Short-Acting Beta-2 Agonist (SABA) Pregnancy: §4.6: administration during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the fetus; there is little published evidence of safety in early human pregnancy and animal studies showed some harmful fetal effects at very high dose levels. Salbutamol is probably secreted in breast milk, so use in nursing mothers requires careful consideration and should be restricted to situations where the expected maternal benefit outweighs any potential risk to the neonate.

Salbutamol (Paediatric — Asthma/Wheeze)

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

Salbutamol is a short-acting beta-2 agonist — the reliever inhaler — used for rapid relief of asthma and reversible airway obstruction, and by nebuliser in acute severe attacks.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 2.5 mg to 5 mg salbutamol (nebulised) up to four times a day

Route: Nebulised inhalation only, breathed in through the mouth using a suitable nebuliser — the solution must not be injected or swallowed

Frequency: Up to four times a day

Max: Up to 40 mg per day can be given under strict medical supervision in hospital

Source: UK SPC (eMC) for Salbutamol 1 mg/ml nebuliser solution, §4.2 (https://www.medicines.org.uk/emc/product/10256/smpc). Adult dose applies to adults including the elderly. PAEDIATRIC POSOLOGY (SPC §4.2 — stated as fixed mg by age, NOT per kg, which is why paedDose is null): children aged 12 years and over — dose as per the adult population; children aged 4–11 years — 2.5 mg to 5 mg up to four times a day; other pharmaceutical forms may be more appropriate for administration in children under 4 years old. INFANTS UNDER 18 MONTHS: clinical efficacy of nebulised salbutamol is uncertain and, as transient hypoxia may occur, supplemental oxygen therapy should be considered. HOME NEBULISER WARNINGS (§4.2): private purchase of nebuliser devices for home use to deliver rescue therapy for acute asthma in children and adolescents is not recommended; only specialists in respiratory medicine should initiate and clinically manage home nebulised medicines for acute asthma in children and adolescents; children should be trained in correct device use and supervised by a responsible adult; urgent medical assistance should be sought if worsening asthma symptoms are not relieved by rescue medicines, even if there is short-term recovery. ADMINISTRATION: nebuliser solutions are intended to be used undiluted, but if prolonged delivery time (more than 10 minutes) is required the solution may be diluted with sterile normal saline. §4.4 adds that increasing use of short-acting beta-2 agonists indicates deteriorating asthma control and that patients taking more than twice-weekly 'as needed' salbutamol (not counting prophylactic use before exercise) should be re-evaluated. Verify all paediatric dosing against a children's formulary and local asthma guidance.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

For oral inhalation only. ( 2 ) Treatment or prevention of bronchospasm in adult and pediatric patients aged 4 years and older: 2 inhalations by oral inhalation every 4 to 6 hours. For some patients, 1 inhalation every 4 hours may be sufficient. ( 2.1 ) Prevention of exercise-induced bronchospasm in adult and pediatric patients aged 4 years and older: 2 inhalations by oral inhalation 15 to 30 minutes before exercise. ( 2.2 ) Priming information: Prime Albuterol Sulfate HFA before using for the first time, when the inhaler has not been used for more than 2 weeks, or when the inhaler has been dropped. To prime Albuterol Sulfate HFA, release 4 sprays into the air away from the face, shaking …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-12-31. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to salbutamol or to any of the excipients
Non-IV formulations of salbutamol must not be used to arrest uncomplicated premature labour or threatened abortion

Side effects

Common: tremor, headache
Common: tachycardia; uncommon: palpitations
Uncommon: mouth and throat irritation; muscle cramps
Rare: hypokalaemia (potentially serious), sleep disturbances, peripheral vasodilatation; not known: lactic acidosis
Very rare: hypersensitivity reactions including angioedema, urticaria, bronchospasm, hypotension and collapse; paradoxical bronchospasm; cardiac arrhythmias; hyperactivity; insomnia. Not known: myocardial ischaemia

Interactions

NOTE: §4.5 was not present in the fetched UK bundle — the entries below are from the US label (Albuterol Sulfate HFA) and must be confirmed against the UK SPC
Beta-adrenergic receptor blocking agents — may block the bronchodilatory effect and may produce severe bronchospasm in patients with asthma (US label §7.1)
Non-potassium-sparing diuretics — ECG changes and/or hypokalaemia associated with these diuretics may worsen with concomitant beta-agonists; use with caution (US label §7.2)
Digoxin — may decrease serum digoxin levels; consider monitoring digoxin levels (US label §7.3)
Monoamine oxidase inhibitors and tricyclic antidepressants — use with extreme caution; may potentiate the effect of salbutamol on the vascular system (US label §7.4)
Other short-acting sympathomimetic aerosol bronchodilators should not be used concomitantly; additional adrenergic drugs by any route should be used with caution (US label §7)
UK §4.4 adds that hypokalaemia may be potentiated in hypoxic patients and in those treated with xanthine derivatives, steroids and diuretics — monitor serum potassium in acute severe asthma

Clinical monograph

How it works

It stimulates β2-adrenoceptors on airway smooth muscle, producing bronchodilation within minutes.

Prescribing in practice

Frequent or escalating reliever use signals poorly controlled asthma and the need to review the preventer and inhaler technique.
Reinforce technique; a spacer improves delivery, especially in children.
High or repeated doses cause tremor, tachycardia and hypokalaemia — monitor potassium in acute severe asthma.

Monitoring

In acute severe asthma monitor response, heart rate and potassium; in chronic use treat reliever frequency as a marker of control.

Counselling the patient

It works within minutes — seek urgent help if it is not working or you need it more often than usual.
Tremor or a faster heartbeat can occur and are not dangerous at usual doses.
Use a spacer if provided and check your technique.

Evidence & guidelines

Short-acting beta-2 agonists relieve symptoms but do not treat the underlying inflammation; over-reliance is a recognised risk marker (NICE NG80; BTS/SIGN).

Reference: BTS/SIGN Asthma Guidelines 2019; NICE NG80; Resuscitation Council UK Paediatric Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways