What is the prescription for Albuterol (Salbutamol)?

From the Guidelines

Albuterol should be prescribed as a rescue inhaler for asthma and other respiratory conditions, with a standard prescription being albuterol sulfate inhalation aerosol (ProAir HFA, Ventolin HFA, or Proventil HFA), 90 mcg per actuation, with instructions to take 1-2 puffs every 4-6 hours as needed for shortness of breath or wheezing. For acute symptoms, patients may use up to 4-8 puffs per day, but frequent use (more than twice weekly) indicates poor control and should prompt medical evaluation. The prescription should include 1-2 inhalers (200 actuations each) with 2-3 refills, lasting approximately 3-6 months depending on use. Patients should be instructed to prime new inhalers with 4 test sprays, rinse their mouth after use to prevent thrush, and use a spacer device if coordination is difficult. Albuterol works as a short-acting beta-2 agonist that relaxes bronchial smooth muscle to open airways quickly, typically within 5-15 minutes, with effects lasting 4-6 hours. Side effects may include tremor, nervousness, increased heart rate, and potential paradoxical bronchospasm in rare cases 1.

Some key points to consider when prescribing albuterol include:

• The dosage for children is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization 1.
• The dosage for adults is 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 continuously 1.
• Albuterol can be administered via nebulizer or metered-dose inhaler (MDI), with the MDI being as effective as nebulized therapy in mild-to-moderate exacerbations 1.
• Patients should be instructed on proper inhaler technique and spacer use to ensure optimal delivery of the medication 1.

It's also important to note that albuterol is a short-acting medication and should not be used as a substitute for long-term control medications, such as inhaled corticosteroids 1. Regular monitoring and follow-up with a healthcare provider is necessary to assess the effectiveness of the medication and adjust the treatment plan as needed. In addition, patients should be educated on the signs and symptoms of asthma exacerbations and when to seek medical attention 1.

Overall, albuterol is a safe and effective medication for the treatment of asthma and other respiratory conditions, when used properly and under the guidance of a healthcare provider 1.

From the FDA Drug Label

The action of albuterol sulfate inhalation solution may last up to six hours, and therefore it should not be used more frequently than recommended Do not increase the dose or frequency of medication without medical consultation.

The prescription for Albuterol (Salbutamol) is not explicitly stated in the provided drug label. However, it is mentioned that the medication should not be used more frequently than recommended and that the dose or frequency should not be increased without medical consultation.

• Key points:
  • The action of albuterol sulfate inhalation solution may last up to six hours
  • Should not be used more frequently than recommended
  • Do not increase the dose or frequency of medication without medical consultation 2

From the Research

Albuterol Prescription

The prescription for Albuterol (Salbutamol) can vary depending on the patient's condition and the severity of their symptoms.

• For acute asthma exacerbation, the National Asthma Education and Prevention Program (NAEPP) recommends a starting dose of 2.5 to 5 mg of aerosolized albuterol every 20 min 3.
• A study comparing 2.5 vs 7.5 mg of inhaled albuterol found no advantage to the routine administration of doses higher than 2.5 mg every 20 min 3.
• For patients hospitalized with acute asthma, ad-lib administration of albuterol is therapeutically as effective as regular, scheduled administration, and reduces the total dose of beta-agonists received by the patient 4.
• In the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD), a study found no statistically significant difference between hourly administration of albuterol and more frequent administration of a higher cumulative dose 5.
• Continuously nebulized albuterol plus ipratropium bromide may be effective in reducing emergency department length of stay and hospital admission rates in patients with acute bronchospasm, although the evidence is not conclusive 6.

Administration Routes

Albuterol can be administered via various routes, including:

• Metered-dose inhaler: an excellent agent for treatment as needed and/or for prevention of acute bronchospasm triggered by exercise or other predictable cause 7.
• Nebulizer: effective for acute dyspneic asthma, and can be used in combination with ipratropium bromide 7, 6.
• Oral: available in the United States, but with limited pharmacokinetic data and a terminal half-life of 3-8 hours 7.
• Parenteral: can be used in acutely dyspneic patients, but produces more side effects than carefully administered intravenous theophylline 7.