ALBUTEROL

(al-byoo'ter-ole)

Accuneb, Novosalmol

, Pro-Air HFA, Proventil, Proventil HFA, Ventolin, Ventolin HFA, VoSpire ER
Classifications: bronchodilator (respiratory smooth muscle relaxant); beta-adrenergic agonist;
Therapeutic:bronchodilator (respiratory smooth muscle relaxant)
Pregnancy Category: C

Availability

2 mg, 4 mg tablets; 4 mg, 8 mg, extended-release tablets; 2 mg/5 mL syrup; 200 mcg capsules for inhalation; 0.083%, 0.5% solution for inhalation

Action

Moderately selective beta₂-adrenergic agonist with comparatively long action. Acts prominently on beta₂ receptors (particularly smooth muscles of trachea, bronchi, uterus, and vascular supply to skeletal muscles). Inhibits histamine release by mast cells. Produces bronchodilation by relaxing smooth muscles of bronchial tree.

Therapeutic Effect

Bronchodilation decreases airway resistance, facilitates mucous drainage, and increases vital capacity.

Uses

To relieve bronchospasm associated with acute or chronic asthma, bronchitis, or other reversible obstructive airway diseases. Also used to prevent exercise-induced bronchospasm.

Unlabeled Uses

Adjunct in treatment of refractory heart failure and to stimulate intracellular transport of potassium in hyperkalemic familial periodic paralysis.

Contraindications

Albuterol or levalbuterol hypersensitivity; congenital long QT syndrome; pregnancy (category C). Use of oral syrup in children <2 y.

Cautious Use

Cardiovascular disease, renal impairment, hypertension, hyperthyroidism, diabetes mellitus, elderly, history of seizures; hypersensitivity to sympathomimetic amines or to fluorocarbon propellant used in inhalation aerosols.

Route & Dosage

Bronchospasm
Adult: PO 2–4 mg 3–4 times/d, 4–8 mg sustained release 2 times/d Inhaled 1–2 inhalations q4–6h
Child: PO 2–6 y, 0.1–0.2 mg/kg t.i.d. (max: 4 mg/dose); 6–12 y, 2 mg 3–4 times/d Inhaled 6–12 y, 1–2 inhalations q4–6h

Administration

Oral

Do not crush extended release tablets. Scored tablets may be broken in half.
Note: An initial dose of 2 mg t.i.d. or q.i.d. is recommended for older adult patients.
Store tablets and syrup between 2°–25° C (36°–77° F) in tight, light-resistant container.

Inhalation

Administer albuterol 20–30 min before concomitant beclomethasone (Vanceril) inhalation treatments to allow deeper penetration of beclomethasone into lungs, unless otherwise directed by physician.
Store canisters between 15°–30° C (59°–86° F) away from heat and direct sunlight.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity reaction. CNS: Tremor, anxiety, nervousness, restlessness, convulsions, weakness, headache, hallucinations. CV: Palpitation, hypertension, hypotension, bradycardia, reflex tachycardia. Special Senses: Blurred vision, dilated pupils. GI: Nausea, vomiting. Other: Muscle cramps, hoarseness.

Diagnostic Test Interference

Transient small increases in plasma glucose may occur.

Interactions

Drug: With epinephrine, other sympathomimetic bronchodilators, possible additive effects; mao inhibitors, tricyclic antidepressants potentiate action on vascular system; beta-adrenergic blockers antagonize the effects of both drugs.

Pharmacokinetics

Onset: Inhaled: 5–15 min; PO 30 min. Peak: Inhaled: 0.5–2 h; PO 2.5 h. Duration: Inhaled: 3–6 h; PO 4–6 h (8–12 h with sustained release). Metabolism: In liver by CYP3A4; may cross the placenta. Elimination: 76% of dose eliminated in urine in 3 d. Half-Life: 2.75 h.

Nursing Implications

Assessment & Drug Effects

Monitor therapeutic effectiveness which is indicated by significant subjective improvement in pulmonary function within 60–90 min after drug administration.
Monitor for: S&S of fine tremor in fingers, which may interfere with precision handwork; CNS stimulation, particularly in children 2–6 y, (hyperactivity, excitement, nervousness, insomnia), tachycardia, GI symptoms. Report promptly to physician.
Lab tests: Periodic ABGs, pulmonary functions, and pulse oximetry.
Consult physician about giving last albuterol dose several hours before bedtime, if drug-induced insomnia is a problem.

Patient & Family Education

Review directions for correct use of medication and inhaler (see ADMINISTRATION).
Avoid contact of inhalation drug with eyes.
Do not increase number or frequency of inhalations without advice of physician.
Notify physician if albuterol fails to provide relief because this can signify worsening of pulmonary function and a reevaluation of condition/therapy may be indicated.
Note: Albuterol can cause dizziness or vertigo; take necessary precautions.
Do not use OTC drugs without physician approval. Many medications (e.g., cold remedies) contain drugs that may intensify albuterol action.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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