cc) in 2 cc NS q1-4 hours
  4. Weight >35 kg or age over 10 years (High Dose)
    1. Albuterol 5.0 mg (1.0 cc) in 2 cc NS q1-4 hours
    2. Standard dose of 2.5 mg is used instead in most cases
  5. Continuous Nebulizer
    1. Dose 10 to 15 mg/hour until improvement (typically first hour)
    2. Intensive monitoring including telemetry within emergency department or ICU
  • Medications
  • Co-administered Medications (May add to Nebulizer)
  1. Ipratropium (Atrovent) 250 mcg (1.25 ml) q6-8 hours
  2. Cromolyn Sodium (Intal) (10 mg/ml) 2cc q6 hours
  3. Flunisolide (Nasalide) (.25%=250 ug/ml) 1-2 ml q6 hours
    1. Antiinflammatory was added to nebulizer in RSV (which has since fallen out of favor)
    2. Study showed significant improvement with fewer hospitalizations
    3. Reijonen T (1996) Arch Pediatr Adolesc 150:512-7 [PubMed]
  1. Onset: Within 15 minutes
  2. Duration 3 to 4 hours
  • Adverse Effects
  1. See Short Acting Bronchodilator
  • Efficacy
  1. Albuterol HFA is at least as effective as the CFC Inhalers they replaced
    1. HFA replaces CFC Inhalers due to ozone depletion
    2. Less force and smaller plume than CFC Inhaler
    3. However small particle allows 2-3x lung deposition
    4. Less coordination needed in HFA firing and inhaling
    5. Spacer devices should still be used with HFA Inhalers
  2. Albuterol MDI as effective as Nebulizer in ER and home
    1. Used with spacer (and mask in younger children)
      1. See Spacer Devices for Asthma Inhalers
    2. Studied Wheezing children aged two years and younger
      1. Delgado (2003) Arch Pediatr Adolesc Med 157:76-80 [PubMed]
  3. Albuterol MDI has significant advantages over Nebulizer
    1. No special equipment or maintenance
    2. Uses only 10% of the amount Albuterol Nebulized
    3. Minimal risk of contamination
  4. Reduced efficacy of Bronchodilators in the 20% of patients with arginine Genotype
    1. Israel (2001) Int Arch Allergy Immunol 124:183-6 [PubMed]
    2. Wechsler (2005) Am J Respir Crit Care Med 172(1):12-8 [PubMed]
  5. References
    1. Delgado (2003) Arch Pediatr Adolesc Med 157:76-80 [PubMed]
    2. Mandelberg (1997) Chest 112:1501-5 [PubMed]
    3. Newman (2002) Chest 121:1036-41 [PubMed]
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Resources
  1. Albuterol Nebulizer Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fa5ebedb-069c-4a1e-9a25-b6fa957e6c2b
  2. Albuterol MDI (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6c64ab5d-f8a2-440a-a929-cb8188d0e8b4
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 88
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. (2022) Comparison of Asthma Medications, Presc Lett, #381217
  4. (2022) Inhaled Medications for COPD, Presc Lett, #381116
  5. (2020) Drugs for COPD, Med Lett Drug Ther 62: 137-44
  6. (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200