Salbutamol: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Salbutamol: clinical details
Prescribing considerations
- In asthma, salbutamol should not be the only or principal treatment where anti-inflammatory treatment is required.
- Increased reliever use or reduced response should trigger assessment of asthma control, adherence, inhaler technique and the wider treatment plan.
- Ensure the patient can perform the technique required by the selected device; lung delivery may differ after device changes.
- Home nebuliser rescue treatment for children and adolescents should be initiated and managed by a respiratory specialist.
- Nebulised and parenteral use can cause greater systemic and metabolic effects than routine inhaled use.
- Intravenous tocolysis is restricted to experienced specialist teams with maternal and fetal monitoring facilities.
Contraindications and cautions
- Hypersensitivity to salbutamol or a formulation excipient.
- Salbulin Novolizer is contraindicated in hypersensitivity to its lactose excipient, which contains small amounts of milk proteins.
- Non-intravenous formulations must not be used to arrest uncomplicated premature labour or threatened abortion.
- Intravenous tocolysis has extensive obstetric and cardiovascular contraindications, including when prolonging pregnancy is hazardous and in significant ischaemic or obstructive cardiac disease.
Monitoring
- Review symptom control, reliever use, inhaler technique and lung function where clinically appropriate.
- Monitor potassium during acute severe asthma or substantial nebulised or parenteral exposure, especially with hypoxia, xanthines, corticosteroids or diuretics.
- Consider blood glucose and ketone monitoring in diabetes, particularly with systemic treatment or corticosteroids.
- Check lactate and acid–base status for unexplained persistent tachypnoea during high-exposure nebulised or intravenous treatment.
- With intravenous treatment, monitor pulse, blood pressure, ECG and electrolytes; tocolysis also requires fluid balance and maternal and fetal surveillance.
Clinical pharmacology
Salbutamol is a direct-acting, predominantly beta-2-selective agonist. Inhalation produces rapid local bronchodilation; swallowed or systemic drug undergoes hepatic sulfate conjugation, with unchanged medicine and inactive metabolite eliminated mainly in urine.
Formulation and product differences
- Salamol Easi-Breathe is a breath-actuated pressurised inhaler containing ethanol and an HFA propellant; it must be held upright and has no dose counter.
- Salbulin Novolizer is a refillable dry-powder device containing lactose with small amounts of milk protein; it requires an adequate inspiratory manoeuvre and protection from moisture.
- Nebuliser products differ in concentration, container and excipients. Ventolin Respirator Solution contains benzalkonium chloride, which can cause bronchospasm.
- Ventolin Injection and Ventolin Solution for IV Infusion are systemic hospital formulations and are not interchangeable with inhaled products.
Salbutamol preparations and strengths
Inhaled preparation
Route: Inhaled
Strengths: 100 micrograms, 100 micrograms/dose, 1 mg/mL, 2 mg/mL
Injection
Route: Parenteral
Strengths: 500 micrograms
Salbutamol interactions
Tell the prescriber or pharmacist about all medicines, inhalers and supplements. Important interactions include:
Non-selective beta blockers, such as propranolol
Can oppose bronchodilation and provoke severe airway narrowing; the combination is generally avoided unless carefully assessed.
Diuretics
May increase the risk of low potassium and associated heart-rhythm problems.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.