Indications Listed in Dosage.

Dosage Adult : PO Acute bronchospasm 2-4 mg 3-4 times/day, up to 8 mg 3-4 times/day. As

modified-release tab: 8 mg bid. IV Severe bronchospasm As 50 mcg/mL soln: 250 mcg
(4 mcg/kg) injected slowly. May be repeated if necessary. As 10 mcg/mL soln: Usual
rate of 3-20 mcg/min (0.3-2 mL/min). Higher doses may be used in resp
failure. Uncomplicated premature labour at 22-37 wk of gestation Initial: 10 mcg/min,
increasing gradually at 10-min intervals until there is response, then increase rate slowly
until contractions cease. Maintain rate for 1 hr after contractions have stopped, then
gradually reduce rate by 50% at intervals of 6 hr. Usual: 10-45 mcg/min. Max duration:
48 hr. IM/SC Severe bronchospasm 500 mcg (8 mcg/kg) and repeated 4 hrly as
required. Inhalation Acute bronchospasm As metered-dose aerosol or dry powd
inhaler: 1 or 2 inhalations up to 4 times/day. Max: 800 mcg/day. Prophylaxis of
exercise-induced bronchospasm As metered-dose aerosol or dry powd inhaler: 2
inhalations 10-15 min prior to exercise. Severe bronchospasm Via nebuliser: 2.5-5 mg,
up to 4 times/day, or continuously at a rate of 1-2 mg/hr. Acute severe asthma As
metered-dose inhaler via spacer device: Initial: 4 inhalations, then a further 2 inhalations
every 2 min according to response. Max: 10 inhalations.
Dosage Details Inhalation/Respiratory
Severe bronchospasm
Adult: Via nebuliser: 2.5-5 mg, up to 4 times daily, alternatively, may be given
continuously at a rate of 1-2 mg/hr.
Child: ≥4 yr Same as adult dose.

Inhalation/Respiratory
Acute bronchospasm
Adult: As metered-dose aerosol or dry powd inhaler (90 or 100 mcg/actuation): 1 or 2
inhalations up to 4 times daily. Max: 800 mcg daily.
Child: 6-12 yr 1 inhalation, may be increased to 2 inhalations as necessary. Max: 400
mcg daily.

Inhalation/Respiratory
Acute severe asthma
Adult: As metered-dose inhaler (100 mcg/actuation) via spacer device: Initially, 4
inhalations, then a further 2 inhalations every 2 min according to response. Max: 10
inhalations.

Inhalation/Respiratory
Prophylaxis of exercise-induced bronchospasm
Adult: As metered-dose aerosol or dry powd inhaler (90 or 100 mcg/actuation): 2
inhalations 10-15 min prior to exercise.
Child: 6-12 yr 1 inhalation 10-15 min prior to exercise.

Intravenous
Uncomplicated premature labour
Adult: For arrest of preterm labour between 22 and 37 wk of gestation: Initially, 10
mcg/min, increasing gradually at 10-min intervals until there is response; increase
infusion rate slowly thereafter until contractions cease. Maintain rate for 1 hr after
contractions have stopped, then gradually reduce rate by 50% at intervals of 6 hr. Usual
dose: 10-45 mcg/min. Max duration: 48 hr. Doses are given preferably w/ the aid of a
syringe pump.

Intravenous
Severe bronchospasm
Adult: As 50 mcg/mL soln: 250 mcg (4 mcg/kg) injected slowly. May be repeated if
 necessary. As 10 mcg/mL soln: Usual rate of 3-20 mcg/min (0.3-2 mL/min), adjusted
according to patient needs. Higher doses may be used in resp failure.
Child: ≥12 yr Same as adult dose.

Oral
Acute bronchospasm
Adult: 2-4 mg 3 or 4 times daily, up to 8 mg 3 or 4 times daily as required in some
patients. As modified-release tab: 8 mg bid.
Child: 2-6 yr 1-2 mg; >6-12 yr 2 mg; >12 yr Same as adult dose. Doses to be given 3 or
4 times daily.
Elderly: 2 mg 3 or 4 times daily.

Parenteral
Severe bronchospasm
Adult: IM/SC: 500 mcg (8 mcg/kg) and repeated 4 hrly as required.
Child: ≥12 yr Same as adult dose.
Administration Should be taken on an empty stomach. Take 1 hr before or 2 hr after meals.
Reconstitution Intravenous:
Bronchospasm: Dilute 5 mL of soln w/ 500 mL NaCl or dextrose inj or other suitable
diluents to provide a 10 mcg/mL soln.
Premature labour: Dilute 10 mL of soln w/ 40 mL of dextrose 5% to provide a 200
mcg/mL soln for use in syringe pump, alternatively, dilute 10 mL of soln w/ 490 mL of
dextrose 5% for use in other infusion methods.
Inhalation:
Dilute 0.5 mL of soln to a total of 3 mL w/ NaCl 0.9% to prepare a 2.5 mg dose.
Contraindications IV (in the treatment of premature labour): Pre-existing or risk factors for ischaemic heart
disease, gestational age <22 wk, conditions in which prolongation of pregnancy is
hazardous (e.g. severe toxaemia, intrauterine infection, vag bleeding resulting from
placenta praevia, eclampsia or severe preeclampsia, placental abruption, cord
compression; use in threatened abortion.
Special Precautions Hyperthyroidism, myocardial insufficiency, arrhythmias, susceptibility to QT-interval
prolongation, HTN, DM, glaucoma, hypokalaemia, seizure disorder. Renal impairment.
Elderly. Pregnancy and lactation.
Adverse Drug Tremor, nervousness, nausea and vomiting, tachycardia, palpitations, chest pain,
Reactions shakiness, dizziness, headache, insomnia, inhalation site sensation, hyperactivity, HTN,
hypotension, increased sweating, allergic reactions, DM, muscle cramps, flu-like
syndrome, conjunctivitis, UTI, hypokalaemia,. Rarely, erythema multiforme, Stevens-
Johnson syndrome.
Potentially Fatal: Paradoxical bronchospasm.
Pregnancy Category ROUTE(S) : Inhalation/Respiratory/Parenteral/PO
(US FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus
(teratogenic or embryocidal or other) and there are no controlled studies in women or
studies in women and animals are not available. Drugs should be given only if the
potential benefit justifies the potential risk to the foetus.
Monitoring
Monitor BP, heart rate, electrolyte and fluid balance; glucose, lactate and K levels.
Parameters
Overdosage Symptoms: Tachycardia, CNS stimulation, tremor, hypokalaemia, hyperglycaemia, lactic
acidosis, nausea, vomiting. Management: Symptomatic and supportive treatment. May
 administer activated charcoal. β-blocking agents (e.g. metoprolol) may be given but w/
extreme caution in asthmatic patients.
Drug Interactions Increased risk of hypokalaemia w/ K depleting agents (e.g. corticosteroid, diuretics,
xanthines, digoxin). Increased uterine inertia w/ halogenated anaesth (IV). Increased risk
of pulmonary oedema w/ corticosteroids. May antagonise the effect of anti-diabetics.
Effects may be altered by guanethidine, reserpine, methyldopa, TCAs and MAOIs.
Increased risk of CV effects w/ other sympathomimetic agents. Antagonistic effect w/ β-
blockers. 
Mechanism of Action Description: Salbutamol activates adenyl cyclase, the enzyme that stimulates the
production of cyclic adenosine-3', 5'-monophosphate (cAMP). Increased cAMP leads to
activation of protein kinase A, which inhibits phosphorylation of myosin and lowers
intracellular ionic Ca concentrations, resulting in smooth muscle relaxation.
Onset: W/in 5 min (inhalation); w/in 30 min (oral).
Duration: Approx 3-6 hr (inhalation); up to 6 hr (oral).
Pharmacokinetics: 
Absorption: Readily absorbed from the GI tract.
Metabolism: Undergoes metabolism in the liver and in the gut wall.
Excretion: Via urine (as metabolites and unchanged drug); faeces (small amounts).
Storage Store between 15-30°C. Protect from light.
MIMS Class Drugs Acting on the Uterus / Antiasthmatic & COPD Preparations
ATC Classification R03AC02 - salbutamol ; Belongs to the class of adrenergic inhalants, selective beta-2-
adrenoreceptor agonists. Used in the treatment of obstructive airway diseases. 
R03CC02 - salbutamol ; Belongs to the class of adrenergics for systemic use, selective
beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.