Albuterol Sulfate

Pronunciation

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 Sulfate

Bronchospasm in Asthma

Symptomatic management or prevention of bronchospasm in patients with reversible, obstructive airway disease (e.g., asthma).132 139 154 181 241 249 255 282

Exercise-induced Bronchospasm

Prevention of exercise-induced bronchospasm.132 181 249

Slideshow: What is Asthma? Causes, Symptoms, and Treatment

Chronic Obstructive Pulmonary Disease

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 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 Sulfate Dosage and Administration

General

  • Albuterol sulfate: Administer by oral inhalation via metered-dose inhaler or nebulizer114 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 Aerosol 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 not used for prolonged periods (i.e., >2 weeks).181 215 237 248 282 Test spray Ventolin HFA aerosol inhaler whenever 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 (ProAir HFA, Proventil 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 Dry thoroughly the mouthpiece before replacing the metal canister and mouthpiece cap.181 215 237 282 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, rewash the mouthpiece and allow to air dry.248 282 Proper cleaning of the albuterol sulfate inhaler (ProAir HFA, Proventil HFA, Ventolin HFA) mouthpiece will prevent medication build-up and blockage.181 237 248 282

Discard canister after the labeled number of actuations 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 sulfate; dosage expressed in terms of albuterol.114 153 154 181 272 281

Pediatric Patients

Bronchospasm in Asthma
Oral Inhalation Aerosol

Children ≥4 years of age: 180 mcg (2 inhalations) every 4–6 hours (ProAir HFA, Proventil HFA, Ventolin HFA).181 237 295 Do not increase dosage or dosage frequency.181 237 295 Alternatively, 90 mcg (1 inhalation) every 4 hours may be sufficient.181 237 295

Oral Nebulization Solution

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

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

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

Oral Extended-release Tablets

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

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

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

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

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

Prevention of Exercise-induced Bronchospasm
Oral Inhalation Aerosol

Children ≥4 years of age: 180 mcg (2 inhalations) administered 15–30 minutes before exercise via metered-dose inhaler (ProAir HFA, Proventil HFA, Ventolin HFA).181 237 295

Adults

Bronchospasm in Asthma
Oral Inhalation Aerosol

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

Oral Nebulization Solution

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 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

Oral 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

Prevention of Exercise-induced Bronchospasm
Oral Inhalation Aerosol

180 mcg (2 inhalations) administered 15–30 minutes before exercise via the metered-dose inhaler (ProAir HFA, Proventil HFA, Ventolin HFA).181 237 282

Chronic Obstructive Pulmonary Disease
Oral 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 >12 inhalations in 24 hours.233

Oral Nebulization Solution

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 in Asthma
Oral Nebulization Solution

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

Adolescents ≥12 years of age: Maximum 2.5 mg 4 times daily.153

Oral Conventional Tablets

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

Adolescents ≥12 years of age: Maximum 8 mg 4 times daily.100 139 280

Oral Extended-release Tablets

Children 6–12 years of age: Maximum 12 mg twice daily.271

Adolescents >12 years of age: Maximum 16 mg twice daily.271

Oral Solution

Children 2–6 years of age: Maximum 4 mg 3 times daily.281

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

Adolescents >14 years of age: Maximum 8 mg 4 times daily.281

Adults

Bronchospasm in Asthma
Oral Nebulization Solution

Maximum 2.5 mg 4 times daily.114 153 241 258 212

Oral Conventional Tablets or Solution

Maximum 8 mg 4 times daily.270 280 281

Oral Extended-release Tablets

Maximum 16 mg twice daily.271

Chronic Obstructive Pulmonary Disease
Oral Inhalation Aerosol

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

Oral Nebulization Solution

Maximum 2.5 mg 6 times daily in fixed combination with ipratropium bromide (0.5 mg per dose).243

Special Populations

Geriatric Patients

Oral Conventional Tablets or 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

Oral Inhalation Aerosol

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

Patients Sensitive to Sympathomimetic Amines

Oral Conventional Tablets or 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 Sulfate

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)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.192 287 (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 orally inhaled albuterol sulfate inhalation aerosols (ProAir HFA, Proventil HFA, Ventolin HFA) not established in children <4 years of age.181 237 295 Safety and efficacy of orally inhaled racemic albuterol sulfate inhalation solution (Proventil) not established in children <12 years of age.241 244 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 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 Sulfate

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 Sulfate 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

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

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

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

Duration

Oral inhalation aerosol: 3–6 hours.145 146 181 237

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

Oral conventional tablets: Up to 8 hours.100

Oral 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 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 ipratropium bromide oral inhalation solution: 2–25°C.243

Actions

  • Stimulates β-adrenergic receptors with little or no effect on α-adrenergic receptors.j

  • Stimulates the production of cyclic adenosine-3′,5′-monophosphate (AMP), which mediates numerous cellular responses, including smooth muscle relaxation and inhibiting the release of mediators from mast cells in the airways.153 181 208

  • Relaxes smooth muscles from the trachea to the terminal bronchial tree.j

Advice to Patients

  • Importance of providing patient with a copy of the manufacturer’s patient information.153

  • Importance of adequate understanding of proper storage, preparation, and inhalation techniques, including use of the nebulization delivery system.146 153 181

  • Importance of adherence to dosing schedules of albuterol and concomitant therapy, including not exceeding the recommended dose or frequency of use unless otherwise instructed by a clinician.145 237 241 255 282

  • Importance of administering albuterol at least 15–30 minutes prior to exercise for prevention of exercise-induced bronchospasm.237 145 146 181

  • If decreased effectiveness occurs, discontinue albuterol and contact a clinician; do not increase the dose or frequency of administration.114 154 227

  • Advise that the outer coating of albuterol extended-release tablets may be excreted in feces where it may be noticeable.154

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.237 270

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.100 114 153

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Albuterol Sulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Solution

2 mg (of albuterol) per 5 mL*

Albuterol Sulfate Syrup

Tablets

2 mg (of albuterol)*

Albuterol Sulfate Tablets

4 mg (of albuterol)*

Albuterol Sulfate Tablets

Tablets, extended-release

4 mg (of albuterol)*

VoSpire ER

Dava

Albuterol Sulfate Extended-Release Tablets

8 mg (of albuterol)*

VoSpire ER

Dava

Albuterol Sulfate Extended-Release Tablets

Oral Inhalation

Aerosol

90 mcg (of albuterol) per metered spray

ProAir HFA (with hydrofluoroalkane propellant)

Teva

Proventil HFA (with hydrofluoroalkane propellant)

Schering

Ventolin+ HFA (with hydrofluoroalkane propellant)

GlaxoSmithKline

Solution, for nebulization

0.021% (of albuterol)*

AccuNeb (available as TwistFlex polyethylene vials)

Dey

Albuterol Sulfate Inhalation Solution

0.042% (of albuterol)*

AccuNeb (available as TwistFlex polyethylene vials)

Dey

Albuterol Sulfate Inhalation Solution

0.083% (of albuterol)*

Albuterol Sulfate Inhalation Solution

Proventil

Schering

Solution, concentrate, for nebulization

0.5% (of albuterol)*

Albuterol Sulfate Inhalation Solution

Albuterol Sulfate Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral Inhalation

Aerosol

90 mcg (of albuterol) with Ipratropium Bromide 18 mcg per metered spray

Combivent (with chlorofluorohydrocarbon propellants)

Boehringer Ingelheim

Solution, for nebulization

2.5 mg (of albuterol) with Ipratropium Bromide 0.5 mg per 3 mL

DuoNeb

Dey

Levalbuterol Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Solution, for nebulization

0.103 mg (of levalbuterol) per mL (0.31 mg)

Xopenex (available as polyethylene vials)

Sepracor

0.21 mg (of levalbuterol) per mL (0.63 mg)

Xopenex (available as polyethylene vials)

Sepracor

0.417 mg (of levalbuterol) per mL (1.25 mg)

Xopenex (available as polyethylene vials)

Sepracor

Levalbuterol Tartrate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral Inhalation

Aerosol

45 mcg (of levalbuterol) per metered spray

Xopenex HFA (with hydrofluoroalkane propellant)

Sepracor

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

AccuNeb 0.63MG/3ML Aerosol (DEY LABS): 75/$56.99 or 225/$155.97

AccuNeb 1.25MG/3ML Aerosol (DEY LABS): 75/$53.82 or 225/$158.28

Albuterol Sulfate (2.5 MG/3ML)0.083% Aerosol (NEPHRON PHARMACEUTICALS CORP.): 75/$18.99 or 225/$49.97

Albuterol Sulfate (5 MG/ML)0.5% Aerosol (HI-TECH): 20/$22.99 or 40/$34.97

Albuterol Sulfate 0.63MG/3ML Aerosol (WATSON LABS): 75/$43.99 or 225/$107.97

Albuterol Sulfate 1.25MG/3ML Aerosol (WATSON LABS): 3/$12.99 or 9/$15.97

Albuterol Sulfate 2MG/5ML Syrup (ACTAVIS MID ATLANTIC): 120/$14.99 or 240/$18.97

Albuterol Sulfate 2MG Tablets (MUTUAL PHARMACEUTICAL): 90/$20.99 or 180/$31.97

Albuterol Sulfate 4MG Tablets (MYLAN): 100/$31.99 or 300/$87.97

Combivent 18-103MCG/ACT Aerosol (BOEHRINGER INGELHEIM): 15/$238.33 or 44/$679.95

DuoNeb 0.5-2.5 (3)MG/3ML Solution (DEY LABS): 90/$80.86 or 270/$228.18

DuoNeb 0.5-2.5 (3)MG/3ML Solution (DEY LABS): 180/$148.24 or 540/$424.54

Ipratropium-Albuterol 0.5-2.5 (3)MG/3ML Solution (MYLAN): 90/$39.99 or 270/$99.96

ProAir HFA 108 (90 Base)MCG/ACT Aerosol (IVAX PHARMACEUTICALS): 9/$46.99 or 26/$122.98

Proventil HFA 108 (90 Base)MCG/ACT Aerosol (SCHERING): 7/$55.99 or 13/$102.97

Ventolin HFA 108 (90 Base)MCG/ACT Aerosol (GLAXO SMITH KLINE): 18/$46.99 or 54/$119.97

VoSpire ER 4MG 12-hr Tablets (DAVA PHARMACEUTICALS): 30/$78.75 or 90/$219.98

VoSpire ER 8MG 12-hr Tablets (DAVA PHARMACEUTICALS): 60/$256.00 or 180/$729.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions August 13, 2012. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

100. Schering Corporation. Proventil (albuterol sulfate) Repetabs and tablets prescribing information. Kenilworth, NJ; 1997 Oct.

101. Powell ML, Weisberger M, Dowdy Y et al. Comparative steady state bioavailability of conventional and controlled-release formulations of albuterol. Biopharm Drug Dispos. 1987; 8:461-8. [IDIS 233727] [PubMed 3663882]

102. Anon. Drugs for asthma. Med Lett Drugs Ther. 1987; 29:11-6. [PubMed 2880281]

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