Bronkolax

Indications

• Effective for managing acute severe asthma and severe bronchospasm.

Administration

• Tablet/Syrup: Take on an empty stomach, 1 hour before or 2 hours after meals.
• Aerosol Metered-Dose Inhaler: Prime before first use or if unused for >2 weeks by releasing 4 test sprays into the air. Shake well before use. Follow these steps:
  1. Exhale fully through the mouth.
  2. Place the mouthpiece into your mouth and close your lips around it.
  3. Inhale deeply and slowly while pressing the top of the canister.
  4. Hold your breath for up to 10 seconds, then remove the inhaler and exhale.
  5. If additional puffs are prescribed, wait 1 minute, shake the inhaler, and repeat.
  6. Clean the mouthpiece weekly to prevent blockage and medication buildup.
• Powder Metered-Dose Inhaler: No priming needed. Keep dry; do not wash. Wipe with a dry cloth if necessary.

Adult Dosage

• Oral:
  • Acute bronchospasm: 2-4 mg, 3 or 4 times daily, up to 8 mg. Modified-release: 8 mg twice daily. Max: 32 mg/day.
• Inhalation:
  • Acute bronchospasm: 1-2 inhalations (90-100 mcg/actuation). Max: 12 inhalations/24 hr.
  • Chronic maintenance: 2 inhalations (90-100 mcg/actuation) 3-4 times daily. Max: 800 mcg/day.
  • Acute severe asthma: 4-8 puffs (100 mcg/actuation) every 20 minutes for up to 4 hours. Max: 10 inhalations.
  • Exercise-induced bronchospasm: 2 inhalations (90-100 mcg/actuation) 10-15 minutes before exercise.
• Nebulizer Solution: 2.5-5 mg, up to 4 times daily, or continuously at 1-2 mg/hr. Dilute 0.5 mL with 3 mL NaCl 0.9% for a 2.5 mg dose.
• Parenteral:
  • IM/SC: 500 mcg (8 mcg/kg) every 4 hours as needed.
  • IV: 250 mcg (4 mcg/kg) slowly, may repeat if necessary. Usual rate: 3-20 mcg/min (0.3-2 mL/min). Dilute 5 mL with 500 mL NaCl or dextrose.

Child Dosage

• Oral:
  • Acute bronchospasm: 2-6 years: 1-2 mg; 6-12 years: 2 mg; >12 years: 2-4 mg, 3 or 4 times daily. Syrup: 2.5 mL (2-6 years), 5 mL (6-12 years), 5-10 mL (over 12 years), 3-4 times daily.
• Inhalation:
  • Acute bronchospasm: 4-12 years: 1 inhalation, may increase to 2. Max: 400 mcg/day.
  • Exercise-induced bronchospasm: 4-12 years: 1 inhalation 10-15 minutes before exercise.
• Nebulizer Solution: 2.5-5 mg, up to 4 times daily, or continuously at 1-2 mg/hr. Dilute 0.5 mL with 3 mL NaCl 0.9%.
• Parenteral:
  • IM/SC: 500 mcg (8 mcg/kg) every 4 hours as needed.
  • IV: 250 mcg (4 mcg/kg) slowly. Usual rate: 3-20 mcg/min (0.3-2 mL/min). Dilute 5 mL with 500 mL NaCl or dextrose.

Contraindications

• Contraindicated in individuals with a history of hypersensitivity to any components. Not suitable for premature labor management or threatened abortion in early pregnancy.

Mode of Action

• Salbutamol is a beta-adrenergic agonist that provides bronchodilation by acting on β2 receptors and reducing uterine contractions.

Precautions

• Caution in cases of hyperthyroidism, myocardial insufficiency, arrhythmias, hypertension, diabetes, glaucoma, hypokalemia, seizure disorders, renal impairment, and elderly patients. Monitor blood pressure, heart rate, electrolyte levels, glucose, lactate, and potassium levels. Not recommended during lactation due to unknown excretion in milk.

Side Effects

• >10%: Tremor (20%), nervousness (20% in children 2-6 years), insomnia (11% in children 6-12 years).
• 1-10%: Nausea (10%), fever (1.6-9%), bronchospasm (8%), vomiting (7%), headache (4-7%), dizziness (1-7%), cough (5%), allergic reactions (4%), and more.
• Rare/Serious: Hypertension, angina, vertigo, CNS stimulation, insomnia, metabolic acidosis, hypersensitivity reactions, hypokalemia, tachycardia, and urticaria. Potentially fatal hypokalemia after large doses.

Interactions

• May increase hypokalemia with diuretics, corticosteroids, and xanthines. CV effects can be amplified by MAOIs, TCAs, and sympathomimetics. Increases sulfamethoxazole absorption and may elevate heart rate and blood pressure with atomoxetine. Reduces digoxin serum levels and increases digitalis toxicity risk. Monitor blood pressure with concurrent linezolid use.