Dose:    0.1 mg/kg/dose PO (titrate dose but do not exceed 4 mg/day)
              1 to 2 puffs per MDI (90 mcg per puff)
              0.05 to 0.15 ml/kg/dose by aerosol

Frequency: Q 8 hours PO        
                     Q 4 to 6 hours MDI
                     Q 2 to 6 hours by aerosol (may be delivered continuously)

Comments: Albuterol is a Beta₂-sympathomimetic bronchodilator used for the relief of reversible bronchospasm by stimulating adenyl cyclase. It can be administered orally or by inhalation. Aerosol delivery can theoretically maximize effects and minimize systemic toxic reactions. There are however many variables, particularly in intubated infants that will adversely affect the delivery of the drug. The overall effectiveness seen with oral administration is less than that seen following inhalation. Although CNS symptoms are less likely, systemic side-effects (especially tremors) can still be a problem compared to the "topical" administration achieved with inhalation. Tolerance may develop following long-term oral administration. The concurrent use of methylxanthines or other sympathomimetic bronchodilators may cause tachycardia or other arrhythmias. Beta-receptor blocking agents (i.e., propranolol) inhibit the effect of albuterol.   More information about inhalant administration of albuterol. More information about oral administration of albuterol.

Toxicity:   Prolonged use may lead to potassium wasting and hypokalemia.  Reported side effects noted in clinical trials which may have been due to the drug included the CNS (tremors, dizziness, headache, and insomnia); GI tract (nausea); CV system (tachycardia and hypertension); and respiratory tract (bronchospasm, cough, bronchospasm, and wheezing). The effects are usually transient or can be alleviated using a lower dose (Facts and Comparisons, Inc. Drug Facts and Comparisons. Olin, B.R. ed. St. Louis, MO:Facts and Comparisons, Inc; 1997, page 173g).

Preparation: Albuterol (Proventil) available as:
Oral: Available in a 2mg/5 ml concentration with a strawberry flavor, stable under refrigeration until date on label.

MDI: Available as a metered dose inhaler that delivers 90 mcg albuterol per actuation. Administer using spacer per protocol.

Inhalant: Available as a 0.5% inhalant solution in 20 cc bottle. Mix the appropriate dose in 2 cc of diluent (NS) prior to administration.