(al BYOO ter ole)

U.S. Brand Names

AccuNeb™; Proventil®; Proventil® HFA; Proventil® Repetabs®; Ventolin® [DSC]; Ventolin® HFA; Volmax®; VoSpire ER™


Albuterol Sulfate; Salbutamol

Generic Available

Yes: Excludes extended release

Canadian Brand Names

Airomir; Alti-Salbutamol; Apo-Salvent®; Gen-Salbutamol; PMS-Salbutamol; ratio-Inspra-Sal; ratio-Salbutamol; Rhoxal-salbutamol; Salbu-2; Salbu-4; Ventolin®; Ventolin® Diskus; Ventolin® HFA; Ventrodisk


Bronchodilator in reversible airway obstruction due to asthma or COPD; prevention of exercise-induced bronchospasm

Pregnancy Risk Factor


Pregnancy Implications

Albuterol crosses the placenta; tocolytic effects, fetal tachycardia, fetal hypoglycemia secondary to maternal hyperglycemia with oral or intravenous routes reported. Available evidence suggests safe use during pregnancy.


Excretion in breast milk unknown/use caution


Hypersensitivity to albuterol, adrenergic amines, or any component of the formulation


Optimize anti-inflammatory treatment before initiating maintenance treatment with albuterol. Do not use as a component of chronic therapy without an anti-inflammatory agent. Only the mildest forms of asthma (Step 1 and/or exercise-induced) would not require concurrent use based upon asthma guidelines. Patient must be instructed to seek medical attention in cases where acute symptoms are not relieved or a previous level of response is diminished. The need to increase frequency of use may indicate deterioration of asthma, and treatment must not be delayed.

Use caution in patients with cardiovascular disease (arrhythmia or hypertension or CHF), convulsive disorders, diabetes, glaucoma, hyperthyroidism, or hypokalemia. Beta agonists may cause elevation in blood pressure, heart rate, and result in CNS stimulation/excitation. Beta2 agonists may increase risk of arrhythmia, increase serum glucose, or decrease serum potassium.

Do not exceed recommended dose; serious adverse events including fatalities, have been associated with excessive use of inhaled sympathomimetics. Rarely, paradoxical bronchospasm may occur with use of inhaled bronchodilating agents; this should be distinguished from inadequate response. All patients should utilize a spacer device when using a metered-dose inhaler; in addition, face masks should be used in children <4 years of age.

Because of its minimal effect on beta1-receptors and its relatively long duration of action, albuterol is a rational choice in the elderly when an inhaled beta agonist is indicated. Oral use should be avoided in the elderly due to adverse effects. Patient response may vary between inhalers that contain chlorofluorocarbons and those which are chlorofluorocarbon-free.

Adverse Reactions

Incidence of adverse effects is dependent upon age of patient, dose, and route of administration.

Cardiovascular: Angina, atrial fibrillation, chest discomfort, extrasystoles, flushing, hypertension, palpitation, tachycardia

Central nervous system: CNS stimulation, dizziness, drowsiness, headache, insomnia, irritability, lightheadedness, migraine, nervousness, nightmares, restlessness, sleeplessness, tremor

Dermatologic: Angioedema, erythema multiforme, rash, Stevens-Johnson syndrome, urticaria

Endocrine & metabolic: Hypokalemia, serum glucose increased, serum potassium decreased

Gastrointestinal: Diarrhea, dry mouth, gastroenteritis, nausea, unusual taste, vomiting, tooth discoloration

Genitourinary: Micturition difficulty

Neuromuscular & skeletal: Muscle cramps, weakness

Otic: Otitis media, vertigo

Respiratory: Asthma exacerbation, bronchospasm, cough, epistaxis, laryngitis, oropharyngeal drying/irritation, oropharyngeal edema

Miscellaneous: Allergic reaction, lymphadenopathy


Symptoms of overdose include tachycardia, tremor, hypertension, angina, and seizures. Hypokalemia also may occur. Cardiac arrest and death may be associated with abuse of beta-agonist bronchodilators. Treatment includes immediate discontinuation and symptomatic and supportive therapies. Cautious use of beta-adrenergic blocking agents may be considered in severe cases.

Drug Interactions

of CYP3A4 (major)


Beta-adrenergic blockers (eg, propranolol) antagonize albuterol's effects; avoid concurrent use

CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of albuterol. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.

Halothane may increase risk of malignant arrhythmias; avoid concurrent use

Inhaled ipratropium may increase duration of bronchodilation

MAO inhibitors may increase side effects; monitor heart rate and blood pressure

TCAs may increase side effects; monitor heart rate and blood pressure

Sympathomimetics may increase side effects; monitor heart rate and blood pressure

Ethanol/Nutrition/Herb Interactions

Food: Avoid or limit caffeine (may cause CNS stimulation).

Herb/Nutraceutical: Avoid ephedra, yohimbe (may cause CNS stimulation).


HFA aerosols: Store at 15°C to 25°C (59°F to 77°F)

Ventolin® HFA: Discard after using 200 actuations or 3 months after removal from protective pouch, whichever comes first. Store with mouthpiece down.

Inhalation solution: AccuNeb™: Store at 2°C to 25°C (36°F to 77°F). Do not use if solution changes color or becomes cloudy. Use within 1 week of opening foil pouch.

Nebulization 0.5% solution: Store at 2°C to 30°C (36°F to 86°F). To prepare a 2.5 mg dose, dilute 0.5 mL of solution to a total of 3 mL with normal saline; also compatible with cromolyn or ipratropium nebulizer solutions

Syrup: Store at 2°C to 30°C (36°F to 86°F)

Mechanism of Action

Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on heart rate


Onset of action: Peak effect: Nebulization/oral inhalation: 0.5-2 hours; Oral: 2-3 hours

Duration: Nebulization/oral inhalation: 3-4 hours; Oral: 4-6 hours

Metabolism: Hepatic to an inactive sulfate

Half-life elimination: Inhalation: 3.8 hours; Oral: 3.7-5 hours

Excretion: Urine (30% as unchanged drug)



Children: Bronchospasm (treatment):

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

Inhalation: MDI 90 mcg/puff:


12 years:

Bronchospasm (acute): 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours; spacer/holding-chamber device should be used

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

Children >12 years and Adults:

Bronchospasm (acute): 4-8 puffs every 20 minutes for up to 4 hours, then every 1-4 hours as needed

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


4 years and Adults: Bronchospasm (chronic treatment): 1-2 inhalations every 4-6 hours; maximum: 12 inhalations/day

NIH guidelines: 2 puffs 3-4 times a day as needed; may double dose for mild exacerbations



12 years:

Bronchospasm (treatment): 0.05 mg/kg every 4-6 hours; minimum dose: 1.25 mg, maximum dose: 2.5 mg

2-12 years: AccuNeb™: 0.63 mg or 1.25 mg 3-4 times/day, as needed, delivered over 5-15 minutes

Children >40 kg, patients with more severe asthma, or children 11-12 years: May respond better with a 1.25 mg dose

Bronchospasm (acute): Solution 0.5%: 0.15 mg/kg (minimum dose: 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg (up to 10 mg) every 1-4 hours as needed; may also use 0.5 mg/kg/hour by continuous infusion. Continuous nebulized albuterol at 0.3 mg/kg/hour has been used safely in the treatment of severe status asthmaticus in children; continuous nebulized doses of 3 mg/kg/hour ± 2.2 mg/kg/hour in children whose mean age was 20.7 months resulted in no cardiac toxicity; the optimal dosage for continuous nebulization remains to be determined.

Note: Use of the 0.5% solution should be used for bronchospasm (acute or treatment) in children <15 kg. AccuNeb™ has not been studied for the treatment of acute bronchospasm; use of the 0.5% concentrated solution may be more appropriate.

Children >12 years and Adults:

Bronchospasm (treatment): 2.5 mg, diluted to a total of 3 mL, 3-4 times/day over 5-15 minutes

NIH guidelines: 1.25-5 mg every 4-8 hours

Bronchospasm (acute) in intensive care patients: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, or 10-15 mg/hour continuously

Hemodialysis: Not removed

Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics


Inhalation: MDI: Shake well before use; prime prior to first use, and whenever inhaler has not been used for >2 weeks, by releasing 4 test sprays into the air (away from face)

Oral: Do not crush or chew extended release tablets.

Monitoring Parameters

FEV1, peak flow, and/or other pulmonary function tests; blood pressure, heart rate; CNS stimulation; serum glucose, serum potassium; asthma symptoms; arterial or capillary blood gases (if patients condition warrants)

Test Interactions

Increased renin (S), increased aldosterone (S)

Dietary Considerations

Oral forms should be administered with water 1 hour before or 2 hours after meals.

Patient Education

Use exactly as directed; do not use more often than recommended. Take oral medicine with water 1 hour before or 2 hours after meals. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. You may experience nervousness, dizziness, or fatigue (use caution when driving or engaging in hazardous activities until response to drug is known); dry mouth, unpleasant taste, stomach upset (frequent, small meals, frequent mouth care, chewing gum, or sucking lozenges may help); or difficulty urinating (always void before treatment). Report unresolved GI upset, dizziness or fatigue, vision changes, chest pain or palpitations, persistent inability to void, nervousness or insomnia, muscle cramping or tremor, or unusual cough. Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Pregnancy/breast-feeding precautions:

Self-administered inhalation: Do not freeze. Shake canister before using. Sit when using medication. Close eyes when administering albuterol to avoid spray getting into eyes. Exhale slowly and completely through nose; inhale deeply through mouth while administering aerosol. Hold breath for 5-10 seconds after inhalation. Wait at least 1 full minute between inhalations. Wash mouthpiece between use. If more than one inhalation medication is used, use albuterol first and wait 5 minutes between medications. Prime inhaler prior to first use, and whenever the inhaler has not been used for more than 2 weeks, by releasing 4 test sprays into the air (away from face). Discard inhaler after labeled number of doses are used, even if the canister does not feel empty. Ventolin® HFA: Discard canister after 200 actuations or 3 months after removal from foil pouch, whichever comes first. Store with mouthpiece down. Do not allow metal canister to become wet.

Self-administered nebulizer: Wash hands before and after treatment. Wash and dry nebulizer after each treatment. Twist open the top of one unit dose vial and squeeze contents into nebulizer reservoir. Connect nebulizer reservoir to the mouthpiece or face mask. Connect nebulizer to compressor. Sit in comfortable, upright position. Place mouthpiece in your mouth or put on face mask and turn on compressor. If face mask is used, avoid leakage around the mask to avoid mist getting into eyes which may cause vision problems. Breathe calmly and deeply until no more mist is formed in nebulizer (about 5 minutes). At this point treatment is finished.

Volmax®: Tablets should be swallowed whole; do not crush or chew. Outer coating of tablet is not absorbed and may be found eliminated in stool.

Anesthesia and Critical Care Concerns/Other Considerations

Frequent use of inhaled beta agonists when used in patients with atrial fibrillation, may counteract pharmacologic interventions directed at rate control. Inhaled beta agonists may be used to treat acute hyperkalemia in patients with renal failure.

Wait at least 1 minute between first and second puff of MDI. Because of its minimal effect on beta1 receptors and its relatively long duration of action, albuterol is a rational choice in the elderly when a beta agonist is indicated. All patients should utilize a spacer device when using a metered-dose inhaler.

Cardiovascular Considerations

Beta agonists will induce increases in heart rate. This should be considered in patients with resting tachycardia. Because of the frequent coexistence of chronic obstructive lung disease and coronary artery disease, many patients are on simultaneous therapy with beta agonists and beta-blockade. This combination should, for obvious reasons, be avoided. Frequent use of inhaled beta agonists when used in patients with atrial fibrillation, may counteract pharmacologic interventions directed at rate control. Inhaled beta agonists may be used to treat acute hyperkalemia in patients with renal failure.

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Xerostomia (normal salivary flow resumes upon discontinuation).

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May produce CNS stimulation resulting in anxiety, tremor, and insomnia

Mental Health: Effects on Psychiatric Treatment

Effect of propranolol may be reduced; cardiovascular effects (tachycardia, palpitations) may be increased with MAO inhibitors, TCAs, and amphetamines

Dosage Forms

[DSC] = Discontinued product

Aerosol, oral: 90 mcg/dose (17 g) [200 doses]

Proventil®: 90 mcg/dose (17 g) [200 doses]

Ventolin® [DSC]: 90 mcg/dose (6.8 g) [80 doses]; (17 g) [200 doses]

Aerosol, oral, as sulfate [chlorofluorocarbon free]:

Proventil® HFA: 90 mcg/dose (6.7 g) [200 doses]

Ventolin® HFA: 90 mcg/dose (18 g) [200 doses]

Solution for oral inhalation, as sulfate: 0.083% (3 mL); 0.5% (20 mL)

AccuNeb™: 0.63 mg/3 mL (3 mL); 1.25 mg/3 mL (3 mL)

Proventil®: 0.083% (3 mL); 0.5% (20 mL)

Syrup, as sulfate: 2 mg/5 mL (480 mL)

Tablet, as sulfate: 2 mg, 4 mg

Tablet, extended release, as sulfate:

Proventil® Repetabs®: 4 mg

Volmax®, VoSpire ER™: 4 mg, 8 mg


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Cook P, Scarfone RJ, and Cook RT, "Adenosine in the Termination of Albuterol-Induced Supraventricular Tachycardia,"Ann Emerg Med, 1994, 24(2):316-9.

Finnerty JP and Howarth PH, "Paradoxical Bronchoconstriction With Nebulized Albuterol But Not With Terbutaline,"Am Rev Respir Dis, 1993, 148(2):512-3.

Katz RW, Kelly HW, Crowley MR, et al, "Safety of Continuous Nebulized Albuterol for Bronchospasm in Infants and Children,"Pediatrics, 1993, 92(5):666-9.

Leikin JB, Linowiecki KA, Soglin DF, et al, "Hypokalemia After Pediatric Albuterol Overdose: A Case Series,"Am J Emerg Med, 1994, 12(1):64-6.

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International Brand Names

AC-Butamol® (HU); Actolin® (BD); Aero-Clenil® (BR); Aerojet® (BR); Aerolin® (BR, CL, DO, EG, GB, GR, IE, IL, JO, KW, LB, NL); Aero-Ped® (BR); Aerovan® (GT); Airomir® (AR, AU, BE); Airomir Autohaler® (FI, SE); Airomir (CA, CR, DK, FI, FR, GB, GT, HN, IE, LU, NL, NO, NZ, PA, PL, SE, SG, SV, TH, TR, ZA); Albugenol® (DO, GT, HN, SV); Aldobronquial® (ES); Aloprol® (YU); Alti-Salbutamol (CA); Alunic® (DO); Amocasin® (AR); Apo-Salvent® (CA); Apsomol® (DE); Asmadil® (BG, JO, KW, LB, MA, MY, SY); Asmakil® (BR); Asmasal Clickhaler® (ES, FR, GB, IE); Asmasal® (TH); Asmatol® (AR); Asmaven® (CZ); Asmavent® (CL); Asmavent Inhalador® (CL); Asmol® (AU); Asmol Inhaler® (NZ); Asmoquinol® (BR); As-Tazis® (JP); Asthalin® (IN); Asthalin SA® (IN); Asthavent® (ZA); Asthmalitan® (DE); Asthmolin® (TH); Azmacon® (ID); Azmasol® (BD); Bemin® (EC); Brodil® (BD); Broncho® (DE); Bronchospray® (DE); Broncodil® (BR); Broncolin® (BD); Broncoterol® (CL); Broncovaleas® (HU, IT); Bronkolax® (BD); Bronter® (CO); Butahale® (SG); Butamol® (BD, TH); Buto Asma® (ES, SG, TH); Butotal 300® (CL); Butotal® (CL); Butovent® (CL, CY, EG, HK, JO, KW, LB, SY, TH, TR); Buventol Easyhaler® (AT, CH, CZ, DK, FI, FR, HU, NO, SE, SG, TH); Ciplabutol® (CO); Ciplabutol IDM® (CO); Combivent® (CY, EG, JO, KW, LB, MT); Cyclocaps Salbutamol® (DE); D-Butamol® (BD); Dilatamol® (ID); Dilatol® (BD); Dipulmin® (ES); Duopack® (AR); Ecosal® (CZ); Ecovent® (CH); Ecovent® [inhal.-liqu.] (CH); Emican® (ES); Epaq® (AU, DE); Farcolin® (RO); Fartolin® (ID); Fesema® (CL); Folbron® (CL); Gen-Salbutamol (CA); Gerivent® (IE); Glisend® (ID); G-Salbutamol® (BD); Huma-Salmol® (HU); Inspiryl Turbuhaler® (SI); JP-Salbo® (BD); Krosalburol® (EC); Lasal® (ID); Librentin® (ID); Loftan® (DE); Maxivent® (GB); Maxivent Steripoules® (GB); Medihaler® (AR); Medolin® (SG); Microterol® (AR); Orsal® (BD); Pädiamol® (DE); Pentamol® (DE); PMS-Salbutamol (CA); Pneumolat® (BR); Pulmolin® (BD); Pulvinal® Salbutamol (GB); ratio-Inspra-Sal (CA); ratio-Salbutamol (CA); Respax® (AU, NZ); Respiroma® (ES); Respolin® (BD, CL, HK, NZ, SG, TH); Rhoxal-salbutamol (CA); Rotacaps® (GB); Sabutol® (SG); Salamol® (CZ, GB, PL, RO, RU, SG); Salamol Easy Breath® (GB, IE); Salamol Steri Neb® (GB); Salbetol® (IN); Salbovent® (RO); Salbu-2 (CA); Salbu-4 (CA); Salbubreathe Sandoz® (DE); Salbu® (DE); Salbu-Fatol® (DE); Salbufax® (IT); Salbuhexal® (DE); Salbulair® (DE); Salbulin Autohaler® (MX); Salbulin® [compr./liqu.oral] (CR, DO, GB, GT, HN, PA, SV); Salbulind® (DE); Salbulin® (GB, LU, TR); Salbumol® (FR); Salbupp® (DE); Salbusian® (TH); Salbutac® (TH); Salbutal® (BD); Salbutamol Aerosol® (RO); Salbutamol AL® (DE); Salbutamol Aldo Union® (ES); Salbutamol AstraZeneca® (AT); Salbutamol Atid® (DE); Salbutamol AZU® (DE); Salbutamol® (BG, BR, CL, CY, CZ, EC, GB, HU, PL, RO, RU, YU); Salbutamol CBA® (AR); Salbutamol Cyclocaps® (GB); Salbutamol Denver® (AR); Salbutamol Ecar® (CO); Salbutamol Fabra® (AR); Salbutamol Genfar® (EC); Salbutamol-GW® (HU); Salbutamol Inhalador® (CL); Salbutamol Lafedar® (AR); Salbutamol L.CH.® (CL); Salbutamol Memphis® (CO); Salbutamol Merck® (CO); Salbutamol MK® (CO, CR, DO, GT, HN, PA, SV); Salbutamol Pharmacia® (SG); Salbutamol-ratiopharm® (DE); Salbutamol Richet® (AR); Salbutamol Rigar® (PA); Salbutamol Sandoz® (DE); Salbutamol Stada® (DE); Salbutamol T® (RO); Salbutamol Trom® (DE); Salbutamol Turbuhaler® (NZ); Salbutamol von ct® (DE); Salbutamol YSP® (SG); Salbut® (BD); Salbutol® (AR, TR); Salbutral® (AR); Salbuven® (ID); Salbuvent® (CN, CZ, FI, PL); Salden® (CR, EC, GT, HN, PA, SV); Salmaplon® (IN); Salmol Atlantic® (TH); Salmol® (BD, SG); Salmolin® (BD); Salmol Syrup® (TH); Salmundin® (DE); Salsol® (IN); Saltamol® (BR); Salvuron® (HU); Servitamol® (CH); Sinasmal® (CL); Spalmotil® (YU); Steri-Neb Salamol® (GB, IE, PL); Sterineb Salamol® (RU); Sultanol® (AT, DE); Sultanol-Dosieraerosol® (AT); Sultolin® (BD); Suprasma® (ID); Teoden® (BR); Uniao Salbuamol® (BR); Venasma® (ID); Venderol® (SG); Venetlin® (JP); Ventab® (ID); Ventadur® (ES); Ventamol® (IE); Venterol® (ID, TH); Venteze Inhaler® (ZA); Venteze® (ZA); Ventilan® (CO, PT); Ventilastin® (DE); Ventisal® (BD); Ventmax® (GB, IT); Ventodisk® (CH, HK, LU, PL, RU); Ventodisk Rotadisk® (NZ); Ventodisks® (CZ, FR, GB, IE, TR); Ventolin Accuhaler® (GB, RO); Ventolin® (AR, AU, BD, BE, BG, CA, CH, CR, CZ, DO, EC, ES, GB, GT, HK, HN, HR, HU, ID, IL, IT, KW, LU, MX, NL, NZ, PA, PL, RO, RU, SG, SI, SV, TH, TR, YU, ZA); Ventolin® Diskus (CA); Ventolin Diskus® (HU); Ventoline Depot® (SE); Ventoline Diskus® (SE); Ventoline® (DK, FI, FR, NO, SE); Ventoline Evohaler® (SE); Ventolin Evohaler® (GB, HU, IE); Ventolin® HFA (CA); Ventolin Inhaler® (GB, RO); Ventolin Nebules® (GB); Ventolin Rotacaps® (GB); Ventrodisk (CA); Violin® (TH); Volmac® (DE); Volmax® (CH, DK, GB, HK, ID, IT, KW, MX, NZ, RU, SG, TH, TR); Zebu® (TH); Zoom® (AR)

Review Date: 1969-12-31 Reviewed By: Keywords: ,
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