Albuterol

Today's med: Albuterol  (al BYOO ter ole)

(brand names: AccuNeb, ProAir, Proventil, Ventolin, VoSpire )

Drug Class: Beta 2 (adrenergic) Agonist 

Other Drugs in this class: Ipratropium bromide/albuterol, Fluticasone/salmeterol,Levosalbutamol, 

Budesonide/formoterol, Salmeterol,Formoterol, AlbuterolSulfate, Metaproterenol, Pirbuterol,Arformoterol, Levalbuterol hydrochloride, Formoterol Fumarate, Formoterol fumarate dihydrate, Levalbuterol tartrate, Arformoterol Tartrate, Salmeterol xinafoate,Pirbuterol acetate, Metaproterenol Sulfate, Mometasone furoate/Formoterol

Indications: Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease; prevention of exercise-induced bronchospasm.  

Contraindications: hypersensitivity to drug or any of its components.  Injection formulation (Canadian labeling; product not available in U.S.):  tachyarrhythmias; risk of abortion during first or second trimester

Adverse Effects:

Cardiovascular: Angina, atrial fibrillation, arrhythmias, chest discomfort, chest pain, extrasystoles, flushing, hyper-/hypotension, palpitation, supraventricular tachycardia, tachycardia; Central nervous system: CNS stimulation, dizziness, drowsiness, headache, insomnia, irritability, lightheadedness, migraine, nervousness, nightmares, restlessness, seizure; Dermatologic: Angioedema, rash, urticaria;  Endocrine & metabolic: Hyperglycemia, hypokalemia, lactic acidosis; Gastrointestinal: Diarrhea, dry mouth, dyspepsia, gastroenteritis, nausea, unusual taste, vomiting;  Genitourinary: Micturition difficulty; Local: Injection: Pain, stinging; Neuromuscular & skeletal: Muscle cramps, musculoskeletal pain, tremor, weakness; Otic: Otitis media, vertigo; Respiratory: Asthma exacerbation, bronchospasm, cough, epistaxis, laryngitis, oropharyngeal drying/irritation, oropharyngeal edema, pharyngitis, rhinitis, upper respiratory inflammation, viral respiratory infection; Miscellaneous: Allergic reaction, anaphylaxis, diaphoresis, lymphadenopathy

Postmarketing and/or case reports: Anxiety, glossitis, hoarseness, metabolic acidosis, myocardial ischemia, pulmonary edema, throat irritation, tongue ulceration

MOST COMMON S/E: Shakiness in the legs, arms, hands, or feet, trembling or shaking of the hands or feet

Standard Dosing: Oral:  Children: Bronchospasm: 2-6 years: 0.1-0.2 mg/kg/dose 3 times/day; maximum dose not to exceed 12 mg/day (divided doses); 6-12 years: 2 mg/dose 3-4 times/day; maximum dose not to exceed 24 mg/day (divided doses); Extended release: 4 mg every 12 hours; maximum dose not to exceed 24 mg/day (divided doses); Children >12 years and Adults: Bronchospasm (treatment): 2-4 mg/dose 3-4 times/day; maximum dose not to exceed 32 mg/day (divided doses); Extended release: 8 mg every 12 hours; maximum dose not to exceed 32 mg/day (divided doses). A 4 mg dose every 12 hours may be sufficient in some patients, such as adults of low body weight.

Elderly: Bronchospasm (treatment): 2 mg 3-4 times/day; maximum: 8 mg 4 times/day

**Oral: should be taken with water 1 hour before or 2 hours after meals.Do not crush or chew extended release tablets.

Metered-dose inhaler (90 mcg/puff):

Children ≤4 years (NIH Guidelines, 2007):

Quick relief: 2 puffs every 4-6 hours as needed

Exacerbation of asthma (acute, severe): 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed

Exercise-induced bronchospasm (prevention): 1-2 puffs 5 minutes prior to exercise

Children 5-11 years (NIH Guidelines, 2007):

Bronchospasm, quick relief: 2 puffs every 4-6 hours as needed

Exacerbation of asthma (acute, severe): 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed

Exercise-induced bronchospasm (prevention): 2 puffs 5-30 minutes prior to exercise

Children ≥12 years and Adults:

Bronchospasm, quick relief (NIH Guidelines, 2007): 2 puffs every 4-6 hours as needed

Exacerbation of asthma (acute, severe) (NIH Guidelines, 2007): 4-8 puffs every 20 minutes for up to 4 hours, then every 1-4 hours as needed

Exercise-induced bronchospasm (prevention) (NIH Guidelines, 2007): 2 puffs 5-30 minutes prior to exercise

**Metered-dose inhaler: Shake well before use; prime prior to first use, and whenever inhaler has not been used for >2 weeks or when it has been dropped, by releasing 3-4 test sprays into the air (away from face). Airomir™ Canadian product labeling recommends releasing a minimum of 4 test sprays when priming. HFA inhalers should be cleaned with warm water at least once per week; allow to air dry completely prior to use. A spacer device or valved holding chamber is recommended for use with metered-dose inhalers.

Drug interactions: LINK: http://www.drugs.com/drug-interactions/albuterol.html

Alpha-/Beta-Blockers: May diminish the therapeutic effect of Beta2-Agonists. Consider therapy modification

AtoMOXetine: May enhance the tachycardic effect of Beta2-Agonists. Monitor therapy

Beta-Blockers (Beta1 Selective): May diminish the bronchodilatory effect of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Monitor therapy

Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Beta2-Agonists. Avoid combination

Betahistine: May diminish the therapeutic effect of Beta2-Agonists. Monitor therapy

Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Avoid combination

Loop Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Loop Diuretics. Monitor therapy

MAO Inhibitors: May enhance the adverse/toxic effect of Beta2-Agonists. Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy

Thiazide Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Thiazide Diuretics. Monitor therapy

Tricyclic Antidepressants: May enhance the adverse/toxic effect of Beta2-Agonists. Monitor therapy

Albuterol if you can't breathe at all....