💊 Salbutamol (Albuterol)

✅ What it is used for

• Relief of bronchospasm in adults and children 6 years of age and older with reversible obstructive airway disease

🧪 Active ingredient

The active ingredient is albuterol (salbutamol) as albuterol sulfate, a relatively selective beta-2 adrenergic bronchodilator. It relaxes bronchial smooth muscle and inhibits the release of mediators of immediate hypersensitivity from cells, especially mast cells.

🌿 Benefits

• Relieves bronchospasm by relaxing bronchial smooth muscle
• In controlled trials, had more effect on the respiratory tract and fewer cardiovascular effects than isoproterenol at comparable doses
• Longer acting than isoproterenol in most patients

📝 How to use

• Tablets are taken by mouth.
• The dose is set by your doctor or pharmacist based on age, condition and response; do not increase or decrease it on your own.
• Do not exceed the maximum daily dose set by your doctor.
• If you need more doses than usual, this may be a sign that your asthma is getting worse; see your doctor.

💊 Dosage forms

• Tablets 2 mg
• Tablets 4 mg

🔄 Drug interactions

• Other oral sympathomimetic agents: concomitant use is not recommended due to possible harmful cardiovascular effects.
• Beta-blockers: block the pulmonary effect of albuterol and may produce severe bronchospasm in asthmatic patients.
• Non-potassium-sparing diuretics (loop or thiazide): ECG changes and/or hypokalemia may be acutely worsened, especially if the recommended beta-agonist dose is exceeded.
• Digoxin: serum digoxin levels may decrease; careful evaluation of digoxin levels is prudent.
• An inhaled adrenergic bronchodilator may be used alongside the tablets only on an individualized basis, not routinely.

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👨‍⚕️ For healthcare professionals

Mechanism of action

Relatively selective beta-2 adrenergic agonist; stimulates adenyl cyclase, increasing cyclic AMP, which leads to bronchial smooth muscle relaxation and inhibition of release of mediators of immediate hypersensitivity from mast cells. It is not a substrate for cellular catecholamine uptake or catechol-O-methyl transferase, hence longer acting than isoproterenol.

Labeled dosing

Per the label: Children 6-12 years: usual dosage 2 mg three or four times daily; may be cautiously increased stepwise, not exceeding 24 mg/day in divided doses. Adults and children over 12 years: usual starting dosage 2 or 4 mg three or four times daily; if no response, cautiously increase stepwise up to a maximum of 8 mg four times daily, total not exceeding 32 mg/day. Elderly or beta-agonist-sensitive patients: start at 2 mg three or four times daily, increasing gradually up to 8 mg three or four times daily as tolerated. The final dose is determined by the doctor or pharmacist.

• Dosages are expressed in terms of albuterol base.
• If an adverse reaction occurs, the dose may be temporarily reduced and then increased in small increments once it subsides.
• Re-evaluate the patient and regimen if more doses than usual are needed; consider early addition of anti-inflammatory agents such as corticosteroids.
• Evaluate serum digoxin levels in patients receiving digoxin and albuterol together.

🎓 Key points for students

• Mechanism: beta-2 stimulation → adenyl cyclase activation → increased cyclic AMP → bronchial smooth muscle relaxation.
• Relatively beta-2 selective, but a population of beta-2 receptors (10% to 50%) exists in the human heart, which may explain some cardiac effects.
• Key adverse effects: tremor, nervousness, headache, palpitations, tachycardia.
• Interactions: beta-blockers (antagonism and bronchospasm risk), non-potassium-sparing diuretics (hypokalemia and ECG changes), digoxin (levels reduced 16-22% in healthy volunteers).
• The only listed contraindication is hypersensitivity to albuterol or its components.
• The WHO recommended name for albuterol base is salbutamol.