SALBUTAMOL (ALBUTEROL)

Salmeterol

Beta-2 adrenergic agonists

• All β2 adrenergic agonists selectively stimulate β2 adrenergic receptors.

• Relax bronchial smooth muscle

• Cardiac: ventricular arrhythmias, vasoconstriction, angina pectoris, tachycardia, and palpitations; may aggravate cardiomyopathy in patients with cardiovascular disease

• Central nervous system/muscular: tremor, headache, anxiety, and sleep disturbances

• Electrolytes

  • Hyperglycemia

  • Hypokalemia (risk of life-threatening arrhythmias): β2-mediated stimulation of Na+/K+-ATPase → intracellular K+ shift

• Development of tolerance

Paradoxical bronchospasm may occur!

• Bronchial asthma: used to achieve spasmolysis of the bronchi.

  • Acute exacerbation: use short-acting selective β2-agonists (e.g., albuterol)

  • Prophylaxis (in chronic disease): use long-acting selective β2-agonists (e.g., salmeterol)

• COPD: used to achieve spasmolysis of the bronchi.

• Preterm/undesired contractions in obstetrics: used for tocolysis

• Hyperkalemia: Beta-2 adrenergic agonists drive K+ intracellularly.

Salmeterol should not be used as monotherapy during an acute asthma attack!

• Absolute contraindication: hypersensitivity to β2 adrenergic agonists

• Use with caution in patients with the following conditions:

  • Hyperthyroidism

  • Glaucoma

  • Diabetes

  • Hypokalemia

  • Seizures

  • Cardiovascular disease (e.g., heart failure, hypertension, arrhythmias, coronary artery disease)

• A face mask is recommended for children < 4 years on inhalational therapy.