Albuterol Sulfate Prescription Guidelines
An albuterol sulfate prescription should be written with specific dosing instructions based on the formulation (MDI or nebulizer) and should typically include 1-2 inhalers for MDI or a 30-day supply for nebulizer solution, with refills as appropriate for the patient's condition. 1, 2
Metered-Dose Inhaler (MDI) Prescription
- For adults and children ≥12 years, prescribe albuterol MDI (90 mcg/puff) with instructions to use 4-8 puffs every 20 minutes for up to 3 doses during acute symptoms, then every 1-4 hours as needed 1
- For maintenance/rescue use, prescribe 1-2 puffs every 4-6 hours as needed for shortness of breath 2
- Specify "Dispense 1-2 inhalers (200 puffs each)" to ensure adequate supply for 30 days 2
- Include instructions to use with a valved holding chamber (spacer) for optimal delivery 1
Nebulizer Solution Prescription
- For adults, prescribe albuterol nebulizer solution 0.083% (2.5 mg/3 mL) with instructions to use 2.5-5 mg every 4-6 hours as needed 3
- For children weighing ≥15 kg, prescribe 2.5 mg (one unit-dose vial) 3-4 times daily 3
- For children weighing <15 kg who require <2.5 mg/dose, prescribe albuterol inhalation solution 0.5% instead 3
- Specify "Dispense 30-day supply (90-120 unit-dose vials)" for typical maintenance use 3
Acute Exacerbation Dosing
- For acute exacerbations in adults, specify higher frequency: 2.5-5 mg via nebulizer or 4-8 puffs via MDI every 20 minutes for 3 doses, then every 1-4 hours as needed 4
- For children during acute exacerbations, specify 0.15 mg/kg (minimum 2.5 mg) via nebulizer or 4-8 puffs via MDI every 20 minutes for 3 doses, then every 1-4 hours as needed 5
Important Prescription Elements
- Include patient's name, date, medication name, strength, dosage form, quantity to dispense, and directions for use 1
- Specify number of refills (typically 3-12 months' worth depending on follow-up schedule) 2
- For MDIs, include "Shake well before use" in the instructions 2
- Consider adding "Rinse mouth after use" to reduce side effects 2
Clinical Considerations
- MDI with spacer is as effective as nebulized therapy for mild-to-moderate exacerbations when proper technique is used 6
- Patients with more severe obstruction may require higher doses and more frequent administration 7
- Consider prescribing a peak flow meter alongside rescue medication to help patients monitor their asthma control 1
- Increased use of rescue medication (>2 times weekly) indicates poor asthma control and need for controller medication adjustment 2
Common Pitfalls to Avoid
- Underprescribing quantity - ensure adequate supply for at least 30 days plus buffer for increased use during exacerbations 2
- Failing to specify proper administration technique in the prescription instructions 1
- Not considering patient-specific factors such as age, severity of condition, and ability to use the device properly 5
- Prescribing nebulizer solution without specifying concentration (0.083% vs 0.5%) 3