(al byoo' ter ole)

Brand Name(s): Accuneb^®, Proair^® HFA, Proair^® Respiclick, Proventil^® HFA, Ventolin^® HFA; also available generically

Other Name(s): Salbutamol

WHY is this medicine prescribed?

Albuterol is used to prevent and treat difficulty breathing, wheezing, shortness of breath, coughing, and chest tightness caused by lung diseases such as asthma and chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways). Albuterol inhalation aerosol and powder for oral inhalation is also used to prevent breathing difficulties during exercise. Albuterol inhalation aerosol (Proair HFA, Proventil HFA, Ventolin HFA) is used in adults and children 4 years of age and older. Albuterol powder for oral inhalation (Proair Respiclick) is used in children 12 years of age and older. Albuterol solution for oral inhalation is used in adults and children 2 years of age and older. Albuterol is in a class of medications called bronchodilators. It works by relaxing and opening air passages to the lungs to make breathing easier.

Are there OTHER USES for this medicine?

Inhaled albuterol is also sometimes used to treat or improve muscle paralysis (inability to move parts of the body) in patients with a condition that causes attacks of paralysis. Talk to your doctor about the possible risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Albuterol comes as a solution (liquid) to inhale by mouth using a special jet nebulizer (machine that turns medication into a mist that can be inhaled) and as an aerosol or powder to inhale by mouth using an inhaler. When the inhalation aerosol or powder for oral inhalation is used to treat or prevent symptoms of lung disease, it is usually used every 4 to 6 hours as needed. When the inhalation aerosol or powder for oral inhalation is used to prevent breathing difficulty during exercise, it is usually used 15 to 30 minutes before exercise. The nebulizer solution is usually used three or four times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use albuterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Call your doctor if your symptoms worsen or if you feel that albuterol inhalation no longer controls your symptoms. If you were told to use albuterol as needed to treat your symptoms and you find that you need to use the medication more often than usual, call your doctor.

Albuterol controls symptoms of asthma and other lung diseases but does not cure them. Do not stop using albuterol without talking to your doctor.

Each albuterol aerosol inhaler is designed to provide 60 or 200 inhalations, depending on its size. Each albuterol powder inhaler is designed to provide 200 inhalations. After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication. Dispose of the aerosol inhaler after you have used the labeled number of inhalations, even if it still contains some liquid and continues to release a spray when it is pressed. Dispose of the powder inhaler 13 months after you open the foil wrapper, after the expiration date on the package, or after you have used the labeled number of inhalation, whichever comes first.

Your inhaler may come with an attached counter that keeps track of the number of inhalations you have used. The counter also tells you when to call your doctor or pharmacist to refill your prescription and when there are no inhalations left in the inhaler. Read the manufacturer's instructions to learn how to use the counter. If you have this type of inhaler, you should not try to change the numbers or remove the counter from the inhaler.

If your inhaler does not come with an attached counter, you will need to keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last. Do not float the canister in water to see if it still contains medication.

The inhaler that comes with albuterol aerosol is designed for use only with a canister of albuterol. Never use it to inhale any other medication, and do not use any other inhaler to inhale albuterol.

Be careful not to get albuterol inhalation into your eyes.

Do not use your albuterol inhaler when you are near a flame or source of heat. The inhaler may explode if it is exposed to very high temperatures.

Before you use albuterol inhaler or jet nebulizer for the first time, read the written instructions that come with the inhaler or nebulizer. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler or nebulizer while he or she watches.

If your child will be using the inhaler, be sure that he or she knows how to use it. Watch your child each time he or she uses the inhaler to be sure that he or she is using it correctly.

To inhale the aerosol using an inhaler, follow these steps:

1. Remove the protective dust cap from the end of the mouthpiece. If the dust cap was not placed on the mouthpiece, check the mouthpiece for dirt or other objects. Be sure that the canister is fully and firmly inserted in the mouthpiece.
2. If you are using the inhaler for the first time or if you have not used the inhaler in more than 14 days, you will need to prime it. You may also need to prime the inhaler if it has been dropped. Ask your pharmacist or check the manufacturer's information if this happens. To prime the inhaler, shake it well and then press down on the canister 4 times to release 4 sprays into the air, away from your face. Be careful not to get albuterol in your eyes.
3. Shake the inhaler well.
4. Breathe out as completely as possible through your mouth.
5. Hold the canister with the mouthpiece on the bottom, facing you and the canister pointing upward. Place the open end of the mouthpiece into your mouth. Close your lips tightly around the mouthpiece.
6. Breathe in slowly and deeply through the mouthpiece.At the same time, press down once on the container to spray the medication into your mouth.
7. Try to hold your breath for 10 seconds. remove the inhaler, and breathe out slowly.
8. If you were told to use 2 puffs, wait 1 minute and then repeat steps 3-7.
9. Replace the protective cap on the inhaler.
10. Clean your inhaler regularly. Follow the manufacturer's directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler.

To inhale the powder using the inhaler, follow these steps. Do not use the Respiclick inhaler with a spacer:

1. If you will be using a new inhaler for the first time, remove it from the foil wrapper. Look at the dose counter at the back of the inhaler and check that you see the number 200 in the window.
2. Holding the inhaler upright, with the cap on the bottom and the inhaler pointing upwards, load the dose by opening the protective dust cap at the end of the mouthpiece until it clicks. Do not open the cap unless you are ready to use the inhaler. Every time the protective cap is opened, a dose is ready to inhale. You will see the number in the dose counter go down. Do not waste doses by opening the inhaler unless you are inhaling a dose.
3. Breathe out as completely as possible through your mouth. Do not blow or exhale into the inhaler.
4. Place the mouthpiece between your lips well into your mouth. Close your lips tightly around the mouthpiece. Inhale slowly and deeply through your mouth. Do not breath in through your nose. Make sure that your fingers or lips do not block the vent above the mouthpiece.
5. Remove the inhaler from your mouth and hold your breath for 10 seconds or as long as you comfortably can. Do not blow or exhale through the inhaler.
6. Close the cap firmly over the mouthpiece.
7. If you are to inhale 2 puffs, repeat steps 2-6.
8. Keep the inhaler clean and dry at all times. To clean your inhaler, use a clean, dry tissue or cloth. Do not wash or put any part of your inhaler in water.

To inhale the solution using a nebulizer, follow these steps;

1. Remove one vial of albuterol solution from the foil pouch. Leave the rest of the vials in the pouch until you are ready to use them.
2. Look at the liquid in the vial. It should be clear and colorless. Do not use the vial if the liquid is cloudy or discolored.
3. Twist off the top of the vial and squeeze all of the liquid into the nebulizer reservoir. If you are using your nebulizer to inhale other medications, ask your doctor or pharmacist if you can place the other medications in the reservoir along with albuterol.
4. Connect the nebulizer reservoir to the mouthpiece or face mask.
5. Connect the nebulizer to the compressor.
6. Place the mouthpiece in your mouth or put on the face mask. Sit in an upright, comfortable position and turn on the compressor.
7. Breathe in calmly, deeply, and evenly for about 5-15 minutes until mist stops forming in the nebulizer chamber.
8. Clean your nebulizer regularly. Follow the manufacturer's directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your nebulizer.

What SPECIAL PRECAUTIONS should I follow?

Before using albuterol inhalation,

• tell your doctor and pharmacist if you are allergic to albuterol (Vospire ER, in Combivent, in Duoneb), levalbuterol (Xopenex), any other medications, or any of the ingredients in albuterol inhalation powder or nebulizer solution. If you will be using the inhalation powder, also tell your doctor if you are allergic to milk proteins. Ask your pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what prescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: beta blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); digoxin (Lanoxin); diuretics ('water pills'); epinephrine (Epipen, Primatene Mist); other inhaled medications used to relax the air passages such as metaproterenol and levalbuterol (Xopenex); and medications for colds. Also tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past 2 weeks: antidepressants such as amitriptyline, amoxapine, clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline ( Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); and monoamine oxidase (MAO) inhibitors, including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam), and tranylcypromine (Parnate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have or have ever had an irregular heartbeat, heart disease, high blood pressure, hyperthyroidism (condition in which there is too much thyroid hormone in the body), diabetes, or seizures.

• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using albuterol, call your doctor.

• you should know that albuterol inhalation sometimes causes wheezing and difficulty breathing immediately after it is inhaled. If this happens, call your doctor right away. Do not use albuterol inhalation again unless your doctor tells you that you should.

What should I do IF I FORGET to take a dose?

If you have been told to use albuterol inhalation on a regular schedule, use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not use a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Albuterol inhalation may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• uncontrollable shaking of a part of the body
• nervousness
• headache
• nausea
• vomiting
• cough
• throat irritation
• muscle, bone, or back pain

Some side effects can be serious. If you experience any of the following symptoms or those in the SPECIAL PRECAUTIONS section, call your doctor immediately:

• fast, pounding, or irregular heartbeat
• chest pain
• rash
• hives
• itching
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• increased difficulty breathing
• difficulty swallowing
• hoarseness

Albuterol inhalation may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Keep unused vials of nebulizer solution in the foil pouch until you are ready to use them. Store nebulizer solution vials in the refrigerator or at room temperature away from excess heat and moisture (not in the bathroom). Store the the inhaler at room temperature and away from excess heat and moisture (not in the bathroom). Do not puncture the aerosol canister, and do not discard it in an incinerator or fire.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• seizures
• chest pain
• fast, irregular or pounding heartbeat
• nervousness
• headache
• uncontrollable shaking of a part of the body
• dry mouth
• nausea
• dizziness
• excessive tiredness
• lack of energy
• difficulty falling asleep or staying asleep

What OTHER INFORMATION should I know?

Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: February 15, 2016.