Albuterol
Ventolin · ProAir · Proventil
Short-acting β2-adrenergic agonist (SABA)
Selective β2 agonist → activates Gs → ↑cAMP → bronchial smooth-muscle relaxation. Some β1 cross-reactivity at high doses (tachycardia).
Indications
- •Acute bronchospasm (asthma, COPD exacerbation, intraoperative wheeze)
- •Anaphylaxis adjunct for bronchospasm
- •Hyperkalemia (β2-driven K+ intracellular shift)
- •Pre-induction nebulizer in known reactive airway disease
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Nebulizer (acute) | 2.5–5 mg in 3 mL NS q20 min × 3, then q1–4 h | 0.15 mg/kg (min 2.5 mg) q20 min × 3 |
| MDI (intraop via ETT) | 8–10 puffs (90 mcg each) into circuit; repeat q15 min as needed | — |
| Continuous neb | 10–15 mg/h | — |
| Hyperkalemia | 10–20 mg neb (drops K+ 0.5–1 mEq/L) | — |
Pharmacokinetics
Inhaled onset 5–15 min. Peak 30–60 min. Duration 3–6 h. Hepatic metabolism + renal excretion of conjugates.
Hemodynamic effects
Tachycardia (most common SE — β1 cross-reactivity at high dose). Mild peripheral vasodilation. Caution in CAD, severe AS.
Respiratory effects
Bronchodilation primary effect.
Side effects
- !Tachycardia, palpitations
- !Tremor (β2 in skeletal muscle)
- !Hypokalemia (K+ shift intracellular)
- !Hyperglycemia
- !Lactic acidosis at very high cumulative doses
- !Paradoxical bronchospasm (rare)
Contraindications
- ×Hypersensitivity
- ×Severe tachyarrhythmia (relative)
Clinical pearls
- ★INTRAOP MDI VIA CIRCUIT: 8–10 puffs needed because of dead space + condensation in the circuit. 1–2 puffs = essentially nothing reaches the patient.
- ★HYPERKALEMIA: 10–20 mg neb shifts K+ — adjunct, NOT replacement for insulin/dextrose or dialysis.
- ★EFFICACY MARKERS: post-treatment ↑PEFR, ↓RR, ↓accessory muscle use, ↓wheeze. Tachycardia from albuterol is expected, not a sign to stop.
- ★ASTHMA + β-BLOCKER: cardioselective β1 (metoprolol, atenolol) is fine. Non-selective (propranolol, labetalol) blunts albuterol response.
Other drugs in Aerosols / Inhalers
- Ipratropium
Inhaled quaternary ammonium muscarinic antagonist — minimal systemic absorption. Blocks parasympathetic vagal tone in airways → bronchodilation. Synergistic with β2 agonists.
- Racemic Epinephrine (nebulized)
Topical airway α-agonism → mucosal vasoconstriction → reduced edema. β2 effect contributes to bronchodilation. Used to treat upper-airway edema rather than lower-airway bronchospasm.
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