Salbutamol (Albuterol)

SCOPE: covers the page's primary routes - nebulised and metered-dose inhalation for bronchospasm - from the two fetched labels; the intravenous route is NOT covered and no IV dose is published. VERBATIM UK SPC 4.2 (nebuliser solution): 'Adults (including the elderly): 2.5 mg to 5 mg salbutamol up to four times a day. Up to 40 mg per day can be given under strict medical supervision in hospital.' DILUTION: 'Salbutamol nebulisers solutions are intended to be used undiluted. However, if prolonged delivery time (more than 10 minutes) is required, the solution may be diluted with sterile normal saline.' The product this dose comes from is 'Salbutamol 1mg/ml nebuliser solution' - check the strength of the nebules actually in use before drawing a volume, as other strengths are marketed. VERBATIM US LABEL (metered-dose inhaler), section 2.1: 'Adult and pediatric patients aged 4 years and older: 2 inhalations by oral inhalation repeated every 4 to 6 hours; in some patients, 1 inhalation every 4 hours may be sufficient. More frequent administration or a greater number of inhalations is not recommended.' Section 2.2: 'Adult and pediatric patients aged 4 years and older: 2 inhalations by oral inhalation 15 to 30 minutes before exercise.' Section 3 pins the strength that makes an inhalation count meaningful: 'Inhalation aerosol: 108 mcg of albuterol sulfate (90 mcg of albuterol base) from the mouthpiece per actuation.' PRIMING (US label 2.3): '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 well before each spray.' CLEANING: 'At least once a week, wash the actuator with warm water and let it air-dry completely.' OVERUSE (UK SPC 4.4): 'Overuse of short-acting beta-agonists may mask the progression of the underlying disease and contribute to deteriorating asthma control, leading to an increased risk of severe asthma exacerbations and mortality. Patients who take more than twice a week “as needed” salbutamol, not counting prophylactic use prior to exercise, should be re-evaluated.' 'Bronchodilators should not be the only or main treatment in patients with severe or unstable asthma.' No acute-severe-asthma, back-to-back nebulisation or hyperkalaemia regimen appears in either fetched label - those uses are not sourced here.

AGE-BANDED, NOT PER-KILOGRAM - both labels give flat doses by age, so no per-kg value is published and the weight calculator is deliberately left inactive. VERBATIM UK SPC 4.2 (nebuliser solution): 'Children aged 12 years and over: Dose as per 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: 'Clinical efficacy of nebulised salbutamol in infants under 18 months is uncertain. As transient hypoxia may occur supplemental oxygen therapy should be considered.' VERBATIM US LABEL (metered-dose inhaler, section 2.1): 'Adult and pediatric patients aged 4 years and older: 2 inhalations by oral inhalation repeated every 4 to 6 hours', each actuation delivering 108 mcg albuterol sulfate (90 mcg albuterol base); section 8.4: 'The safety and effectiveness of albuterol sulfate HFA in pediatric patients younger than 4 years have not been established.' HOME NEBULISER WARNINGS (UK SPC 4.2, verbatim): 'Private purchase of nebuliser devices for use at home to deliver rescue therapy for the acute treatment of asthma in children and adolescents is not recommended.' 'Only specialists in respiratory medicine should initiate and clinically manage use of nebulisers and associated nebulised medicines at home for acute treatment of asthma in children and adolescents.' 'Children should be trained in the correct use of their device to deliver rescue therapy and use should be 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 following use of prescribed nebulised medication.' No paediatric maximum daily dose is stated separately - the 40 mg per day figure appears under the adult heading only, so it is not repeated here. Verify every paediatric figure against a children's formulary and current national asthma guidance before use.