albuterol
Brand: Ventolin, ProAir, Proventil
Prototype Drug
Drug Class: bronchodilator
Drug Family: bronchodilator
Subclass: short-acting beta-2 agonist (SABA)
Organ Systems: respiratory
Mechanism of Action
Selective beta-2 receptor agonist activating adenylyl cyclase increasing cAMP; causes bronchial smooth muscle relaxation and bronchodilation; onset within minutes.
beta-2 adrenergic receptor (bronchial smooth muscle)
Indications
- acute bronchospasm (asthma, COPD exacerbation)
- exercise-induced bronchospasm
- hyperkalemia (IV/nebulized)
Contraindications
- hypersensitivity to albuterol
- tachyarrhythmias (relative)
Adverse Effects
Common
- tachycardia
- palpitations
- tremor
- hypokalemia (high doses — K+ shift)
Serious
- paradoxical bronchospasm (rare)
- severe hypokalemia
- cardiac arrhythmias
Pharmacokinetics (ADME)
| Absorption | oral: first-pass; inhalation preferred: ~5-15% reaches lungs (spacer improves) |
| Distribution | local (inhaled) |
| Metabolism | CYP450 hepatic (minor) |
| Excretion | renal |
| Half-life | 4-6 hours |
| Onset | 5-15 minutes (inhaled) |
| Peak | 15-60 min |
| Duration | 3-6 hours |
| Protein Binding | low |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| beta-blockers | antagonize bronchodilation; may cause severe bronchospasm | major |
| MAOIs | potentiate cardiovascular effects | major |
| loop diuretics | additive hypokalemia | moderate |
Nursing Considerations
- Rescue inhaler: 2 puffs q4-6h PRN; use spacer device to improve delivery
- Frequent use (>2x/week) signals inadequately controlled asthma — step up therapy
- Monitor K+ in high-dose or IV use (hypokalemia from beta-2-mediated K+ cellular uptake)
- Shake and prime MDI before use
- Teach correct inhalation technique: slow deep breath, hold 10 seconds
Clinical Pearls
- SABA reliever therapy only: does not treat underlying inflammation
- Hypokalemia mechanism: beta-2 stimulation activates Na/K-ATPase shifting K+ intracellularly
- GINA 2024: SABA alone as primary reliever no longer recommended — use ICS-formoterol as preferred reliever in mild asthma
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.