Maximum Daily Dose of Salbutamol (Albuterol)
For adults, the maximum daily dose of salbutamol is 10-15 mg via nebulizer or up to 20 puffs (1800-2000 μg) via metered-dose inhaler (MDI) with spacer. 1, 2
Metered-Dose Inhaler (MDI) Dosing
Adults
- Standard dosing: 200-400 μg (2-4 puffs) every 4-6 hours as needed for mild to moderate symptoms 1
- For moderate symptoms: Up to 1000 μg (10 puffs) every 4-6 hours as needed 1
- During acute exacerbations: 4-8 puffs every 20 minutes for up to 4 hours, then every 1-4 hours as needed 2
- Maximum daily dose should generally not exceed 8-12 puffs for routine use, or up to 20 puffs in acute situations 1, 2
Children
- Children aged 5-11 years: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 2
- Children under 5 years: 1-2 puffs every 4-6 hours, which may be increased during acute symptoms 2
- For acute severe asthma in children: Up to 10 puffs (1000 μg) may be used via MDI with spacer 3
Nebulizer Dosing
Adults
- Standard dosing: 2.5-5.0 mg every 20 minutes for three doses in the first hour of acute symptoms 1
- Maintenance dosing: 2.5 mg four times daily for chronic symptoms 1
- For severe symptoms: Up to 5 mg four times daily 1
- Continuous nebulization: 10-15 mg/hour for severe exacerbations 2
- Maximum daily dose: Should not exceed 20 mg per 24 hours 1
Children
- Standard dosing: 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 2
- For acute severe asthma: 5 mg or 0.15 mg/kg 3
- Continuous nebulization: 0.5 mg/kg/hour (up to 10-15 mg/hour) for severe exacerbations 3, 2
Important Considerations
- Using a spacer with MDI improves drug delivery and is as effective as nebulized therapy for mild-to-moderate exacerbations 2, 4
- Oxygen is the preferred gas source for nebulization to maintain adequate oxygen saturation 3
- For nebulizer solutions, dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min for optimal delivery 2
- Monitoring for side effects is essential, particularly with high doses, including tachycardia, tremor, and hypokalemia 5, 6
Potential Pitfalls
- Paradoxical elevation in serum potassium levels may occur in the first minutes following inhalation, which could be problematic in patients with hyperkalemia 5
- Regular use of rescue inhaler exceeding twice weekly indicates poor asthma control and need for controller medication adjustment 2
- Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention 2
- Higher doses (600 μg at 10-minute intervals) may produce slightly better bronchodilation but with greater side effects compared to standard dosing (400 μg at 10-minute intervals) 6