"Counseling of Salbutamol"

Counseling Parameters for Salbutamol

Salbutamol is a very commonly used drug for the treatment of asthma and COPD. Counseling of drugs is one of the important responsibility of pharmacist. This article covers some useful parameters that must be communicated to the patients before dispensing the drugs to them. It will ultimately improves the quality of life of patients.

Therapeutic Class:

Beta 2 adrenergic bronchodilator."Counseling of Salbutamol"

Therapeutic Indications:

  • Salbutamol is prescribed for the treatment and management of asthma & other conditions associated with reversible airway obstruction.
  • Premature labour
  • For management of bronchospasm in patient suffering from COPD who require regular treatment.

Counseling for Storage:

  • Patients should be instructed that the ideal storage temperature for Salbutamol is 15-25Co. Avoid direct exposure to heat and don’t use if solution is decolorized.
  • Protect from heat &heat

Counseling for Administration:

  • Patient should be encouraged for cessation of smoking if the patient is smoker as it is first step of treatment; if you are smoker immediately stop smoking because smoking can affect functions of lung and may lead to bronchoconstriction.
  • Nebulized solution should not escape into your eyes because it may cause complication like narrow angle glaucoma. To prevent this you wear goggles before administration.
  • If you are pregnant then you should always use drug in inhalation route because parentral salbutamol may affect your myometrium

Counseling for Proper Use of Inhaler:

Most of the asthmatic and COPD patients do not know the proper method of use of inhaler. So it is the duty of pharmacist to counsel the patients regarding how to use salbutamol if physician has prescribed them inhaler. Following are some key steps that should be communicated to the patients regarding the proper use of inhaler.

  1. Sit up straight and lift the chin to open airways
  2. Remove the cap from mouthpiece
  3. Shake inhaler vigorously
  4. Spray the inhaler into air to check that it works or not
  5. Take deep breath & breathe out gently
  6. Immediately place inhaler into your mouth & seal your lips around mouth piece holding it between your lips
  7. Start to breath slowly &deeply through mouthpiece
  8. As you breathe press down to release the medicine
  9. Continue to breathe deeply to ensure that medicine gets into your lungs
  10. Hold your breath 10 seconds as long as comfortable you can
  11. If you need to take another puff wait for 30 seconds
  12. Shake your inhaler again &repeat the process again
  13. Replace the cap on the mouth piece

You can read further detail regarding the use of inhaler by clicking on the following link Proper Use of Asthma Inhalers.

Pregnancy Category:

Salbutamol has been designated pregnancy category C.  If you are a nursing mother stop the use of medicine or discontinue nursing because it may harms baby

Counselling for dose:

  • Orally (but use by inhalation preferred), 4 mg (elderly and sensitive patients initially 2 mg) 3–4x daily; max. single dose 8 mg (but unlikely to produce much extra benefit or even be tolerated); child under couple of years 100 micrograms/kg 4 times daily [unlicensed]; 2–6 years 1–2 mg 3–4 times daily, 6–12 years 2 mg 3–four times daily
  • By subcutaneous or intramuscular injection, 500 micrograms, repeated every 4 hours if needed
  • By slow intravenous injection (dilute into a power of 50 micrograms/mL), 250 micrograms, repeated if necessary; child 1 month–couple of years 5 micrograms/kg being a single dose [unlicensed]; 2–18 years 15 micrograms/kg (max. 250 micrograms) being a single dose [unlicensed]
  • By intravenous infusion, initially 5 micrograms/minute, adjusted according to response and heart-rate usually in range 3–20 micrograms/minute, and up if needed; child 1 month–18 years initially 1–5 micrograms/kg/minute, adjusted in line with response and pulse (doses above 2 micrograms/kg/minute in intensive care setting) [unlicensed]
  • By aerosol inhalation, 100–200 micrograms (1–2 puffs); for persistent symptoms nearly 4 times daily (child 100 micrograms (1 puff), increased to 200 micrograms (2 puffs) if required; for persistent symptoms as much as four times daily
  • Prophylaxis of allergen- or exercise-induced bronchospasm, 200 micrograms (2 puffs); child 100 micrograms (1 puff), increased to 200 micrograms (2 puffs) if needed
  • By inhalation of powder (for Asmasal Clickhaler®, Salbulin Novolizer®, and Ventolin Accuhaler® doses, see under preparations), 200–400 micrograms; for persistent symptoms nearly 4 times daily; child over five years 200 micrograms; for persistent symptoms as much as 4x daily
  • Prophylaxis of allergen- or exercise-induced bronchospasm, 400 micrograms; child 200 micrograms
  • By inhalation of nebulised solution, chronic bronchospasm unresponsive to conventional therapy and severe acute asthma, adult and child over 18 months 2.5–5 mg, repeated approximately 4 times daily; oftener in severe cases; max. 40 mg daily; child under 1 . 5 years, [unlicensed] (transient hypoxaemia may occur—consider supplemental oxygen), 2.5 mg approximately 4x daily or maybe more frequently in severe cases

Counseling for Side Effects:

  • This drug may cause reversible hypoglycemia, GIT motility disturbances, if you are suffering from these problems after taking salbutamol then consult to your doctor.
  • Under 12 year children it is not safe for use
  • If this drug is taken in large IV it may cause ketoacidosis.

Counseling for Drug Interactions:

  • This drug should not use with xanthine derivatives, steroids, diuretics in severe asthma as it may lead to hypoxia
  • Beta blockers & salbutamol should not use concomitantly because they inhibit effect of each other
  • Don’t use it with tricyclic antidepressants
  • Don’t use alcohol with this medicine

Counseling for Contraindications:

  • This drug is contraindicated in patients with hyperthyroidism, cardiovascular disease so if you have any of these problems you should not use the drug
  • If you have intra-uterine infection or antepartum hemmorhage than don’t use this medicine because it is contraindicated in these conditions

Counseling for Allergy:

  • If you are hypersensitive to this medicine then avoid using this drug
  • If you are hypersensitive to atropine then don’t use this medicine
  • Symptoms of allergy are urticaria, rash, bronchospasm, anaphylaxis if you have these symptoms stop the use

Common Brands:

  1. Ventolin
  2. Ventoline
  3. Ventilan
  4. Aerolin
  5. Ventrolin
  6. Asthalin
  7. Proventil
  8. Asmol
  9. Ventoso

References: 

  1. Tatro DS, Borgsdorf LR. A to z drug facts. Facts & Comparisons, 2003.
  2. Committee JF, Britain RPSoG. British National Formulary (BNF) 64. Pharmaceutical Press, 2012.
  3. Knoben JE, Anderson PO, Watanabe AS. Handbook of clinical drug data. Drug Intelligence Publications Hamilton, IL, 1988.
  4. Baxter K, Stockely IH. Stockley’s drug interactions. Pharmaceutical Press London, 2010.

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