Albuterol dosage, forms, and strengths

Albuterol (brand names: Proair, Proventil, Ventolin) is a prescription drug that treats and prevents bronchospasm in adults and children. Common causes of bronchospasm include lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). Albuterol is classified as a bronchodilator and a beta-2 agonist. It is sold in a variety of formulations under the brand names ProAir Digihaler, ProAir HFA, Proair Respiclick, Proventil HFA, Ventolin HFA, and ReliOn Ventolin HFA. Albuterol nebulizer solution was previously available under the brand name AccuNeb but is now only available as a generic. Depending on the formulation being used, doses may be scheduled regularly or taken as needed for symptoms.

Albuterol forms and strengths

Albuterol is taken orally as a syrup, immediate-release tablet, or extended-release tablet. It is also available for inhalation as an aerosol, dry powder, or nebulizer solution.

• Immediate-release tablets: 2 mg, 4 mg

• Extended-release tablets: 4 mg, 8 mg

• Oral syrup: 2 mg/5 mL

• Aerosol spray: 90 mcg/inhalation

• Dry powder for inhalation: 90 mcg/inhalation

• Nebulizer solution: 0.63 mg/3 mL (0.021%), 1.25 mg/3 mL (0.042%), 2.5 mg/3 mL (0.083%), 2.5 mg/0.5mL (0.5%)

Albuterol dosage for adults

Albuterol dosage for bronchospasm

A bronchospasm is a reflexive spasm of the smooth muscles that line bronchial tubes. When these muscles contract during a spasm, the airways become narrower. Breathing during bronchospasm requires more effort than normal breathing. This is a common symptom of reversible obstructive airway diseases such as asthma but may also occur during a flare-up of chronic obstructive pulmonary disease (COPD). Albuterol causes bronchial muscles to relax, which opens the airways. Albuterol inhalation acts quickly and can be used as needed when bronchospasms occur. The recommended dose for an albuterol inhaler is two inhalations, not to exceed twelve within 24 hours. The typical dose for albuterol nebulized inhalation is 2.5 mg three to four times daily as needed. Oral forms can take longer to act so they need to be taken regularly. For albuterol syrup and immediate-release tablets, the typical dose is 4 mg three to four times daily. For extended-release tablets, the typical dose is 8 mg taken every twelve hours.

Albuterol dosage for acute bronchospasm

Bronchospasms can cause breathing problems that range from mild to severe. While no single parameter has been identified to assess severity, an acute bronchospasm typically includes the use of muscles that are not usually used for breathing (accessory muscles), chest wall retractions, and wheezing. Patients should use a peak flow meter to measure lung function if possible. 

All patients with asthma should receive an asthma action plan from their doctor, outlining how much of their medication to take based on their symptoms and peak flow meter results. The typical dose for an albuterol inhaler is four to eight puffs every twenty minutes for up to four hours followed by four to eight puffs every one to four hours as needed. The typical dose for a nebulizer is 2.5-5 mg every twenty minutes for three doses, then 2.5-10 mg every one to four hours as needed. Oral albuterol is not indicated for the treatment of acute bronchospasm due to its slower onset of action compared to inhaled dosage forms.

Albuterol dosage for prevention of exercise-induced bronchospasm

Albuterol inhalers are used for the prevention of bronchospasms caused by exercise. The dose is two puffs fifteen to thirty minutes before exercise. Oral albuterol is not indicated for the prevention of exercise-induced bronchospasm due to slower onset of action compared to inhaled dosage forms. 

Albuterol dosage for children

Approximate dosing by body weight: For children weighing 10-15 kg (22-33 lbs), the general dose is 1.25 mg. For children weighing greater than 15 kg (33 lbs), give 2.5 mg. For patients weighing less than 33 lbs who require a dose less than 2.5 mg, use 0.5% solution. For a dose greater than 2.5 mg use 0.08% solution.

Albuterol dosage restrictions

The safety and efficacy of albuterol aerosol, powder for inhalation, oral syrup, and oral tablets have not been established in all age groups. Albuterol has not been FDA approved for the following forms/ages:

• Oral syrup in patients younger than 2 years. 

• Aerosol and powder for inhalation in patients younger than 4 years. 

• Tablets for patients younger than 6 years.

• While immediate-release tablets are used off-label in children less than 6 years, extended-release tablets are not recommended for children younger than 6 years.

Patients with a history of hypersensitivity (i.e. severe allergic reaction such as angioedema, rash, or anaphylaxis) to albuterol should not use any formulation of albuterol. A history of a hypersensitivity reaction to any other components of oral albuterol, albuterol inhalers, or nebulizer solution is a contraindication to those products.

Some patients may experience a sudden worsening of their asthma symptoms when taking albuterol. This tightening of the airways is called paradoxical bronchospasm and may be life-threatening. This is a rare but serious adverse event and should be reported to a doctor immediately so that an alternative treatment option can be prescribed.

Patients with a non-severe sensitivity to beta-agonists can begin albuterol sulfate therapy with 2 mg orally three to four times daily, If adequate bronchodilation is not achieved, the albuterol doses may be gradually increased to 8 mg four times daily.

Albuterol should be used with caution in patients with an overactive thyroid gland (hyperthyroidism)—an inverse relationship exists between thyroid function and response to inhaled albuterol.

Albuterol should be used with caution in patients with low potassium levels (hypokalemia) or cardiovascular disorders such as coronary insufficiency (i.e. coronary artery disease, angina), cardiac arrhythmias (i.e. atrial fibrillation, tachycardia), QT prolongation, and high blood pressure. Albuterol may precipitate significant cardiovascular events in patients with underlying cardiovascular conditions, as evidenced by changes in heart rate, potassium levels, blood pressure, and ECG results while taking albuterol. 

All patients taking albuterol should report to their doctor if they experience possible signs of a heart arrhythmia such as fluttering in the chest, chest pain, pulsations in the neck, rapid heartbeats (tachycardia), shortness of breath, or dizziness.

Albuterol may increase risk of seizures and should be used with caution in patients with a convulsive disorder. 

Consult with a healthcare provider for medical advice if you have any of the conditions listed above or if you have concerns about possible adverse reactions.

Albuterol dosage for pets

Albuterol may be prescribed by a veterinarian to treat asthma and cough in cats. It is administered using an MDI and a spacer with a mask, just like those used for children. The strength of albuterol used is 90 mcg per inhalation, with 1-2 puffs given twice daily as needed. Most cats tolerate administration very well.

How to take albuterol

How to use a metered-dose inhaler (ProAir HFA, Proventil HFA, Ventolin HFA)

1. Shake your inhaler well before each use. 

2. Remove the cap and prime the inhaler before using for the first time, or when the inhaler has not been used for more than two weeks. 

3. Breathe out fully to release as much air out of the lungs as possible. Push the top of the canister all the way down once while breathing in deeply and slowly through your mouth. Hold your breath for five to ten seconds, then breathe out slowly.

How to use a spacer with your metered dose inhaler

1. Remove the mouthpiece cap from the inhaler and shake the inhaler for five to ten seconds.

2. Breathe out fully, tilt your head back slightly, and close your lips around the spacer mouthpiece. 

3. Release medicine into the spacer by pressing down on the canister once. 

4. Breathe in the medication slowly until your lungs are full. Hold your breath for five to ten seconds, then breathe out.

How to use albuterol dry powder inhaler (DPI)

1. Hold 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. 

2. Keep the inhaler upright (mouthpiece at the bottom), breathe out as completely as possible through your mouth. Close your lips tightly around the mouthpiece. Breathe in slowly and deeply through your mouth only. 

3. Remove the inhaler from your mouth and hold your breath for 10 seconds. 

How to use albuterol nebulizer solution:

1. Mix the exact amount of solution using the dropper provided for each dose. 

2. Connect the nebulizer reservoir to the mouthpiece or face mask. 

3. Connect the nebulizer to the compressor. 

4. Place the mouthpiece in your mouth or put on the face mask and turn on the compressor. 

5. Breathe normally through the mouthpiece or face mask for about 5-15 minutes until mist stops forming in the medicine chamber.

All forms of albuterol may be stored at room temperature. Store away from heat, moisture, and light, keeping the bottle or device closed when not in use.

Albuterol dosage FAQs

How long does it take albuterol to work?

All forms of inhaled albuterol (powder, aerosol, nebulizer) are similar in their onset of action, which is approximately five to ten minutes. In a study conducted on children with asthma, nebulized albuterol took longer to have its maximum effect (60-120 minutes) compared to aerosolized albuterol (31-90 minutes).

Oral albuterol takes longer to absorb and take effect. Oral albuterol works in approximately thirty minutes. The maximum effect occurs within two hours for albuterol syrup and immediate-release tablets, and six hours for extended-release tablets. Additionally, food may decrease the absorption rate of albuterol extended-release tablets. 

How long does albuterol stay in your system?

In adults and children, albuterol aerosol inhalation continues to have an effect for around three to six hours. In children, immediate-release tablets continued to have an effect for six to eight hours. Albuterol may remain in the system after its effects are gone. It takes approximately eighteen hours to remove 90% of albuterol immediate-release tablets or albuterol syrup, 27 hours to remove ninety percent of albuterol extended-release tablets, and fifteen hours to remove nebulized albuterol from the body.

What happens if I miss a dose of albuterol?

Albuterol is generally taken as needed. For oral albuterol, if you forget to take a dose, simply take it as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra doses to make up for a missed dose.

What is the maximum dosage for albuterol?

The maximum dose of oral albuterol is generally 32 mg per day for adults. The inhaled forms of albuterol are used as needed to control symptoms of asthma, and patients should not exceed the number of doses outlined on their asthma medication action plan. In some cases, asthma attacks may be life-threatening. If asthma symptoms are severe and are not controlled after taking medication, seek immediate medical attention.

What interacts with albuterol?

Beta blockers such as carvedilol, labetalol, nadolol, timolol, and propranolol can precipitate bronchospasms in patients with asthma or COPD. Beta blockers can oppose the effects of albuterol on the airways. A cardioselective beta-blocker such as atenolol or metoprolol is preferred if beta blockers must be used with albuterol.

Medications that prolong the QTc interval or decrease potassium levels may result in an increased risk of arrhythmias when used with albuterol. Risk is further increased with each additional medication carrying these side effects.

Phentermine, midodrine, ketamine, linezolid, ozanimod, and procarbazine may increase the risk of hypertension and other cardiovascular adverse effects when combined with albuterol.

Other drugs that could potentially interact with albuterol are listed below. This may not be an exhaustive list of all possible drug interactions. It is best to consult with a doctor or pharmacist for drug information, including potential interactions with other medications you are taking.

• acebutolol

• amitriptyline

• amoxapine

• arsenic trioxide

• atenolol

• betaxolol

• bisoprolol

• clomipramine

• desipramine

• doxepin

• dronabinol

• epinephrine inhaled

• esmolol

• imipramine

• isocarboxazid

• levalbuterol inhaler

• metaproterenol

• metoprolol

• midodrine

• nadolol

• nebivolol

• nortriptyline

• ozanimod

• phenelzine

• pindolol

• procarbazine

• propranolol

• protriptyline

• rasagiline

• safinamide

• selegiline

• selegiline transdermal

• terbutaline

• timolol

• tranylcypromine

• trimipramine

Resources:

• AccuNeb (albuterol sulfate) inhalation solution

• A comparison of three different techniques for giving nebulized albuterol to asthmatic patient

• Albuterol

• Asthma in cats

• Asthma action plan

• Feline bronchial asthma: Treatment

• Albuterol

• Management of acute asthma exacerbation

• ProAir RespiClick

• Instructions for use ProAir Digihaler

• Toxin and drugs reported to induce seizures

• Ventolin HFA

• Ventolin tablets

• Ventolin syrup