Monday, October 10, 2016

Albuterol



Class: Selective beta-2-Adrenergic Agonists
VA Class: RE102
CAS Number: 18559-94-9
Brands: AccuNeb, Combivent, DuoNeb, ProAir HFA, Proventil, Proventil HFA, Ventolin HFA, VoSpire ER

Introduction

Bronchodilator; relatively selective, short-acting β2-adrenergic agonist.j


Uses for Albuterol


Bronchospasm


Asthma


Symptomatic management or prevention of bronchospasm in patients with reversible, obstructive airway disease (e.g., asthma).100 114 115 132 139 153 154 227 145 154 146


Exercise-induced Bronchospasm


Prevention of exercise-induced bronchospasm.132 181


COPD


Albuterol sulfate in fixed combination with ipratropium bromide: Symptomatic management of reversible bronchospasm associated with COPD in patients who continue to have evidence of bronchospasm despite regular use of an orally inhaled bronchodilator and who require a second bronchodilator.233 250 251 252


Albuterol or albuterol sulfate: Symptomatic management of reversible bronchospasm associated with COPD when given on an as-needed or regular (e.g., 4 times daily) basis, either alone or concomitantly with other inhaled bronchodilators.181 206 251 266 267 268 269 Regular use of a selective, short-acting inhaled β2-adrenergic agonist (e.g., albuterol) in the management of COPD, in contrast to that in asthma, does not appear to be detrimental.206 247 250 251


Albuterol Dosage and Administration


General



  • Albuterol or albuterol sulfate: Administer by oral inhalation via metered-dose inhaler or nebulizer114 146 153 181 212 237 241 242 244 255 258 or orally.100 139 154 208 281




  • Albuterol sulfate in fixed combination with ipratropium bromide: Administer by oral inhalation via metered-dose aerosol inhaler233 or nebulizer.243




  • Adjust dosage carefully according to individual requirements and response.139 145 146 153 154 208 212 255



Administration


Oral Inhalation


Metered-dose Inhaler

Administer inhalation aerosol only with the actuator provided by the manufacturer.146 181 210 215


Shake inhaler well before use.146 181 210 215


Test-spray inhalation aerosol (3 times for ProAir HFA, 4 times for Ventolin HFA or Proventil HFA) into the air (away from the face) before first use and whenever the inhaler has not been used for prolonged periods (i.e., >2 weeks).181 215 237 248 282 Test spray Ventolin HFA aerosol inhaler whenever it has been dropped.237


Avoid spraying aerosols into the eyes.181 210 215


Exhale slowly and completely and place the mouthpiece of the inhaler well into the mouth with the lips closed around it.210 215 Inhale slowly and deeply through the mouth.210 215 Actuate aerosol inhaler, hold breath for as long as possible, withdraw mouthpiece, and exhale slowly.210 215


Allow 1 minute to elapse between subsequent inhalations from aerosol inhaler.248 261


Clean the albuterol sulfate inhalation aerosol (Proventil HFA, ProAir HFA, Ventolin HFA) inhaler by removing the metal canister and running warm water through the plastic mouthpiece of the actuator for 30 seconds at least once a week.181 237 282 Clean the albuterol inhalation aerosol (Proventil) by removing the metal canister and running warm water through the plastic case and cap at least once daily.261 Dry thoroughly the mouthpiece or the plastic case and cap of inhaler before replacing the metal canister.181 237 261 282 If the inhaler is to be used before it is completely dry, shake off excess water, replace the canister, and test the inhaler by spraying once (Ventolin HFA) or twice (ProAir HFA, Proventil HFA) away from the face before administering the dose.237 248 282 After such use, the mouthpiece should be rewashed and allowed to air dry.248 282 Proper cleaning of the albuterol sulfate inhaler (Proventil HFA, Ventolin HFA, ProAir HFA) mouthpiece will prevent medication build-up and blockage.181 237 248 282


Discard canister after the labeled number of actuations have been used.181 233 237 282


Nebulization

When administering via nebulization, use proper aseptic technique to avoid microbial contamination.114 241


For administration of albuterol sulfate solution for nebulization in single-use units, empty the entire contents of a single-use unit into the nebulizer reservoir and use immediately to avoid microbial contamination.241 242 243 255 256 263 283 For administration of single-use units of albuterol sulfate 0.5% concentrate solution for nebulization, empty the entire contents of the plastic vial into the nebulizer reservoir and add 2.5 mL of 0.9% sodium chloride solution into the nebulizer reservoir to provide a final volume of 3 mL.272 273


Attach the reservoir to the mouthpiece or face mask and to the compressor according to the manufacturer’s instructions.213 256 257 263 283


Place the mouthpiece of the nebulizer in the mouth or put on the nebulizer face mask and turn on the compressor.213 256 257 263 283 Breathe as calmly, deeply, and evenly as possible until the nebulizer stops producing mist (flow rate of nebulizer should be adjusted to provide the full dose over about 5–15 minutes).213 256 257 263 283


Clean the nebulizer after use according to the manufacturer’s instructions.213 241 244 245 246 256 257 263 283


Continue nebulization therapy as necessary to control recurrent bronchospasm.249 258 Optimum benefit is obtained when nebulization is used regularly.249 258


Oral Administration


Albuterol sulfate extended-release tablets should not be chewed or crushed.100 154 271


Dosage


Available as albuterol or albuterol sulfate; dosage expressed in terms of albuterol.114 153 154 181 272 281


Pediatric Patients


Bronchospasm

Asthma

Oral Inhalation

Inhalation aerosol without chlorofluorocarbons in children ≥4 years of age: 180 mcg (2 inhalations) every 4–6 hours (Ventolin HFA, Proventil HFA).181 237 Do not increase dosage or dosage frequency.181 237 Alternatively, 90 mcg (1 inhalation) every 4 hours may be sufficient.181 237


Inhalation aerosol with chlorofluorocarbons in adolescents ≥12 years of age: 180 mcg (2 inhalations) every 4–6 hours (Proventil).145


Inhalation aerosol without chlorofluorocarbons in adolescents ≥12 years of age: 180 mcg (2 inhalations) every 4–6 hours (ProAir HFA).282


0.042% Inhalation solution for nebulization in children 2–12 years of age: 0.63 or 1.25 mg 3 or 4 times daily.255 Dosage of 1.25 mg 3 or 4 times daily may improve initial response in children 6–12 years of age with more severe asthma (baseline FEV1 <60% of predicted), patients weighing >40 kg, or children 11–12 years of age.255 For acute exacerbations, a 0.083% solution containing 2.5 mg of albuterol per 3 mL may be more appropriate, particularly in children ≥6 years of age.255 258


0.083% Inhalation solution for nebulization in children 2–12 years of age: 2.5 mg 3 or 4 times daily in children weighing ≥15 kg.153 258 Do not increase dosage or dosage frequency.114 153 212 241 255 258 In children 2–12 years of age weighing<15 kg who require <2.5 mg per dose, the 0.5% inhalation solution should be used to prepare the appropriate dose for nebulization.153 255 258 212


0.083% Inhalation solution for nebulization in adolescents ≥12 years of age: 2.5 mg 3 or 4 times daily (Proventil single-use inhalation solution).241 258


0.5% Inhalation solution for nebulization in adolescents ≥12 years of age: 2.5 mg 3–4 times daily.272


Oral

Conventional tablets in children 6–12 years of age: Initially, 2 mg 3 or 4 times daily.280 If necessary, increase dosage cautiously and gradually as tolerated to a maximum of 6 mg 4 times daily (maximum 24 mg total daily dosage).280


Conventional tablets in adolescents ≥12 years of age: Initially, 2 or 4 mg 3 or 4 times daily.280 If necessary, increase dosage cautiously and gradually as tolerated to a maximum of 8 mg 4 times daily (maximum 32 mg total daily dosage).280


Extended-release tablets in children 6–12 years of age: Initially, 4 mg every 12 hours (VoSpire ER).271 If necessary, increase dosage cautiously and gradually as tolerated to a maximum of 12 mg twice daily (maximum 24 mg total daily dosage).271


Extended-release tablets in adolescents ≥12 years of age: Initially, 8 mg every 12 hours.271 In some patients, 4 mg every 12 hours may be sufficient (e.g., low body weight).271 If necessary, increase dosage cautiously and gradually as tolerated to a maximum of 16 mg twice daily (maximum 32 mg total daily dosage).271 When transferring from conventional tablets to extended-release tablets, each 2 mg administered every 6 hours as conventional tablets is approximately equivalent to 4 mg every 12 hours as extended-release tablets.271


Oral solution in children 2–6 years of age: Initially, 0.1 mg/kg (up to 2 mg) 3 times daily.281 If necessary, increase dosage cautiously and gradually as tolerated to 0.2 mg/kg (up to 4 mg) 3 times daily (maximum 12 mg total daily dosage).281


Oral solution in children or adolescents >6–14 years of age: Initially, 2 mg 3 or 4 times daily.281 If necessary increase dosage cautiously and gradually as tolerated to a maximum of 24 mg daily in divided doses.281


Oral solution in adolescents >14 years of age: 2 or 4 mg 3–4 times daily.281 If necessary, increase dosage cautiously and gradually to a maximum of 8 mg 4 times daily.281


Exercise-induced Bronchospasm

Prevention

Oral Inhalation

Inhalation aerosol with chlorofluorocarbons in children ≥12 years of age: 180 mcg (2 inhalations) administered 15 minutes before exercise via metered-dose inhaler (Proventil).145


Inhalation aerosol without chlorofluorocarbons in children ≥4 years of age: 180 mcg (2 inhalations) administered 15–30 minutes before exercise via metered-dose inhaler (Ventolin HFA, Proventil HFA).181 237


Inhalation aerosol without chlorofluorocarbons in children ≥12 years of age: 180 mcg (2 inhalations) administered 15–30 minutes before exercise via metered-dose inhaler (ProAir HFA).282


Adults


Bronchospasm

Asthma

Oral Inhalation

Inhalation aerosol: 180 mcg (2 inhalations) every 4–6 hours.145 181 237 282 Do not increase dosage or dosage frequency of orally inhaled albuterol aerosol.137 237 145 282 Alternatively, 90 mcg (1 inhalation) every 4 hours.237 145 146 181 282


Inhalation solution for nebulization: 2.5 mg 3 or 4 times daily.114 212 241 258 Do not increase dosage or dosage frequency.114 153 212 241 255 258


Oral

Conventional tablets or oral solution: Initially, 2 or 4 mg 3 or 4 times daily.100 139 262 208 280 If necessary, increase dosage cautiously and gradually as tolerated to a maximum of 8 mg 4 times daily.100 139 208 262 280


Extended-release tablets: Initially, 4 or 8 mg every 12 hours.271 In some patients (e.g., low body weight), 4 mg every 12 hours may be sufficient.271 If necessary, increase dosage cautiously and gradually as tolerated to maximum of 16 mg twice daily.271


Exercise-induced Bronchospasm

Prevention

Oral inhalation

Inhalation aerosol with chlorofluorocarbons: 180 mcg (2 inhalations) administered 15 minutes before exercise (Proventil).145


Inhalation aerosol without chlorofluorocarbons: 180 mcg (2 inhalations) administered 15–30 minutes before exercise via the metered-dose inhaler (Ventolin HFA, ProAir HFA, Proventil HFA).237 181 282


Bronchospasm

COPD

Oral Inhalation

Inhalation aerosol: Initially, 180 mcg (2 inhalations) 4 times daily in fixed combination with ipratropium bromide (18 mcg per inhalation).233 If necessary, additional inhalations may be used, with dosage not exceeding 12 inhalations in 24 hours.233


Inhalation solution for nebulization: Initially, 2.5 mg 4 times daily in fixed combination with ipratropium bromide (0.5 mg per dose) (DuoNeb).243 If necessary, may administer 2.5 mg in fixed combination with ipratropium bromide (0.5 mg per dose) up to 6 times daily.243


Prescribing Limits


Pediatric Patients


Bronchospasm

Asthma

Oral Inhalation

Inhalation aerosol with chlorofluorocarbons in adolescents ≥12 years of age: Maximum 180 mcg (2 inhalations) 4 times daily (Proventil).145


Inhalation aerosol without chlorofluorocarbons in children ≥4 years of age: Maximum 180 mcg (2 inhalations) 4 times daily (Ventolin HFA, Proventil HFA).181 237


Inhalation solution for nebulization in children 2–12 years of age: Maximum 2.5 mg 4 times daily in children weighing at least 15 kg.153 258


Inhalation solution for nebulization in adolescents ≥12 years of age: Maximum 2.5 mg 4 times daily.153


Oral

Conventional tablets in children 6–12 years of age: Maximum 24 mg daily (in divided doses).280


Conventional tablets in adolescents 12 years of age: Maximum 8 mg 4 times daily.100 139 280


Extended-release tablets in children 6–12 years of age: Maximum 12 mg twice daily.271


Extended-release tablets in adolescents >12 years of age: Maximum 16 mg twice daily.271


Oral solution in children 2–6 years of age: Maximum 4 mg 3 times daily.281


Oral solution in children or adolescents >6 to 14 years of age: Maximum 24 mg daily in divided doses.270 281


Oral solution in adolescents >14 years of age: Maximum 8 mg 4 times daily.281


Exercise-induced Bronchospasm

Prevention

Oral Inhalation

Inhalation aerosol: Maximum 12 inhalations in 24 hours in children ≥4 years of age (Ventolin HFA, Proventil HFA) or adolescents ≥12 years of age (Proventil, ProAir HFA).145 181 237 282


Adults


Bronchospasm

Asthma

Oral Inhalation

Inhalation aerosol: Maximum 180 mcg (2 inhalations) 4 times daily.237 145 146


Inhalation solution for nebulization: Maximum 2.5 mg 4 times daily.114 153 241 258 212


Oral

Conventional tablets or oral solution: Maximum 8 mg 4 times daily.270 280 281


Extended-release tablets: Maximum 16 mg twice daily.271


Exercise-induced Bronchospasm

Prevention

Oral Inhalation

Inhalation aerosol: Maximum 12 inhalations in 24 hours.145 146 181 237 282


Bronchospasm

COPD

Oral Inhalation

Inhalation aerosol: Maximum 180 mcg (2 inhalations) 4 times daily in fixed combination with ipratropium bromide (18 mcg per inhalation).233


Inhalation solution for nebulization: Maximum 2.5 mg 6 times daily in fixed combination with ipratropium bromide (0.5 mg per dose).243


Special Populations


Geriatric Patients


Conventional tablets or oral solution: Initially, 2 mg 3 or 4 times daily.280 281 May increase gradually as tolerated up to a maximum of 8 mg 3 or 4 times daily (conventional tablets).280


Inhalation aerosol: Initiate therapy with dosages at the lower end of the usual range.237 282


Patients Sensitive to Sympathomimetic Amines


Conventional tablets or oral solution: Initially, 2 mg 3 or 4 times daily.280 281 May increase gradually as tolerated up to 8 mg 3 or 4 times daily.280


Cautions for Albuterol


Contraindications



  • Known hypersensitivity to albuterol or any ingredients in the formulations.j




  • Known history of hypersensitivity to soya lecithin or related food products such as soybeans or peanuts; atropine and its derivatives; or any other ingredient in the specific formulation (albuterol sulfate in fixed combination with ipratropium bromide).233 243



Warnings/Precautions


Warnings


Acute or Worsening Asthma

Oral inhalation therapy is intended for the acute symptomatic relief of bronchospasm.188 189 190 191 192 249 If control of mild asthma deteriorates such that regular (i.e., exceeding 4 times daily) use of a short-acting β2-agonist becomes necessary, institute maintenance therapy (e.g., inhaled corticosteroids and/or mast cell stabilizers, long-acting bronchodilators [e.g., inhaled salmeterol] or oral extended-release drugs)188 189 191 249 and discontinue regular use of short-acting β2-agonists in such patients; instead, use short-acting β2-agonists only as a supplement for relief of acute asthma symptoms.188 189 190 191 192 194 197 249 Contact a clinician for reevaluation if control of mild asthma deteriorates.114 154 192 193 196


Failure to respond to a previously effective dosage of albuterol may indicate seriously worsening asthma.156 157 181 188 189 190 191 192 193 194 196 197 237 241 242 243 244 249 Reevaluate asthma therapy and institute alternative regimens or therapy.156 157 181 188 189 190 191 192 193 194 196 197 237 241 242 243 244 249 Discontinue and contact a clinician if decreased effectiveness occurs; do not increase the dose or frequency of administration.241


Excessive Doses

Possible fatalities associated with excessive use of inhaled sympathomimetic drugs.114 139 153 237 241 243 255 258 145 154 212 262 208 146 181 233 The safety of concomitant use of >8 inhalations per day of a short-acting β2-adrenergic agonist with a long-acting β2-agonist (e.g., salmeterol) oral inhalation therapy has not been established.192 (See Sympathomimetic Agents under Interactions.)


Paradoxical Bronchospasm

Possible life-threatening, acute paradoxical bronchospasm.181 241 255 Frequently occurs with the first use of a new canister or vial (oral inhalation aerosol),181 241 255 but also may occur with orally administered conventional or extended-release tablets.271 280


Discontinue therapy immediately if bronchoconstriction occurs and institute alternative therapy.271 280


Cardiovascular Effects

Possible clinically important cardiovascular effects, including cardiac arrhythmias (e.g., atrial fibrillation, supraventricular tachycardia, extrasystoles) , increased or decreased BP, and related symptoms.146 153 181


Cautious use recommended in patients with cardiovascular disorders (e.g., coronary insufficiency, cardiac arrhythmias), hypertension, and those with sensitivity to sympathomimetic amines.114 181 237 241 281 May require drug discontinuance.139 181


Sensitivity Reactions


Immediate hypersensitivity reactions (e.g., urticaria,139 146 153 181 angioedema,139 146 153 181 227 rash,100 139 146 153 181 bronchospasm,139 146 153 181 anaphylaxis,146 oropharyngeal edema)139 146 153 181 have been reported.139 153 181 Possible acute bronchospasm.181 185 186 (See Paradoxical Bronchospasm under Cautions.)


General Precautions


Nervous System Effects

Possible CNS stimulation and adverse nervous system effects.100 139 181


Cautious use recommended in patients with seizure disorders and in those with sensitivity to sympathomimetic amines.114 237


Metabolic Effects

Possible hypokalemia, which may increase risk of adverse cardiovascular effects.100 114 139 153 237 241 243 255 258 145 154 212 262 208 146 181 233 (See Cardiovascular Effects under Cautions.) Serum potassium decrease generally is transient and usually does not require supplementation.181 281


Diabetes mellitus or increased blood glucose in patients receiving orally inhaled or nebulized albuterol.112 181


Cautious use recommended in patients with diabetes mellitus or hyperthyroidism.181 237 241 281


GI Effects

Possible GI obstruction when extended-release tablets are used in patients with preexisting GI narrowing; cautious use recommended.154


Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.


Specific Populations


Pregnancy

Category C.237


Lactation

Not known whether albuterol is distributed into milk.114 154 Discontinue nursing or the drug.114 154


Pediatric Use

Safety and efficacy of certain orally inhaled albuterol sulfate inhalation aerosols (Proventil HFA, Ventolin HFA) not established in children <4 years of age.181 237 Safety and efficacy of orally inhaled racemic albuterol aerosol (Proventil, ProAir HFA) or albuterol sulfate inhalation solution (Proventil) not established in children <12 years of age.145 181 241 244 282 Safety and efficacy of some albuterol inhalation solutions for nebulization (e.g., AccuNeb, albuterol sulfate 0.083%) not established in children <2 years of age.242 255 258 Safety and efficacy of albuterol sulfate in fixed combination with ipratropium bromide not established in pediatric patients233 243 <18 years of age.243


Safety and efficacy of albuterol conventional and extended-release tablets not established in children <6 years of age.100 139 154 Safety and efficacy of albuterol sulfate oral solutions not established in children younger <2 years of age.270 281


Geriatric Use

No overall differences in safety and efficacy observed between geriatric and younger patients for albuterol sulfate in fixed combination with ipratropium bromide inhalation solution.243 Special caution should be used in geriatric patients who have cardiovascular disease.181 (See Cautions: Cardiovascular Effects.) Cannot rule out possibility that some geriatric patients may exhibit increased sensitivity to the drug.243 Substantially eliminated by kidneys; assess renal function periodically since geriatric patients more likely to have decreased renal function.279 282 Risk of toxicity greater in patients with renal impairment, including geriatric patients.282


Common Adverse Effects


Albuterol or albuterol sulfate: Tremor,100 139 146 153 181 208 asthma exacerbation, bronchospasm, nervousness, shakiness, otitis media, nausea, cough, bronchitis, headache, tachycardia/palpitations, muscle cramps, hypokinesia, insomnia, weakness, dizziness, excitement, hyperactivity, increased appetite, flu syndrome, lymphadenopathy, skin/appendage infection, urticaria.100 114 139 146 153 181 208 212 241 255 258 154 262 208


Albuterol sulfate in fixed combination with ipratropium bromide: Bronchitis, upper respiratory tract infection, lung disease, headache, dyspnea, pharyngitis, coughing, chest pain, pain, respiratory disorder, sinusitis, nausea, diarrhea, urinary tract infection, influenza, pneumonia, leg cramps, dyspepsia, constipation, voice alterations, bronchospasm.233 243


Interactions for Albuterol


Specific Drugs





















Drug



Interaction



Comments



β-Adrenergic blocking agents



Antagonism of pulmonary effects resulting in severe bronchospasm in asthmatic patients181 241



If concomitant therapy required, consider cautious use of cardioselective β-adrenergic blocking agents181 241 281



Digoxin



Decreased serum digoxin concentrations181 241



Careful evaluation of serum digoxin concentrations recommended181 241



Diuretics, nonpotassium-sparing



Decreased serum potassium concentrations and/or ECG changes, especially when the recommended β-agonist dose is exceeded181 241 281



Cautious use recommended181 241 281



MAO inhibitors



Increased effect on vascular system181 241



Extreme caution recommended with concomitant therapy181 241 or in patients receiving albuterol within 2 weeks of discontinuance of these agents115 132 139 146 153 154 181



Sympathomimetic agents (e.g., epinephrine)



Increased cardiovascular adverse effects241



Avoid concomitant use of inhaled albuterol and other short-acting inhaled sympathomimetic amine bronchodilators or oral albuterol and other oral sympathomimetic agents114 237 241


Concomitant oral albuterol and inhaled sympathomimetic agent may be used on individualized basis270 271 280 281


If such concomitant use regularly required, consider alternative therapy270 271 280 281


Albuterol Pharmacokinetics


Absorption


Single-dose oral bioavailability of extended-release albuterol sulfate tablets is about 80% that of conventional tablets.271 Efficacy of orally inhaled drug appears to result from local action rather than systemic absorption.j Drug plasma concentrations do not predict therapeutic effect.j


Onset


Conventional tablets or solution: Within 30 minutes.100 262 208 281


Inhalation aerosol: Within 5–15 minutes.145 146 181 237


Oral inhalation solution: Within 5 minutes.114 153 241 258 212


Duration


Inhalation aerosol: 3–6 hours.181 237 145 146


Oral inhalation solution: 2–4 hours, occasionally ≥6 hours.114 153 237 255 212


Conventional tablets: Up to 8 hours.100


Extended-release tablets: Up to 12 hours.271


Oral solution: Up to 6 hours.281


Food


Reduces the rate of absorption of albuterol sulfate extended-release tablets.271


Distribution


Extent


Albuterol crosses the placenta.j Not known whether albuterol distributes into milk.100


Elimination


Metabolism


Extensively metabolized in the intestinal wall282 and liver to inactive metabolites.279


Elimination Route


Substantially eliminated by kidneys.279 282 Approximately 72% of a dose (oral inhalation) excreted in urine as unchanged drug and metabolites within 24 hours.145 About 76% of a single dose (oral administration) excreted in urine over 3 days; about 4% is excreted in feces.280 281


Half-life


Oral inhalation: 3.8–6 hours in healthy adults,145 282 j 1.7–7.1 hours in patients with asthma.j


Conventional tablets: 5–7.2 hours.271 280


Extended-release tablets: 9.3 hours.271


Oral solution: 5 hours in healthy individuals.270 281


Stability


Storage


Oral


Extended-release tablets: 20–25°C; protect from light.271


Conventional tablets: 20–25°C; protect from light.280


Oral solution: 2–30°C or 20–25°C, depending on manufacturer; protect from light.270 281


Oral Inhalation


Albuterol inhalation aerosol: 25°C (may be exposed to 15–30°C) for (Proventil).145


Albuterol sulfate inhalation aerosol: 15–25°C (ProAir HFA, Proventil HFA, Ventolin HFA).181 237 282


Failure to use inhalers within these respective temperature ranges could result in delivery of improper doses.145


Albuterol sulfate in fixed combination with ipratropium bromide inhalation aerosol: 25°C (may be exposed to 15–30°C); protect from excessive humidity.233


Albuterol sulfate oral inhalation solution: 2–25°C or 15–30°C depending on manufacturer.114 241 242 244 272 Discard albuterol sulfate oral inhalation concentrate solution if the solution changes color or becomes cloudy.244 Discard albuterol sulfate solution for nebulization (in single-use units) if it becomes discolored.242 255


Albuterol sulfate in fixed combination with ipratropiu


No comments:

Post a Comment