BNF for Children 2011-2012

BNFC 2011–2012 3.1.1 Adrenoceptor agonists 139Relief of bronchospasm. By inhalation of powderChild 6–18 years 6–12 microgramsPrevention of exercise-induced bronchospasm. By inhalation of powderChild 6–18 years 6–12 micrograms before exerciseChild 2–6 years 1–2 mg 3–4 times dailyChild 6–12 years 2 mg 3–4 times dailyChild 12–18 years 4 mg (sensitive patients initially2 mg) 3–4 times daily; max. single dose 8 mg(but unlikely to provide extra benefit or to betolerated)Compound preparationsFor compound preparations containing formoterol,see section 3.2SALBUTAMOL(Albuterol)Cautions see notes abovePregnancy see p. 133Breast-feeding see p. 133Side-effects see notes above; also lactic acidosis withhigh dosesLicensed use not licensed for use in hyperkalaemia;syrup not licensed for use in children under 2 years;modified-release tablets not licensed for use inchildren under 3 years; injection not licensed for usein children; Pulvinal c Salbutamol not licensed foruse in children under 6 yearsIndication and doseAcute asthma. By aerosol or nebulised solution inhalationSee Management of Acute Asthma, p. 134. By intravenous injection over 5 minutes (seealso Management of Acute Asthma, p. 134)Child 1 month–2 years 5 micrograms/kg as asingle doseChild 2–18 years 15 micrograms/kg (max.250 micrograms) as a single dose. By continuous intravenous infusionChild 1 month–18 years 1–2 micrograms/kg/minute, adjusted according to response and heartrate up to 5 micrograms/kg/minute; doses above2 micrograms/kg/minute should be given in anintensive care settingExacerbations of reversible airways obstruction(including nocturnal asthma) and prevention ofallergen- or exercise-induced bronchospasm,see also Management of Chronic Asthma, p. 135. By aerosol inhalationChild 1 month–18 years 100–200 micrograms(1–2 puffs); for persistent symptoms up to 4 timesdaily. By inhalation of powder(for Asmasal Clickhaler c , Salbulin Novolizer c ,and Ventolin Accuhaler c doses, see under preparations)Child 5–12 years 200 micrograms; for persistentsymptoms up to 4 times dailyChild 12–18 years 200–400 micrograms; forpersistent symptoms up to 4 times daily. By mouth (but use by inhalation preferred)Child 1 month–2 years 100 micrograms/kg(max. 2 mg) 3–4 times dailySevere hyperkalaemia (section 9.2.1.1). By intravenous injection over 5 minutesNeonate 4 micrograms/kg as a single dose; repeatif necessaryChild 1 month–18 years 4 micrograms/kg as asingle dose; repeat if necessary. By inhalation of nebulised solution (but intravenousinjection preferred)Neonate 2.5–5 mg as a single dose; repeat ifnecessaryChild 1 month–18 years 2.5–5 mg as a singledose; repeat if necessaryAdministration for continuous intravenous infusion,dilute to a concentration of 200 micrograms/mL withGlucose 5% or Sodium Chloride 0.9%; if fluidrestricted,can be given undiluted through centralvenous catheterFor intravenous injection, dilute to a concentration of50 micrograms/mL with Glucose 5%, Sodium Chloride0.9%, or Water for injectionsFor nebulisation, dilute nebuliser solution with asuitable volume of sterile Sodium Chloride 0.9%solution according to nebuliser type and duration ofadministration; salbutamol and ipratropium bromidesolutions are compatible and can be mixed for nebulisationOralSalbutamol (Non-proprietary) ATablets, salbutamol (as sulphate) 2 mg, net price 28-tab pack = £17.74; 4 mg, 28-tab pack = £16.40Oral solution, salbutamol (as sulphate) 2 mg/5 mL,net price 150 mL = £1.55Brands include Salapin c (sugar-free)Ventmax c SR (Chiesi) ACapsules, m/r, salbutamol (as sulphate) 4 mg (green/grey), net price 56-cap pack = £8.08; 8 mg (white), 56-cap pack = £9.69. Label: 25DoseChronic asthma (but see notes above). By mouthChild 3–12 years 4 mg twice dailyChild 12–18 years 8 mg twice dailyVentolin c (A&H) ASyrup, sugar-free, salbutamol (as sulphate) 2 mg/5 mL, net price 150 mL = 60pParenteralVentolin c (A&H) AInjection, salbutamol (as sulphate) 500 micrograms/mL, net price 1-mL amp = 38pSolution for intravenous infusion, salbutamol (assulphate) 1 mg/mL. Dilute before use. Net price 5-mLamp = £2.483 Respiratory system