Indications & Dose:
Asthma
Other conditions associated with reversible airways obstruction
Adult: 4 mg 3–4 times a day, maximum single dose 8mg (but unlikely to provide much extra benefit or to be tolerated), inhalation route preferred over oral route, use elderly dose for sensitive patients
Elderly: Initially 2 mg 3–4 times a day, maximum single dose 8 mg (but unlikely to provide much extra benefit or to be tolerated), inhalation route preferred over oral route
Adult: 500 micrograms every 4 hours if required
Adult: 250 micrograms, repeated if necessary, injection to be diluted to a concentration of 50 micrograms/mL, reserve intravenous beta2 agonists for those in whom inhaled therapy cannot be used reliably
Adult: Initially 5 micrograms/minute, adjusted according to response and heart rate, usual dose 3–20 micrograms/minute, higher doses may be required, reserve intravenous beta2 agonists for those in whom inhaled therapy cannot be used reliably
Adult: 100–200 micrograms, up to 4 times a day for persistent symptoms
Adult: 2.5–5 mg, repeated up to 4 times daily or more frequently in severe cases
Prophylaxis of allergen- or exercise-induced bronchospasm
Adult: 200 micrograms Acute asthma
Child 1–23 months: 5 micrograms/kg for 1 dose, dose to be administered over 5 minutes, reserve intravenous beta2 agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect
Child 2–17 years: 15 micrograms/ kg (max. per dose 250 micrograms) for 1 dose, dose to be administered over 5 minutes, reserve intravenous beta2 agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect
Moderate, severe, or life-threatening acute asthma
Child 1 month–4 years: 2.5 mg, repeat every 20–30 minutes or when required, give via oxygendriven nebuliser if available
Child 5–11 years: 2.5–5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available
Child 12–17 years: 5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available
Adult: 5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available continued
Moderate and severe acute asthma
Child: 2–10 puffs, each puff is to be inhaled separately, repeat every 10–20 minutes or when required, give via large volume spacer (and a close-fitting face mask in children under 3 years), each puff is equivalent to 100 micrograms Adult: 2–10 puffs, each puff is to be inhaled separately, repeat every 10–20 minutes or when required, give via large volume spacer, each puff is equivalent to 100 micrograms Exacerbation of reversible airways obstruction (including nocturnal asthma) | Prophylaxis of allergen- or exerciseinduced bronchospasm
Child: 100–200 micrograms, up to 4 times a day for persistent symptoms
Child 1 month–1 year: 100 micrograms/kg 3–4 times a day (max. per dose 2 mg), inhalation route preferred over oral route
Child 2–5 years: 1–2 mg 3–4 times a day, inhalation route preferred over oral route
Child 6–11 years: 2 mg 3–4 times a day, inhalation route preferred over oral route
Child 12–17 years: 2–4 mg 3–4 times a day, inhalation route preferred over oral route Chronic asthma
Child 3–11 years: 4. OR
Tablets
Adults : 4 mg (elderly and sensitive patients initially 2 mg) 3-4 times daily; max. single dose 8 mg (but unlikely to provide much extra benefit or to be tolerated)
Syrup
Adults: 5-20ml three or four times daily.
Children: Under 2 years not recommended, 2-6 year2.5-5ml, 6-12 year5ml, over 12 year, 5-10ml three to four times daily.
Inj
Adults: By subcutaneous or intramuscular injection, 500 micrograms, repeated every 4 hours if necessary by slow intravenous injection, 250 micrograms, repeated if necessary. Children: Not recommended.
Infusion
Adults: By intravenous infusion, initially 5 micrograms/minute, adjusted according to response and heart rate usually in range 3-20 micrograms/ minute or more if necessary.
Inhalars:
By aerosol inhalation, 100-200 micrograms (1-2 puffs); for persistent symptoms to 3-4 times daily; child 100 micrograms (1 puff), increased to 200 micrograms (2 puffs) if necessary. Prophylaxis in exercise induced bronchospasm, 200 micrograms (2 puff); child 100 micrograms (1puff).
Children: Aerosol Inhalation: 100mcg (1 puff) increased to 200mcg (2 puffs) if necessary.
Nebules
Adults : By inhalation of nebulised solution, chronic bronchospasm unresponsive to conventional therapy and severe acute asthma, 2.5 mg- 5 mg if necessary; in refractory patients with severe acute asthma upto 10 mg can be given but may be associated with increased side-effects,
Children: Over 18 months 2.5mg, upto 4 times daily. Under 18 months, clinical efficacy uncertain.
Contraindications:
Though salbutamol is recommended for the prevention of uncomplicated premature labour, their use in premature labour associated with toxaemia of pregnancy or antepartum haemorrhage from whatever cause is contra-indicated.Threatened abortion during first or second trimester of pregnancy. History of hypersensitivity.
Side Effects:
Fine tremors (usually hands), nervous tension, headache, peripheral vasodilation, palpitations, tachycardia (seldom troublesome when given by aerosol inhalation); rarely muscle cramps; hypokalamia after high doses, hypersensitivity, urticaria, and angioedema reported; slight pain on intramuscular injection.
Cautions:
HYPOKALEMIA. Serious hypokalaemia may result from beta adrenoceptor stimulant therapy, particular caution is required in severe asthma, as this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentrations should therefore, be monitored in severe asthma.
Precautions:
Hyperthyroidism, myocardial insufficiency, arrhythmias, susceptibility to QTinterval prolongation, hypertension, diabetesspecially in I.V. administration to diabetics (ketoacidosis reported).
Pregnancy, Breastfeeding: Use with caution.
Old age: Use reduced dose.
Interaction:
Drugs
Beclomethasone, Theophylline: Enhances respiratory function.
ß-Blockers: Inhibit bronchodilator effect.
Diuretics and Xanthines: Increased risk of hypokalemia.
Digitalis: Increased risk of digitalis toxicity when salbutamol is given in high doses due to hypokalemia.
Warnings:
Adverse Effects:
Lactations:
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
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