Short-Acting Beta-2 Agonist (SABA) Pregnancy: Compatible — beta-2 agonists preferred in pregnancy; IV salbutamol can delay premature labour (tocolytic)

Salbutamol (Paediatric — Asthma/Wheeze)

Brand names: Ventolin, Salamol, Bricanyl (terbutaline — different drug)

Adult dose

Dose: Inhaled: 100–200 mcg (1–2 puffs) PRN up to QDS. Nebulised: 2.5 mg (1 year and over), 5 mg (5 years and over). IV: 5 mcg/kg loading, 1–20 mcg/kg/min infusion.

Route: Inhaled (MDI+spacer), nebulised, or IV

Frequency: PRN (reliever)

Max: 800 mcg/day (MDI); nebulised can be back-to-back in acute severe asthma

Full adult dosing in respiratory section

Paediatric dose

Route: Inhaled (MDI + spacer) or nebulised

Frequency: PRN (reliever); back-to-back nebulisers in acute severe

Max: 10 puffs per acute episode (MDI + spacer); nebuliser every 20 min in severe attack

Concentration: 2.5 mg/2.5 mL nebuliser solution; 100 mcg/puff MDI mcg or mg/ml

Age <5 years: 100 mcg MDI + large-volume spacer (+ face mask <3 years). Acute asthma: 2–10 puffs MDI every 20–30 min initially (NICE/BTS). Nebulised (acute severe): <5 years: 2.5 mg; ≥5 years: 2.5–5 mg. IV for severe/life-threatening: loading 5 mcg/kg over 10 min, infusion 1–20 mcg/kg/min.

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Clinical pearls

MDI + spacer as effective as nebuliser in mild-moderate acute asthma — spacer preferred (less aerosol waste, fewer side effects)
Hypokalaemia: occurs with high-dose nebulised treatment — check potassium in acute severe asthma (especially concurrent use of corticosteroids and aminophylline)
Infants <1 year: wheeze may be viral bronchiolitis not asthma — salbutamol evidence limited in bronchiolitis (Cochrane review shows no benefit)
If not responding to 10 puffs in 20 min — escalate to severe/life-threatening protocol

Contraindications

No absolute contraindications for reliever use in asthma/wheeze

Side effects

Tachycardia
Tremor
Hypokalaemia (especially high-dose nebulised)
Palpitations
Headache
Irritability (infants)

Interactions

Non-selective beta-blockers — antagonise bronchodilation (avoid in asthma)
Corticosteroids/diuretics — additive hypokalaemia with high-dose salbutamol

Monitoring

Heart rate and SpO2
Serum potassium (high-dose use)
Respiratory rate and wheeze
Peak flow or SpO2 response

Reference: BNF for Children; BTS/SIGN Asthma Guidelines 2019; NICE NG80; Resuscitation Council UK Paediatric Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways