Short-acting beta-2 agonist
Salbutamol (albuterol)
Stimulates beta-2 receptors on airway smooth muscle, raising cyclic AMP and producing rapid bronchodilation within minutes.
Brands
Ventolin · Asthalin · ProAir
Adult dosing
Maximum Dictated by response and toxicity, not a fixed ceiling in acute care| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Acute asthma, nebulised | 2.5-5 mg | Nebuliser (oxygen driven) | Every 20 minutes, or continuously in life-threatening attacks |
| Acute asthma, spacer | 4-10 puffs of 100 micrograms | Inhaled via spacer | Every 10-20 minutes |
| As-needed reliever | 100-200 micrograms | Inhaled | As required, up to four times daily |
Paediatric dosing
Always confirm the weight and the local paediatric formulary| Indication | Dose | Route | Frequency |
|---|---|---|---|
| Acute wheeze, under 5 years | 2.5 mg nebulised or 2-6 puffs by spacer | Nebuliser or spacer | Every 20-30 minutes as needed |
| Acute wheeze, 5 years and older | 2.5-5 mg nebulised or 4-10 puffs by spacer | Nebuliser or spacer | Every 20-30 minutes as needed |
Renal adjustment
Move the slider to the patient's eGFRNo adjustment
- Any eGFRNo adjustment
Hepatic adjustment
- Any gradeNo adjustment
Practical notes
The things that go wrong at the bedside- Repeated high doses cause tachycardia, tremor, lactic acidosis and hypokalaemia — check potassium.
- A spacer matches nebuliser efficacy in mild to moderate attacks and spreads fewer aerosols.
DrZep structured dosing table (demo dataset, formulary-aligned) · DrZep. Confirm every dose against your local formulary and the patient's weight, renal function and comorbidities.
Indications
- Acute asthma and reliever therapy
- COPD exacerbation and symptom relief
- Exercise-induced bronchoconstriction
- Hyperkalaemia (adjunct, nebulised)
Dosing summary
- Acute severe asthma
- Nebulised 2.5-5 mg, repeated every 20 min or continuously as needed
- Reliever
- 100-200 µg (1-2 puffs) via metered-dose inhaler with a spacer as required
- Children (nebulised)
- 2.5 mg under 5 years, 2.5-5 mg over 5 years
- Hyperkalaemia
- 10-20 mg nebulised alongside insulin-dextrose
Organ adjustment
Renal
- All stages
- No adjustment; watch potassium
Hepatic
- All grades
- No adjustment
Monitoring
- 1Response: peak flow, respiratory rate, oxygen saturation
- 2Potassium and lactate in repeated or continuous nebulisation
- 3Reliever use frequency — more than 2 canisters a year signals poor control
Contraindications & cautions
Do not use / use with care
- Hypersensitivity to salbutamol
- Caution rather than contraindication in tachyarrhythmia, severe coronary disease and thyrotoxicosis
Pregnancy & lactation
- Pregnancy
- Safe and recommended — uncontrolled asthma is far more dangerous to the fetus than the drug.
- Lactation
- Compatible.
Interactions
- Non-selective beta-blockers (propranolol)Antagonism of bronchodilation — avoid in asthmamajor
- Diuretics, corticosteroids, theophyllineAdditive hypokalaemiamoderate
- QT-prolonging drugsArrhythmia risk with electrolyte shiftsmoderate
Adverse effects
Common
- Tremor
- Palpitations and tachycardia
- Headache
- Muscle cramps
Serious
- Hypokalaemia
- Lactic acidosis with high cumulative doses
- Paradoxical bronchospasm
- Arrhythmia in susceptible patients
Toxicity & overdose
Recognise and treat
- Excess dosing causes tachycardia, tremor, hypokalaemia and lactic acidosis; supportive care, potassium replacement and cautious beta-1 selective blockade in extreme cases
Alternatives
- Terbutaline
- Ipratropium as an adjunct
- ICS-formoterol as reliever therapy in the modern asthma pathway
Linked diseases & guidelines
GINA Global Strategy for Asthma Management and Prevention
Track 1 ICS-formoterol reliever strategy, stepwise control and exacerbation management.
Global Initiative for AsthmaGlobal2025
GOLD Global Strategy for Diagnosis, Management and Prevention of COPD
ABE assessment groups, initial inhaler choice by symptoms and exacerbations, eosinophil-guided ICS use.
GOLDGlobal2025
Demo monograph for educational use. Always confirm dose, route and interactions against your national formulary and the product label before prescribing.
Demo content. Educational decision support only. Verify every dose, citation and recommendation against your national formulary and the primary source before clinical use.