Salbutal

Salbutamol tablet or syrup for children: ages 2 to 6 years may take 2.5 ml of syrup 3 to 4 times daily; ages 6 to 12 years, 5 ml of syrup 3 to 4 times daily; over 12 years, 5 to 10 ml of syrup 3 to 4 times daily (or a 2 to 4 mg tablet 3 to 4 times daily). Adults may take a 2 to 4 mg tablet 3 to 4 times daily, and the maximum single dose is an 8 mg tablet.

Salbutamol respirator solution should be used only with a suitable nebulizer device under a physician's direction, and the solution must never be injected or swallowed. Under Method 1, intermittent administration, adults and the elderly may take 0.5 ml to 1.0 ml of salbutamol up to four times a day, and up to 40 mg per day can be given under strict medical direction in hospital. The 0.5 to 1 ml of solution should be diluted to a final volume of 2 to 4 ml with sterile normal saline, and this will take about 10 minutes. The respiratory solution may also be used undiluted for intermittent administration, placing 2.0 ml of the solution in the nebulizer and letting the patient inhale until bronchodilation is achieved, which usually takes 3 to 5 minutes. For children under 12 years, 0.5 ml of the solution should be diluted to 2.0 to 4.0 ml with normal saline, though some children may need a higher dose of up to 1.0 ml, and this intermittent treatment may be repeated four times a day. Under Method 2, continuous administration, 1 to 2 ml of solution is diluted up to 100 ml with normal saline and given through a suitable nebulizer device, and where there is a risk of anoxia from hypoventilation, oxygen should be added to the inspired air.

Salbutamol nebulizer solution should likewise be used only with a suitable nebulizer device under a physician's direction, and the solution must never be injected or swallowed. Adults and the elderly may take 2.5 mg to 5 mg of salbutamol up to four times a day, with up to 40 mg per day permitted under strict medical direction in hospital. Children under 12 years may take 2.5 mg up to four times a day, and a higher dose of up to 5 mg four times a day may be used if required.

For salbutamol injection in adults, the I.V. infusion solution is used to prepare a solution for continuous intravenous infusion and should not be injected undiluted. A suitable infusion may be prepared by diluting 5 ml of salbutamol I.V. infusion solution (1000 mcg/ml) in 500 ml of a chosen I.V. solution to give a salbutamol concentration of 10 mcg/ml, using only sodium chloride injection, or sodium chloride and dextrose injection, as diluents. Infusion rates providing 3 to 20 micrograms of salbutamol per minute (0.3 to 2 ml per minute of the infusion solution) are usually adequate. Infusion may be started at 5 mcg of salbutamol per minute and increased to 10 mcg per minute and then 20 mcg per minute at intervals of 15 to 30 minutes if necessary. As with all parenteral products, intravenous admixtures should be inspected visually for clarity, particulate matter, precipitate, discoloration and leakage before use, and any unused admixture of salbutamol infusion solution should be discarded 24 hours after preparation. For children and adolescents under 18 years, a dosage regimen for the infusion solution has not been established, as there is currently insufficient data to recommend one.

For the salbutamol inhalation capsule, adults seeking relief from bronchospasm or managing intermittent episodes of asthma may take one or two inhalation capsules as a single dose. The usual recommended dosage for maintenance or prophylactic therapy in adults is the contents of one 200 microgram capsule every 4 to 6 hours using an inhaler device, though some patients may need the contents of two 200 microgram capsules every 4 to 6 hours; larger doses or more frequent use are not recommended. Use of the powder for inhalation can continue as medically indicated to control recurring or intermittent bronchospasm. For children aged 4 years and older, one inhalation capsule is the recommended dose for relief of acute bronchospasm in episodic asthma or before exercise, with one inhalation given three or four times a day for routine maintenance or prophylactic therapy; this may be increased to two inhalation capsules if necessary. The bronchodilator effect of each dose lasts at least four hours, and patients should be told not to increase the dose themselves but to seek medical advice immediately if it seems insufficient. For exercise-induced asthma, adults may take 400 micrograms and children 200 micrograms, 15 to 30 minutes before physical exertion.