Salbutamol

Albuterol sulfate tablets, extended-release tablets, and the oral solution should be stored at 2-30 °C, unit-dose packages of the extended-release tablets should be protected from excessive moisture. /Albuterol sulfate/

Preparations containing albuterol or albuterol sulfate should be stored in well-closed, light resistant containers. Commercially available metered-dose albuterol and albuterol sulfate inhalers should be stored at 15-30 adn 15-25 °C, respectively.

SRP: The most favorable course of action is to use an alternative chemical product with less inherent propensity for occupational exposure or environmental contamination. Recycle any unused portion of the material for its approved use or return it to the manufacturer or supplier. Ultimate disposal of the chemical must consider: the material's impact on air quality; potential migration in soil or water; effects on animal, aquatic, and plant life; and conformance with environmental and public health regulations.

Following single-dose IV or oral administration of albuterol to healthy individuals who had received digoxin for 10 days, a 16-22% decrease in serum digoxin concentration was observed.

Epinephrin, other orally inhaled sympathomimetic amines: May increase sympathomimetic effects and risk of toxicity. Avoid use together /with albuterol/.

MAO inhibitors, tricyclic antidepressants: Serious cardiovascular effects and risk of toxicity. Avoid use together /with albuterol/.

Propanolol, other beta blockers: May antagonize effects of albuterol. Use together cautiously.

TERRESTRIAL FATE: Based on a classification scheme(1), an estimated Koc value of 23(SRC), determined from a water solubility of 1.41X10+4 mg/L(2) and a regression-derived equation(3), indicates that albuterol is expected to have very high mobility in soil(SRC). However, the estimated pKa of albuterol is 10(4), indicating that this compound may partially exist in the protonated form in the environment. Cations generally adsorb more strongly to organic carbon and clay than their neutral counterparts(5), suggesting that mobility may be much lower in some soils(SRC). Volatilization of albuterol from moist soil surfaces is not expected to be an important fate process(SRC) given an estimated Henry's Law constant of 6.4X10-16 atm-cu m/mole(SRC), using a fragment constant estimation method(6). Albuterol is not expected to volatilize from dry soil surfaces(SRC) based upon an estimated vapor pressure of 8.9X10-9 mm Hg(SRC), determined from a fragment constant method(7).

AQUATIC FATE: Based on a classification scheme(1), an estimated Koc value of 23(SRC), determined from a water solubility of 1.41X10+4 mg/L(2) and a regression-derived equation(3), indicates that albuterol is not expected to adsorb to suspended solids and sediment(SRC). Volatilization from water surfaces is not expected(3) based upon an estimated Henry's Law constant of 6.4X10-16 atm-cu m/mole(SRC), developed using a fragment constant estimation method(4). The pKa1 and pKa2 of albuterol are 9.2 and 10.7(5), respectively, indicating that this compound will partially exist in the protonated in the environment and cations generally adsorb more strongly to suspended solids and sediment than their neutral counterparts(6). According to a classification scheme(7), an estimated BCF of 3(SRC), from its water solubility(2) and a regression-derived equation(3), suggests the potential for bioconcentration in aquatic organisms is low(SRC).

ATMOSPHERIC FATE: According to a model of gas/particle partitioning of semivolatile organic compounds in the atmosphere(1), albuterol, which has an estimated vapor pressure of 8.9X10-9 mm Hg at 25 °C(SRC), determined from a fragment constant method(2), is expected to exist solely in the particulate phase in the ambient atmosphere. Particulate-phase albuterol may be removed from the air by wet and dry deposition(SRC).

The primary adverse effects of albuterol therapy are tremors and nervousness, and although they can occur at any age, they are predominantly observed in children aged 2 to 6. Tremors result from the activation of β2-receptors found on motor nerve terminals, leading to an increase in intracellular cAMP. These adverse effects occur in approximately 1 in every 5 patients. Additional adverse effects include insomnia and nausea, which occur in approximately 1 in every 10 patients. Less common adverse effects may include fever, bronchospasm, vomiting, headache, dizziness, cough, allergic reactions, otitis media, epistaxis, increased appetite, urinary tract infections, dry mouth, gas, hyperhidrosis, pain, dyspepsia, hyperactivity, chills, lymphadenopathy, ocular pruritus, sweating, conjunctivitis, and dysphonia. Albuterol also has been shown to increase blood pressure levels and may cause hypokalemia. Although rare, occurrences of increased blood glucose concentrations, prolonged QTc interval, and ST-segment depression have been reported.

Signs and Symptoms of Overdose

Salbutamol is a beta(2)-adrenergic agonist and thus it stimulates beta(2)-adrenergic receptors. Binding of albuterol to beta(2)-receptors in the lungs results in relaxation of bronchial smooth muscles. It is believed that salbutamol increases cAMP production by activating adenylate cyclase, and the actions of salbutamol are mediated by cAMP. Increased intracellular cyclic AMP increases the activity of cAMP-dependent protein kinase A, which inhibits the phosphorylation of myosin and lowers intracellular calcium concentrations. A lowered intracellular calcium concentration leads to a smooth muscle relaxation and bronchodilation. In addition to bronchodilation, salbutamol inhibits the release of bronchoconstricting agents from mast cells, inhibits microvascular leakage, and enhances mucociliary clearance.

The Koc of albuterol is estimated as 23(SRC), using a water solubility of 1.41X10+4 mg/L(1) and a regression-derived equation(2). According to a classification scheme(3), this estimated Koc value suggests that albuterol is expected to have very high mobility in soil. However, the estimated pKa1 and pKa2 values for albuterol are 9.2 and 10.7, respectively(4), indicating that this compound may partially exist in the protonated form in the environment. Cations generally adsorb more strongly to organic carbon and clay than their neutral counterparts(5), suggesting that mobility may be much lower in some soils(SRC).

/HUMAN EXPOSURE STUDIES/ During worldwide marketing experience, various congenital anomalies, including cleft palate and limb defects, have been reported in the offspring of patients being treated with albuterol. Some of the mothers were taking multiple medication during their pregnancies. No consistent pattern of defects can be discerned, and a relationship between albuterol use and congenital anomalies has not been established.

/HUMAN EXPOSURE STUDIES/ This study was designed to determine the threshold dose for toxicity, the potential for serious medical complications, and the medical care required after unintentional albuterol ingestion in children. This study was prospective and descriptive. Data were obtained on pediatric albuterol ingestions evaluated emergently as reported to three regional poison control centers. Data elements included dose ingested, physical findings, medical treatment, and outcome. During 18 months, 78 patients who ingested albuterol and who received urgent medical evaluation were identified. Mean age was 2.8 years. The amount ingested ranged from 0.2 to 8.8 mg/kg. The most commonly reported signs of toxicity were tachycardia (57%, 44/78), widened pulse pressure (50%, 27/54), hyperglycemia (50%, 12/24), agitation (45%, 35/78), low serum carbon dioxide (42%, 10/24), vomiting (26%, 20/78), and hypokalemia (26%, 9/35). We found a threshold dose of 1 mg/kg for three or more signs of toxicity (P < 0.01). No patient required any specific treatment for toxicity. Seventy-two percent of patients were discharged from medical care within six hours of ingestion. Albuterol overdose in children causes a variety of cardiovascular, neuromuscular, and metabolic effects that are usually benign. The threshold dose for the development of three or more signs of toxicity is 1 mg/kg or three to 10 times the recommended daily dose. Toxicity is short-lived and does not require specific therapy or hospital admission in most cases.

/SIGNS AND SYMPTOMS/ signs and symptoms of overdose including exaggeration of common adverse reactions, particularly angina, hypertension, hypokalemia, and seizures. Cardiac arrest may occur.

/SIGNS AND SYMPTOMS/ Albuterol also has been reported to cause maternal and fetal tachycardia and hyperglycemia (especially in patients with diabetes), as well as maternal hypotension, acute congestive heart failure, pulmonary edema, and death.

/CASE REPORTS/ Albuterol overdose can lead to tachycardia, hypotension, tremor, hypokalemia, and hyperglycemia in children. Hypoglycemia had been previously reported in only one child. A 3-year-old boy who ingested high-dose albuterol in this report /is described/. On arrival to the emergency department, the child was agitated and had noticeable restlessness, sinus tachycardia, mild hypokalemia (3.2 mEq/L), and hyperglycemia (187 mg/dL). Activated charcoal and intravenous hydration were given, and electrocardiogram monitoring was performed. Sinus tachycardia resolved within 4 to 6 hours. Hypoglycemia (45 mg/dL) was identified 4 hours after admission. The child recovered uneventfully within 24 hours with glucose replacement. This case suggests that hypoglycemia could be a late complication of acute albuterol overdose; thus, the period of observation should be extended in these cases.

Drug Induced Liver Injury Rank (DILIrank 2.0)

Albuterol

vNo-DILI-concern

0

No match

DOI:10.1016/j.drudis.2016.02.015

An estimated BCF of 3 was calculated for albuterol(SRC), using a water solubility of 1.41X10+4 mg/L(1) and a regression-derived equation(2). According to a classification scheme(3), this BCF suggests the potential for bioconcentration in aquatic organisms is low(SRC).

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl albuterol, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act.

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl albuterol sulfate, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act. /Albuterol Sulfate/

Certain other dosage form new animal drugs. Albuterol. Indications for use: for the immediate relief of bronchospasm and bronchoconstriction associated with reversible airway obstruction in horses. Limitations: Not for use in horses intended for food.

Bronchodilator; tocolytic

Medication

Medication (Vet)

Use (kg; approx.) in Germany (2009): >250

For symptomatic relief and prevention of bronchospasm due to bronchial asthma, chronic bronchitis, and other chronic bronchopulmonary disorders such as COPD.

Oral Inhalation: Aerosol: 90 ug/metered spray Proventil Inhalation Aerosol (with chlorofluorohydrocarbon propellants and oleic acid), (Schering), Ventolin Inhalation Aerosol (with chlorofluorohydrocarbon propellants and oleic acid), (GlaxoSmithKline).

Oral: Solution 2 mg (of albuterol) per 5 mL Proventil Syrup (Schering). Tablets: 2 mg (of albuterol) Proventil (scored), (Schering); 4 mg (of albuterol) Proventil (scored), (Schering), Ventolin (scored), (GlaxoSmithKline). Tablets, extended release: 4 mg (of albuterol) Volmax (with povidone), (Muro), Vospire ER (Odyssey); 8 mg (of albuterol) Volmax (with povidone), (Muro), Vospire ER (Odyssey). Tablets, extended-release core, film-coated: 4 mg (core 2 mg with 2 mg immediate release) (of albuterol) Proventil Repetabs (with butylparaben), (Schering). /Albuterol Sulfate/

Oral Inhalation: Aerosol: 90 ug (of albuterol) per metered spray Proventil HFA (with alcohol, hydrofluoroalkane propellant, and oleic acid), (Schering), Ventolin HFA (with hydrofluoroalkane propellant), (GlaxoSmithKline); Solution, for nebulization: 0.21 mg (of albuterol) per mL (0.63 mg) AccuNeb (preservative-free; available as polyethylene vials), (Dey); 0.42 mg (of albuterol) per mL (1.25 mg) AccuNeb (preservative-free; available as polyethylene vials), (Dey); 0.083% (of albuterol) Albuterol Albuterol Sulfate Inhalation Solution (Dey), Proventil (preservative-free), (Schering). Solution, concentrate, for nebulization: 0.5% (of Albuterol) Albuterol Sulfate Inhalation Solution (with benzalkonium chloride), (Warrick), Proventil (with benzalkonium chloride), (Schering).