SALBUTAMOL

Short-acting beta₂ receptor agonist bronchodilator that makes breathing easier

Dosage Forms

Tablet

4 mg

Aerosol inhalation

100 µg/metered inhalation

Nebuliser solution

Vial 2 mg/ml

Respirator solution

5 mg/ml

Uses

  • Acute asthma attacks
  • Asthma maintenance therapy - Step 1
  • Asthma-like symptoms in anaphylaxis
  • Difficulty in breathing in bronchiolitis

Dose and Duration

Acute asthma attack, asthma-like symptoms

Adult: 5 mg by nebuliser OR by inhaler 2 puffs (200 µg) every 10 minutes for 30–60 minutes

Child >18 months–12 years: 2.5 mg by nebuliser.

→ Monitor response 30 minutes after the dose. Repeat if necessary

Mild to moderate acute asthma attack

Adult: 2.5 mg by nebuliser repeated after 15 minutes OR by inhaler 2 puffs (200 µg) every 2–5 minutes for 20 puffs.

→ Review every 3–4 hours and continue same dose if necessary every 3–4 hours

Child <2 years: Tablets 100 µg/kg 3–4 times daily

Child 2–6 years: Tablets 1–2 mg 3–4 times daily

Child 6–12 years: Tablets 2 mg 3–4 times daily

Relief of wheezing/difficulty in breathing in bronchiolitis

Child: tablets 100 µg/kg

Chronic asthma maintenance therapy

Inhale 1–2 puffs (100–200 µg) when necessary

OR if inhaler not available, give tablets in doses indicated below

Adult: 2–4 mg every 6–8 hours (Max single dose 8 mg)

Child 6–12 years: 2 mg every 6–8 hours

Child 2–5 years: 1–2 mg every 6–8 hours

Child <2 years: 100 $\mu$g/kg every 8 hours

Preparation

  • Dilute salbutamol nebules with 2 ml of sodium chloride 0.9% to obtain a total volume of 4 ml in the reservoir of the nebuliser
  • Disperse diluted solution with oxygen at a flow rate of 5 to 8 L/min. Stop nebulisation when reservoir is empty
  • Respirator Solution is diluted with sterile sodium chloride 0.9% to contain 50-100 micrograms of salbutamol per ml (i.e. 1-2 ml solution made up to 100ml with diluents). The diluted solution is administered by nebuliser

Contra-indications

  • Allergy to salbutamol

Side Effects

  • Palpitations
  • Shaking of hands
  • Allergic reactions
  • Headache

Interactions

  • Methyldopa (risk of acute hypotension )
  • Theophylline (risk of low potassium blood level)
  • Aminophylline (risk of low potassium blood level)
  • Hydrocortisone (risk of low potassium blood level)

Patient Instructions

  • Always report to health worker when you feel worsening of symptoms

Pregnancy

  • Can be used; preferably use inhaled route

Breast-feeding

  • Can be used

⚠️ Caution

  • Do not use oral salbutamol for management of acute asthma as its onset of action is 30 minutes
  • Only use oral route when the inhaled route is not possible. Inhaled route is preferred as the medicine is delivered directly to site of action so it acts faster, and smaller doses are used so there are less systemic side effects
  • The nebuliser should always be driven by oxygen to avoid worsening of low oxygen levels
  • Educate the patient on how to use the inhaler, and let them demonstrate. Incorrect use of inhaler leads to inadequate delivery of dose and hence treatment failure