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Legal classification of medication

POM

Salbutamol can only be obtained in accordance with a prescription given by an appropriate practitioner and therefore the legal status of the medication is prescription only medication (POM).

Salbutamol is available with the following formulations and strengths:

• Tablets: 2mg and 4mg
• Capsules: Modified release (M/R) 4mg and 8mg.
• Syrup: 2mg/5ml.
• Solution for injection: 500mcg/1ml
• Inhalation: 95mg, 100mcg, and 200mcg

The preferred route for administration of the drug is inhalation via pressurized-metered dose inhalers (sometimes abbreviated to MDI by health staff) as they are effective and convenient to use. The following give a summary of the inhalation devices used:

• Aerosol inhalation (Salamol®, Ventolin Evohaler®, Airomir®). Is a pressurised metered-dose inhaler delivering 100 micrograms of salbutamol (as Salbutamol Sulphate BP) per actuation. Available as CFC and non-CFC inhaler.
• Dry powder for inhalation (Easyhaler®, Pullvinal®, Asmasal Clickhaler®, Salbulin Novolizer®, Accuhaler®). A dry powder inhaler (DPI) is a device that delivers medication to the lungs in the form of a dry powder.
• Breath-actuated inhaler (Airomir® Autohaler, Salamol Easi-breath®). Similar to aerosol inhalation, but used by patients who have not developed a good enough technique to use MDI inhalers.

Class of drug

Salbutamol is a selective ß₂-adrenoceptor agonist.

Indications

Salbutamol provides short-acting (4 to 6 hour) dilation (widening) of small airways in the lung with fast onset (within 5 minutes) in reversible airways obstruction (mild to moderate symptoms of asthma).

How does it work?

Asthma is respiratory disease characterised by recurrent reversible obstruction to airflow of the small airways in the lungs. The narrowing of the small airways causes obstruction to airflow, which leads to symptoms such as wheezing and breathlessness. There is also usually excess mucus formation in these airways. Airway smooth muscles in the lungs contain receptors, which when activated by salbutamol cause smooth muscle relaxation and widening of the airways, improving airflow.

How is it taken?

How the inhaler is used will depend what type is used to administer the drug to the lungs.

Aerosol inhalation

• Remove the mouthpiece cover and check that the inhaler is clean before using it.
• Shake the inhaler 3-4 times to ensure the contents of the inhaler are mixed.
• Hold the inhaler upright with the thumb on the base below the mouthpiece.
• Breath out as far as comfortable, do not breathe in yet.
• Place the mouthpiece in your mouth between your teeth and close your lips around it, do not bite.
• Breathe in through your mouth, just after starting to breathe in press down on top of the canister to release a puff of the medication. Do this while breathing in steadily and deeply.
• Take the inhaler out of your mouth and continue to hold your breath for as long as comfortable this allows the drug to be lodged deep with the airways of the lungs.

Dry powder inhalation. Inhaler technique will depend on which brand is used.

Ventolin Accuhaler®

• Accuhaler has a disk containing 60 blisters of salbutamol 200mcg.
• To prepare the Accuhaler for use, hold the outer case of the closed Accuhaler in one hand and put the thumb of your other hand on the thumb grip.
• Push your thumb away from you as far as it will go until you hear a click.
• Hold the Accuhaler with the mouthpiece towards you.
• Now slide the lever away from you, as far as it will go until it clicks. Your Accuhaler is now ready for use.
• To inhale the medicine, hold the Accuhaler away from your mouth. Breathe out as far as you comfortably can. Never breathe into your Accuhaler.
• Put the mouthpiece between your lips. Suck in quickly and deeply through the Accuhaler.
• Remove the Accuhaler from your mouth. Hold your breath for about 10 seconds or for as long as you comfortably can.

Pulvinal® Salbutamol

• Unscrew the protective cap and before twisting the inhaler, hold it upright and tap it gently against a hard surface to level the powder in the chamber.
• Holding the inhaler upright press the blue button on the mouth piece and rotate the inhaler body anti-clockwise until the red mark on the body shows through the hole in the mouthpiece (dose-loading position).
• While still holding the inhaler upright, rotate the inhaler body clockwise until the green mark on the body shows through the hole in the mouthpiece (dose-delivery position).
• Breathe out deeply. While still holding the inhaler upright put the mouthpiece between your lips and breathe in through your mouth. Hold your breath for a few seconds.

Brands such as Asmasal Clickhaler® and Salbulin Novolizer® are used in a very similar manner to the Pulvinal® Salbutamol

Pregnancy and Breast feeding

The effects of salbutamol on human pregnancy are unknown and should only be used if necessary. Small amount of salbutamol are excreted into breast milk, the effects on babies is not known, however use of salbutamol and the benefit to the mother is thought to outweigh any potential harm to the baby.

Contra-indications

Salbutamol should be avoided if the patient has an allergy to any of the substances in the inhaler.

Side-effects

Side-effects of salbutamol include:

• Headache
• Tremor
• Fast heart rate
• Muscle cramps

Side effects which are uncommon and rare include:

• Palpitations
• Mouth/throat irritation
• Low Potassium
• Disturbance of heart rhythm