Bronchospasm: Salbutamol inhaler is indicated for the treatment or prevention of bronchospasm in bronchial asthma, and for reversible airway obstruction associated with bronchitis and emphysema.

Exercise-Induced Bronchospasm: It may be used to relieve acute attacks of dyspnoea and can also be used prophylactically before physical exertion to prevent exercise-induced bronchospasm.

Salbutamol is a selective β2-adrenoceptor agonist. At therapeutic doses, it acts mainly on β2-adrenoceptors of bronchial smooth muscle with little or no effect on β1-adrenoceptors of cardiac muscle. It produces short-acting bronchodilation (4–6 hours) with a rapid onset of action (within 5 minutes) in reversible airway obstruction. It also exhibits an anti-inflammatory effect on mast cells by inhibiting the release of bronchoconstrictor mediators, including histamine, neutrophil chemotactic factor (NCF), and prostaglandin D2.

Administer Salbutamol Inhaler by oral inhalation only. Shake Salbutamol Inhaler well before each spray.

For relief of acute episodes of bronchospasm:

• Adults: 1 or 2 puffs as necessary. The maximum dose is up to 8 puffs in 24 hours.
• Children: Half the adult dose.

To prevent allergen- or exercise-induced bronchospasm:

• Adults: 2 puffs 15 minutes prior to exercise or exposure to the allergen. The maximum dose is 2 puffs, up to 4 times a day.
• Children: Half the adult dose.

Chronic therapy:

• Adults: Up to 200 mcg (2 puffs) four times daily.
• Children: Up to 200 mcg (2 puffs) four times daily.

Using an Inhaler seems simple, but most patients do not know how to use it in the right way. If the Inhaler is used in the wrong way, less medicine can reach the lungs. Correct and regular use of the Inhaler will prevent or lessen the severity of asthma attacks.

Following simple steps can help to use Inhaler effectively (According to "National Asthma Guidelines for Medical Practitioners" published by Asthma Association):

• Take off the cap.
• Shake the inhaler (at least six times) vigorously before each use.
• If the inhaler is new or if it has not been used for a week or more, shake it well and release one puff into the air to make sure that it works.
• Breathe out as full as comfortably possible & hold the inhaler upright.
• Place the actuator into mouth between the teeth and close lips around the mouthpiece.
• While breathing deeply and slowly through the mouth, press down firmly and fully on the canister to release medicine.
• Remove the inhaler from mouth. Continue holding breath for at least 10 seconds or as long as it is comfortable.
• If doctor has prescribed more than one inhalation per treatment, wait 1 minute between puffs (inhalations).
• Shake the inhaler well and repeat steps 4 to 7.
• After use, replace the cap on the mouthpiece. After each treatment, rinse mouth with water.
• Check your technique in front of a mirror from time to time, if you see a white mist during the inhalation, you may not have closed your lips properly around mouthpiece, or you may not be breathing in as you press the can. This indicates failure of technique. If this happens, repeat the procedure from step 4 carefully.

Instructions for Cleaning Inhaler: Clean your Inhaler at least once a week. Remove canister and rinse the plastic actuator and cap in warm water but do not put the metal canister into water. Dry the actuator and cap thoroughly and gently replace the metal canister into the actuator with a twisting motion. Put the cap on the mouthpiece.

Salbutamol and non-selective beta-blockers such as propranolol should generally not be used together. β2-agonist therapy may cause potentially serious hypokalaemia. This effect may be enhanced in acute severe asthma when used with xanthine derivatives, corticosteroids, diuretics, or in the presence of hypoxia. Serum potassium should be monitored in such situations.

Salbutamol inhaler is contraindicated in patients with a known hypersensitivity to salbutamol or any of the components of the inhaler.

Salbutamol is generally well tolerated when inhaled. Reported side effects include tremor, anxiety, muscle cramps, headache, palpitations, a small increase in heart rate, and cardiac arrhythmias (including atrial fibrillation, supraventricular tachycardia, and extrasystoles). Tachycardia may also occur in some patients. Mouth and throat irritation may occur with inhaled salbutamol.

Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Salbutamol inhaler should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether the components of this inhaler are excreted in human breast milk. Caution should be exercised when administering to nursing mothers.

Paradoxical Bronchospasm: Inhaled salbutamol may cause paradoxical bronchospasm, which can be life-threatening. If it occurs, the inhaler should be discontinued immediately and alternative therapy started. It may occur more commonly with first use of a new canister.

Cardiovascular Effects: Like other β2-agonists, salbutamol may cause clinically significant cardiovascular effects such as changes in pulse rate or blood pressure. It may also cause ECG changes including T-wave flattening, QTc prolongation, and ST-segment depression. It should be used cautiously in patients with coronary insufficiency, arrhythmias, or hypertension.

Immediate Hypersensitivity Reactions: Reactions such as urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema may occur. The drug should be discontinued if these occur.

Coexisting Conditions: Caution is required in patients with seizures, hyperthyroidism, diabetes mellitus, or those overly sensitive to sympathomimetics. High doses of intravenous salbutamol may worsen diabetes and ketoacidosis.

Use in children: Safety and effectiveness have been established in children aged 4 years and older.

Short-acting selective β2-adrenoceptor stimulants

Pressurized container. Do not puncture, break, or burn even when apparently empty. Store below 30°C, away from sunlight and heat. Do not freeze. Keep away from eyes and children. Dispense only on the prescription of a registered physician.