Salbutamol nebulised
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for nebulisation containing salbutamol.
Drugs List
Therapeutic Indications
Uses
Acute exacerbation of chronic obstructive airways disease
Chronic bronchospasm when conventional therapy ineffective
Treatment of acute severe asthma
Unlicensed Uses
Hyperkalaemia
Dosage
The 5mg/ml respirator solution formulation may be administered intermittently or continuously.
The 1mg/ml (2.5mg/2.5ml) or 2mg/ml (5mg/2.5ml) unit dose formulations are intended for intermittent administration.
Adults
Unit Dose Formulations: 2.5mg to 5mg up to four times a day. Maximum dose of 40mg per day can be given under strict medical supervision in hospital.
Respirator Solution - Intermittent Administration: 2.5mg to 5mg (0.5ml to 1ml). Some patients may require up to 10mg (2ml).
Respirator Solution - Continuous Administration: 1mg to 2mg per hour.
Children
Other pharmaceutical forms may be more appropriate in children aged under 4 years.
In infants under 18 months, the clinical efficacy of nebulised salbutamol is uncertain. As transient hypoxia may occur supplemental oxygen therapy should be considered.
Unit dose formulations
Children aged over 12 years: 2.5mg to 5mg up to four times a day. Maximum dose of 40mg per day can be given under strict medical supervision in hospital.
Children aged 4 to 12 years: 2.5mg to 5mg by intermittent nebulisation up to four times a day.
Respirator Solution - Intermittent Administration
Children aged over 12 years: 2.5mg to 5mg (0.5ml to 1ml). Some patients may require up to 10mg (2ml).
Children aged 18 months to 12 years: 2.5mg to 5mg (0.5ml to 1ml) 4 times a day.
Respirator Solution - Continuous Administration
Children aged 4 to 18 years
1mg to 2mg per hour.
Severe hyperkalaemia (unlicensed)
Intravenous administration of salbutamol is preferred to the use of nebulised therapy.
Children from birth to 18 years: 2.5mg to 5mg as a single dose, repeated if necessary.
Additional Dosage Information
For the management of moderate and severe acute asthma in adults and children an alternative dosing schedule may be suitable (if possible via an oxygen-driven nebuliser):
Adults and children aged over 12 years: 5mg, repeat every 20 to 30 minutes or when required.
Children aged 5 to 12 years: 2.5 to 5mg, repeat every 20 to 30 minutes or when required.
Children aged 1 month to 5 years: 2.5mg, repeat every 20 to 30 minutes or when required.
Contraindications
Long QT syndrome
Torsade de pointes
Precautions and Warnings
Children under 4 years
Family history of long QT syndrome
Impaired glucose tolerance
Breastfeeding
Cardiac arrhythmias
Diabetes mellitus
Electrolyte imbalance
History of torsade de pointes
Hypokalaemia
Hypoxia
Ischaemic heart disease
Lactic acidosis
Pregnancy
Recent myocardial infarction
Severe cardiovascular disorder
Thyrotoxicosis
Correct electrolyte disorders before treatment
May decrease glucose tolerance in patients with diabetes mellitus
Not all available brands are licensed for all indications
Not to be used as the sole or main treatment for severe or unstable asthma
Some formulations contain benzalkonium chloride
Do not allow solution or mist to enter eyes
Consider monitoring ECG in patients at risk of QT prolongation
Monitor blood glucose closely in patients with diabetes mellitus
Monitor for development of lactic acidosis
Monitor serum electrolytes
Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
Monitor serum potassium in hypoxic patients
Monitor serum potassium regularly in patients with severe asthma
Advise patient to report any chest pain
May reduce serum potassium levels
Discontinue if paradoxical bronchospasm occurs
Advise patient to consult physician if condition worsens / does not improve
Pregnancy and Lactation
Pregnancy
Use salbutamol with caution during pregnancy.
The manufacturer does not recommend the use of salbutamol during pregnancy, unless the expected benefit is thought to outweigh any possible risk to the fetus. In animal studies there is evidence of some harmful effects on the fetus at very high doses. Human data is limited and as such a potential risk cannot be ruled out.
Salbutamol has however, been in widespread use for many years in human beings without apparent ill consequences; this includes its well established use in the management of premature labour. Inhaled salbutamol is considered a drug of choice for pregnant women (Schaefer 2015).
Lactation
Use salbutamol with caution during breastfeeding.
The manufacturer does not recommend the use of salbutamol during breastfeeding, unless the expected benefit is thought to outweigh any possible risk to the fetus. Inhaled salbutamol is likely to be present in human breast milk. Briggs and Schaefer state that inhaled salbutamol is generally considered compatible with breastfeeding, although very large maternal doses of inhaled beta 2 agonists may cause restlessness and tachycardia in the infant (Schaefer 2015).
Side Effects
Angina pectoris
Angioedema
Atrial fibrillation
Blood pressure changes
Bronchospasm (paradoxical)
Burning tongue
Cardiac arrhythmias
Chest pain
Collapse
Dizziness
Dyspnoea
Erythema
Extrasystoles
Fine tremor (usually hands)
Hallucinations
Headache
Hyperactivity
Hyperexcitability (children)
Hyperglycaemia
Hypersensitivity reactions
Hypokalaemia
Hypotension
Ketoacidosis
Lactic acidosis
Mouth irritation
Muscular cramps
Myocardial ischaemia
Nausea
Palpitations
Peripheral vasodilatation
Pruritus
Rash
Restlessness
Sleep disturbances
Supraventricular tachycardia
Tachycardia
Taste disturbances
Throat irritation
Urticaria
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet (www.toxbase.org) or if this is unavailable at the backup site (www.toxbasebackup.org).
Further Information
Last Full Review Date: January 2023
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Brodilaten 2.5mg/2.5ml nebuliser solution. Noridem Enterprises Limited. Revised July 2019.
Summary of Product Characteristics: Salbutamol 2.5mg/2.5ml nebuliser solution. Accord UK Ltd. Revised August 2021.
Summary of Product Characteristics: Salbutamol 5mg/2.5ml nebuliser solution. Accord UK Ltd. Revised August 2021.
Summary of Product Characteristics: Ventolin Respirator Solution 5mg/ml. GlaxoSmithKline UK Ltd. Revised November 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 13 January 2023
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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