Names and pronunciation
(al-byoo′ter-ole) Airomir , ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin Diskus , Ventolin Nebules , Ventolin HFA
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Drug reference
(al-byoo′ter-ole) Airomir , ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin Diskus , Ventolin Nebules , Ventolin HFA
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Func. class.: Bronchodilator
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Chem. class.: Adrenergic β2-agonist, sympathomimetic, bronchodilator
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Do not confuse: albuterol/atenolol/Albutein Proventil/Prinivil
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ACTION: Causes bronchodilation by action on β2 (pulmonary) receptors by increasing levels of cAMP
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USES: Prevention of exercise-induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis, or other reversible airway obstruction
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Unlabeled uses: Hyperkalemia in dialy- sis patients, COPD, emphysema
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CONTRAINDICATIONS: Hyper- sensitivity to sympathomimetics Precautions: Pregnancy, breastfeeding, cardiac/renal disease, hyperthyroidism, diabetes mellitus, hypertension, prostatic hypertrophy, angle-closure glaucoma, seizures, exercise-induced broncho- spasm (aerosol) in children <12 yr, hypoglycemia, tachydysrhythmias, severe cardiac disease, heart block
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SIDE EFFECTS CNS: Tremors, anxiety, insomnia, head- ache, stimulation, restlessness CV: Angina, hypo/hypertension, dys- rhythmias, chest pain EENT: Dry nose, irritation of nose and throat GI: Nausea, vomiting MISC: Hyperglycemia RESP: Paradoxical bronchospasm
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INTERACTIONS Increase: digoxin level—digoxin Increase: CNS stimulation—CNS stimulants Increase: ECG changes/hypokalemia— potassium-losing diuretics Increase: severe hypotension—oxytocics Increase: toxicity—theophylline Increase: action of aerosol bronchodila- tors Increase: action of albuterol—tricyclics, MAOIs, other adrenergics; avoid use together Increase: CV effects—atomoxetine, sele- giline Decrease: albuterol—other β-blockers Drug/Herb Increase: stimulation—caffeine (cola nut, green/black tea, guarana, yerba maté, coffee, chocolate) Drug/Lab Test Decrease: potassium
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TREATMENT OF OVERDOSE: Administer β1-adrenergic blocker, IV fluids
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DOSAGE AND ROUTES Bronchospasm prophylaxis/ treatment • Adult and child ≥4 yr: INH (metered- dose inhaler) 2 puffs (180 mcg) q4-6hr as needed; >12 yr INH (powdered in- haler) (ProAir RespiClick) 180 mcg (2 INH) q4-6hr as needed • Adult and child ≥13 yr: PO (ext rel) 4-8 mg q12hr, max 32 mg/day; PO (regu- lar release) 2-4 mg tid, max 32 mg/day • Child 6-12 yr: PO (extended release) 4 mg q12hr, max 24 mg/day; PO (regular release) 6-13 yr 2 mg tid-qid, max 24 mg/day • Child 2-5 yr: PO 0.1 mg/kg tid, max 12 mg/day • Adult and child ≥15 yr: PO (syrup) 2-4 mg tid-qid, max 32 mg/day • Child 6-14 yr: PO (syrup) 2 mg tid- qid, max 24 mg/day • Child 2-5 yr: PO (syrup) 0.1 mg/kg tid, max 12 mg/day Asthma (unlabeled) • Child <4 yr: INH (metered-dose in- haler) 180-600 mcg q2 min, max 6 doses; persistent asthma 2 puffs (HFA) q4-6hr To prevent exercise-induced broncho spasm (not ProAir RespiClick) • Adult/child ≥4 yr: INH 2 puffs before exercise, max 12 puffs/24 hr • Adult/child ≥12 yr: INH (ProAir RespiClick) 2 puffs 15-30 min prior to exercise Other respiratory conditions • Adult and child ≥12 yr: INH (metered- dose inhaler) 1 puff q4-6hr; PO 2-4 mg tid-qid, max 32 mg; NEB/IPPB 2.5 mg tid-qid • Geriatric: PO 2 mg tid-qid, may in- crease gradually to 8 mg tid-qid • Child 2-12 yr: INH (metered-dose in- haler) 0.1 mg/kg tid (max 2.5 mg tid- qid); NEB/IPPB 0.1-0.15 mg/kg/dose tid-qid or 1.25 mg tid-qid for child 10-15 kg or 2.5 mg tid-qid for child >15 kg Hyperkalemia (unlabeled) • Adult: ORAL INH (albuterol nebu- lizer solution) 10-20 mg over 15 min
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Available forms: INH aerosol 100 mcg/ , INH powder 108 mcg/actua- actuation tion; syrup 2 mg/5 mL; tablets 2, 4 mg; ext rel 4, 8 mg; INH sol 0.63 mg/3 mL, 1.25 , 1 mg/3 mL; 2.5 mg/3 mL, 0.5 mg/mL , 2 mg/mL , 5 mg/1 mL mg/mL
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Administer: • Store in light-resistant container; do not expose to temperatures of more than 86°F (30°C) PO route A • Do not break, crush, or chew extended-release tablets; give with meals to decrease gastric irritation • Oral solution to children (no alcohol, sugar) Inhalation route • For geriatric patients and children, a spacing device is advised • After shaking metered-dose inhaler, exhale, place mouthpiece in mouth, in- hale slowly while depressing inhaler, hold breath, remove, exhale slowly; give INH at least 1 min apart • NEB/IPPB dilute 5 mg/mL solution/2.5 mL 0.9% NaCl for INH; other solutions do not require dilution; for NEB O2 flow or compressed air 6-10 L/min, 1 treatment lasts 10 min; IPPB 5-20 min ProAir Respistick: • Prior to using for the first time, check that the number “200” is show- ing. Do not wash or put any part of the inhaler in water; if the mouthpiece needs cleaning, wipe with a dry cloth or tissue; when there are “20” doses left, the counter will change to red; refill
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Assess: • Respiratory function: vital capacity, pulse oximetry, forced expiratory vol- ume, ABGs, VBGs; lung sounds, heart rate and rhythm, B/P, sputum (baseline and peak); whether patient has received theophylline therapy before giving dose • Patient’s ability to self-medicate • Trouble breathing with wheezing, hold medication, notify prescriber if broncho- spasm occurs • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected; use only if necessary; avoid breastfeeding
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Evaluate: • Therapeutic response: absence of dys- pnea, wheezing; improved airway ex- change; improved ABGs, VBGs
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To use exactly as prescribed; to take missed dose when remembered, alter dosing schedule; not to use OTC medica- tions; that excess stimulation may occur, to use this product before other medica- tions, allow 5 min between each • About use of inhaler: review package insert with patient; use demonstration, return demonstration; shake, prime before first use and when not used for >2 wk; release 4 test sprays into air, away from the face; about when empty and when to renew, a bad taste may occur • To avoid getting aerosol in eyes (blur- ring of vision may result) or use near flames or sources of heat • Do not wash inhaler, wipe with dry cloth, to discard product when counter changes to red • To avoid smoking, smoke-filled rooms, persons with respiratory infections • That paradoxical bronchospasm may occur; to stop product immediately, call prescriber, usually from first dose of new inhaler • To limit caffeine products such as chocolate, coffee, tea, colas • Pregnancy/breastfeeding: to advise prescriber if pregnancy is planned or suspected, or if breastfeeding • To notify health care professional im- mediately if product does not relieve symptoms, corticosteroids may be needed
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PHARMACOKINETICS Extensively metabolized in the liver and tissues, crosses placenta, breast milk, blood-brain barrier, half-life 2.7-6 hr, well absorbed PO: Onset ½ hr, peak 2-3 hr, duration 4-6 hr PO-ER: Onset ½ hr, peak 2-3 hr, dura- tion 8-12 hr INH: Onset 5-15 min, peak 1.5-2 hr, duration 2-6 hr, half-life 4 hr
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• Adult and child ≥4 yr: INH (metered- dose inhaler) 2 puffs (180 mcg) q4-6hr as needed; >12 yr INH (powdered in- haler) (ProAir RespiClick) 180 mcg (2 INH) q4-6hr as needed
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• Adult and child ≥13 yr: PO (ext rel) 4-8 mg q12hr, max 32 mg/day; PO (regu- lar release) 2-4 mg tid, max 32 mg/day
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• Child 6-12 yr: PO (extended release) 4 mg q12hr, max 24 mg/day; PO (regular release) 6-13 yr 2 mg tid-qid, max 24 mg/day
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• Child 2-5 yr: PO 0.1 mg/kg tid, max 12 mg/day
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• Adult and child ≥15 yr: PO (syrup) 2-4 mg tid-qid, max 32 mg/day
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• Child 6-14 yr: PO (syrup) 2 mg tid- qid, max 24 mg/day
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• Child 2-5 yr: PO (syrup) 0.1 mg/kg tid, max 12 mg/day Asthma (unlabeled)
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• Child <4 yr: INH (metered-dose in- haler) 180-600 mcg q2 min, max 6 doses; persistent asthma 2 puffs (HFA) q4-6hr To prevent exercise-induced broncho spasm (not ProAir RespiClick)
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• Adult/child ≥4 yr: INH 2 puffs before exercise, max 12 puffs/24 hr
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• Adult/child ≥12 yr: INH (ProAir RespiClick) 2 puffs 15-30 min prior to exercise Other respiratory conditions
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• Adult and child ≥12 yr: INH (metered- dose inhaler) 1 puff q4-6hr; PO 2-4 mg tid-qid, max 32 mg; NEB/IPPB 2.5 mg tid-qid
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• Child 2-12 yr: INH (metered-dose in- haler) 0.1 mg/kg tid (max 2.5 mg tid- qid); NEB/IPPB 0.1-0.15 mg/kg/dose tid-qid or 1.25 mg tid-qid for child 10-15 kg or 2.5 mg tid-qid for child >15 kg Hyperkalemia (unlabeled)
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