Salbutamol

ADMINISTRATION ROUTES

  • IV, Neb, Inhaler

BRAND NAMES

  • Ventolin, Combivent, Duolin, Albuterol, Respigen, Salamol.

ICU INDICATIONS

  1. bronchospasm
  2. hyperkalaemia

PRESENTATION AND ADMINISTRATION

  • IV:
    5mg in 5ml solution.
    For infusion add 5mg to 50ml or 10mg to 100ml of compatible IV fluid. Note that Ventolin solution for IV infusion (5mg in 5ml) should not be injected undiluted. If a bolus dose of salbutamol is required, dilute with Water for injection prior to administration. For example, add 0.5ml (500mcg) to 10ml to make a solution of 50mcg/ ml and inject bolus doses of up to 5ml (repeat as required)
    Compatible with the following IV fluids: 0.9% sodium chloride 5% glucose Glucose and sodium chloride
    Store at room temperature.
    Protect from light
  • Inhaler:
    Respigen, Salamol & ventolin: 100mcg/dose
    Combivent: salbutamol 100mcg/dose plus ipratropium 20mcg/dose
  • Nebuliser:
    Ventolin 2.5mg/2.5ml nebules and 5mg/2.5ml nebules
    Duolin 2.5mg salbutamol and 500mcg ipratropium / 2.5ml nebules

DOSAGE

  • IV:
    Usual bolus dose 250mcg
    Usual infusion range 0-10ml/hr when made up in standard ICU infusion dilution
  • Inhaler:
    For intubated patients, use metered dose inhalers in preference to nebulisers. Administer 5-10 puffs into ventilator circuit using MDI adaptor.
  • Nebuliser:
    2.5-5mg nebulisers as required (initially continuously if required)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS

  • IV salbutamol bolus:
    Give 10 micrograms/kg (single dose maximum 500 micrograms). Over 2 minutes. Give in a minimum volume of 5ml (can be diluted with 0.9% Saline). Repeat dose at 10 minutes if still not improving
  • IV salbutamol infusion:
    Dose 5 -10 microgram/kg/min for 1 hour then reduce to 1 – 2 microgram/kg/minIf Patient Weight < 16kg
    Add 3 mg/kg of IV salbutamol solution (1 mg/ml) to a 50 ml syringe and make up to 50 ml with 5% dextrose
    Then 1 ml/hr = 1 microgram/kg/minIf Patient Weight > 16kg
    Draw up neat IV salbutamol solution (1 mg/ml) into a 50ml syringe (i.e. not diluted)
    Then rate (ml/hr) = 0.06 x weight (kg) x dose (microgram/kg/min)
    For example if you have a 20 kg child and want to infuse salbutamol at 5 microgram/kg/ min then set rate at 0.06 x 20 x 5 = 6 ml/hr

CLINICAL PHARMACOLOGY

  • Salbutamol is a selective β2 adrenoceptor agonist which acts on bronchial smooth muscle to relieve bronchospasm

CONTRAINDICATIONS

  1. hypersensitivity to salbutamol

WARNINGS

  • Hypokalaemia:
    Potentially serious hypokaliemia may result from β2 agonist therapy mainly from parenteral and nebulised administration. Particular caution is advised in acute severe asthma as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and hypoxia. It is recommended the serum potassium levels are monitored in such situations.

PRECAUTIONS

  • General:
    Salbutamol should be administered cautiously to patients suffering from hyperthyroidism, cardiovascular disease and diabetes.
  • Laboratory Tests: No tests in addition to routine ICU tests are required.
  • Drug/Laboratory Test Interactions: None noted.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Salbutamol will enhance the activity of other β2 sympathomimetics.
  • β receptor blocking agents such as propranolol inhibit the activity of salbutamol.
  • The effects of salbutamol may be enhanced by concomitant administration of aminophylline or other xanthines.

ADVERSE REACTIONS

  • Musculoskeletal system: fine tremor of skeletal muscle (particularly of the hands), palpitations and muscle cramps.
  • Cardiovascular system: Tachycardia, peripheral vasodilation with hypotension
  • Hypersensitivity reactions: Angioedema, urticaria, bronchospasm, hypotension and collapse have been reported rarely.
  • Respiratory system: Paradoxical bronchospasm may also occur requiring immediate discontinuation of therapy and institution of appropriate treatment.

Critical Care Drug Manual

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