Ventolin Dosage/Direction for Use

Evohaler/Respirator Solution/Nebule/Infusion: VENTOLIN has a duration of action of 4 to 6 hours in most patients.
Increasing use of beta₂-agonists may be a sign of worsening asthma. Under these conditions, a reassessment of the patient's therapy plan may be required and concomitant corticosteroid therapy should be considered.
Evohaler/Respirator Solution/Nebule: As there may be adverse effects associated with excessive dosing, the dosage or frequency of administration should only be increased on medical advice.
Syrup: Route of administration: oral.
Adults: The minimum starting dose is: 2 mg three times a day given as 5 ml syrup. The usual effective dose is 4 mg (10 ml syrup) three or four times a day, which may be increased to a maximum of 8 mg (20 ml syrup) three or four times a day if adequate bronchodilation is not obtained.
Elderly: In elderly patients or in those known to be unusually sensitive to beta-adrenergic stimulant drugs, it is advisable to initiate treatment with the minimum starting dose.
Paediatric Population: 2-6 years: the minimum starting dose is 1 mg as 2.5 ml of syrup three times daily. This may be increased to 2 mg as 5 ml of syrup three or four times daily.
6-12 years: the minimum starting dose is 2 mg as 5 ml syrup three times daily. This may be increased to four times daily.
Over 12 years: the minimum starting dose is 2 mg three times daily given as 5 ml syrup. This may be increased to 4 mg as 10 ml syrup three or four times daily.
Ventolin is well tolerated by children so that, if necessary, these doses may be cautiously increased to the maximum dose.
For lower doses the syrup may be diluted with freshly prepared purified water.
Evohaler: VENTOLIN is administered by the oral inhaled route only.
In patients who find coordination of a pressurised metered-dose inhaler difficult a spacer may be used with VENTOLIN Evohaler.
Babies and young children using the VENTOLIN Evohaler may benefit from the use of a paediatric spacer device with a face mask. (See Pharmacology: Pharmacodynamics: Clinical Studies under Actions.)
Relief of Acute Bronchospasm: Adults: 100 or 200 micrograms.
Children: 100 micrograms. The dose may be increased to 200 micrograms if required.
Prevention of Allergen or Exercise-Induced Bronchospasm: Adults: 200 micrograms before challenge or exertion.
Children: 100 micrograms before challenge or exertion. The dose may be increased to 200 micrograms if required.
Chronic Therapy: Adults: Up to 200 micrograms 4 times daily.
Children: Up to 200 micrograms 4 times daily.
On demand use of VENTOLIN should not exceed four times daily. Reliance on such supplementary use or a sudden increase in dose indicates deteriorating asthma (see Precautions).
Respirator Solution: VENTOLIN Respirator Solution is to be used with a respirator or nebuliser, only under the direction of a physician.
The solution must not be injected, or swallowed.
Delivery of the aerosol may be by facemask, 'T' piece or via an endotracheal tube. Intermittent positive pressure ventilation may be used but is rarely necessary. When there is a risk of anoxia through hypoventilation, oxygen should be added to the inspired air.
As many nebulisers operate on a continuous flow basis, it is likely that nebulised drug will be released in the local environment. Ventolin Respirator Solution should therefore be administered in a well-ventilated room, particularly in hospitals when several patients may be using nebulisers at the same time.
By intermittent administration: Intermittent treatment may be repeated 4 times daily.
Adults: VENTOLIN Respirator Solution 0.5 to 1.0 ml (2.5 to 5.0 milligrams of salbutamol) should be diluted to a final volume of 2.0 or 2.5 ml using sterile normal saline as a diluent. The resulting solution is inhaled from a suitably driven nebuliser until aerosol generation ceases. Using a correctly matched nebuliser and driving source this should take about 10 minutes.
VENTOLIN Respirator Solution may be used undiluted for intermittent administration. For this, 2.0 ml of VENTOLIN Respirator Solution (10.0 milligrams salbutamol) is placed in the nebuliser and the patient allowed to inhale the nebulised solution until bronchodilatation is achieved.
This usually takes 3 to 5 minutes.
Some adult patients may require higher doses of salbutamol, up to 10 milligrams, in which case nebulisation of the undiluted solution may continue until aerosol generation ceases.
Children: The same mode of administration for intermittent administration is also applicable to children. The usual dosage for children under the age of 12 years is 0.5 ml (2.5 milligrams salbutamol) diluted to 2.0 or 2.5 ml using sterile normal saline as a diluent. Some children may however require higher doses of salbutamol up to 5.0 milligrams.
Clinical efficacy of nebulised VENTOLIN in infants under 18 months is uncertain. As transient hypoxaemia may occur, supplemental oxygen therapy should be considered.
By continuous administration: VENTOLIN Respirator Solution is diluted using sterile normal saline to contain salbutamol 50-100 μg of salbutamol per ml, (1 to 2 ml solution made up to 100 ml with diluent). The diluted solution is administered as an aerosol by a suitably driven nebuliser. The usual rate of administration is 1 to 2 milligrams per hour.
Nebule: VENTOLIN Nebules are to be used undiluted. However, if prolonged delivery time is desirable (more than 10 minutes) dilution using sterile normal saline as a diluent may be required.
VENTOLIN Nebules are to be used with a nebuliser, under the direction of a physician.
The solution must not be injected or swallowed.
Delivery of the aerosol may be by facemask, 'T' piece or via an endotracheal tube. Intermittent positive pressure ventilation may be used but it is rarely necessary. When there is a risk of anoxia through hypoventilation, oxygen should be added to the inspired air.
As many nebulisers operate on a continuous flow basis, it is likely that nebulised drug will be released in the local environment. VENTOLIN nebules should therefore be administered in a well ventilated room, particularly in hospitals when several patients may be using nebulisers at the same time.
Adults and Children: A suitable starting dose of salbutamol by wet inhalation is 2.5 milligrams.
This may be increased to 5 milligrams. Treatment may be repeated four times daily. In adults higher dosing, up to 40 milligrams per day, can be given under strict medical supervision in hospital for the treatment of severe airways obstruction.
Clinical efficacy of nebulised VENTOLIN in infants under 18 months is uncertain. As transient hypoxaemia may occur, supplemental oxygen therapy should be considered.
Infusion: VENTOLIN parenteral preparations are to be used under the direction of a physician.
Note: The contents of the ampoules of VENTOLIN Solution For Intravenous Infusion must not be injected undiluted. The concentration should be reduced by 50% before administration.
VENTOLIN parenteral preparations should not be administered in the same syringe or infusion as any other medication.
In severe bronchospasm and status asthmaticus: Adults: Infusion: In status asthmaticus, infusion rates of 3 to 20 micrograms per minute are generally adequate but in patients with respiratory failure, higher dosage has been used with success. A starting dose of 5 micrograms per minute is recommended with appropriate adjustments in dosage according to patient response.
A suitable solution for infusion may be repeated by diluting 5 ml of VENTOLIN Solution For Intravenous Infusion in 500 ml of an infusion solution such as sodium chloride and dextrose injection BP to provide a salbutamol dose of 10 micrograms/ml of solution.
Children: At present there is insufficient evidence to recommend a dosage regimen for routine use in children.
In the management of premature labour: Treatment with VENTOLIN Solution For Intravenous Infusion should only be initiated by obstetricians/physicians experienced in the use of tocolytic agents. Ideally, it should be carried out in facilities adequately equipped to perform continuous monitoring of maternal and foetal health status.
Duration of treatment should not exceed 48 hours as data show that the main effect of tocolytic therapy is a delay in delivery of up to 48 hours. No statistically significant effect on perinatal mortality or morbidity has been observed in randomised, controlled trials. This delay may be used to administer glucocorticoids or to implement other measures known to improve perinatal health.
VENTOLIN Solution for infusion should be administered as early as possible after the diagnosis of premature labour, and after evaluation of the patient to eliminate any contraindications to the use of VENTOLIN (see Contraindications). This should include an adequate assessment of the patient's cardiovascular status with continuous ECG monitoring throughout treatment (see Precautions).
For this indication, VENTOLIN Solution for Intravenous Infusion is recommended using a solution prepared as previously mentioned. Infusion rates of 10 to 45 micrograms per minute are generally adequate to control uterine contractions but greater or lesser infusion rates may be required according to the strength and frequency of contractions. A starting rate of 10 micrograms per minute is recommended, increasing the rate at 10-minute intervals until there is evidence of patient response shown by diminution in strength, frequency or duration of contractions. Thereafter the infusion rate may be increased slowly until contractions cease. Careful attention should be given to cardio-respiratory function, including increases in pulse rate and changes in blood pressure, electrolytes, glucose and lactate levels and fluid balance monitoring. A maximum sustained maternal heart rate of 120 beats/min should not be exceeded. Treatment should be discontinued should signs of pulmonary oedema or myocardial ischaemia develop (see Precautions and Adverse Reactions).
Once uterine contractions have ceased the infusion rate should be maintained at the same level for 1 hour and then reduced by 50% decrements at 6-hourly intervals.