Salbutamol

ATC code

R03AC02

Therapeutic class

Selective beta-2 adrenergic agonist · Short-acting beta-agonist (SABA)

Forms

inhalation aerosol, inhalation solution for nebulizer, oral tablet, injectable solution, oral syrup

Brand names

Ventoline (FR) · Salbuair (ES) · Ventolin (US) · ProAir (US) · Airomir (CA)

Overall confidence

high

Regulatory sources consulted

Approved indications

Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease (asthma, COPD).
Prevention of exercise-induced bronchospasm.
Treatment of acute hyperkalemia. · off-label

Contraindications

Absolute

Hypersensitivity to salbutamol or any of the excipients.

Clinical warnings

Major warning · Cardiovascular effects: May cause tachycardia, increased blood pressure, and myocardial ischemia. Use with caution in patients with cardiovascular disease. — ANSM
Major warning · Hypokalemia: High doses can cause potentially serious hypokalemia, especially with concomitant use of other hypokalemic drugs (diuretics, corticosteroids). — ANSM
Major warning · Paradoxical bronchospasm: An acute bronchospasm may occur immediately after inhalation, which can be life-threatening. If it occurs, discontinue immediately and use an alternative bronchodilator. — Clinical Practice
Lactic acidosis: Very rare cases have been reported with high doses (IV or nebulized), mainly in acute asthma exacerbations. — ANSM

Drug interactions

HighPropranololC07AA05
Mechanism: Pharmacodynamic antagonism. Non-selective beta-blockers antagonize the bronchodilator effect of salbutamol and can induce severe bronchospasm.
Recommendation: Avoid concomitant use. If a beta-blocker is necessary, use a cardioselective one (e.g., metoprolol, atenolol) with extreme caution.
ANSM RCP
ModerateHydrochlorothiazideC03AA03
Mechanism: Additive hypokalemic effect. Concomitant use with non-potassium-sparing diuretics can increase the risk of hypokalemia and arrhythmias.
Recommendation: Monitor serum potassium levels, especially with high doses or frequent use of salbutamol.
ANSM RCP
HighHalothaneN01AB01
Mechanism: Increased cardiac reactivity and sensitization of the myocardium to the effects of catecholamines, with risk of serious ventricular arrhythmias.
Recommendation: Salbutamol treatment is discouraged during halothane anesthesia.
ANSM RCP

Adverse events

Common (≥1%)

tremor · headache · tachycardia · palpitations · muscle cramps

Rare but serious

myocardial ischemia · severe hypokalemia · lactic acidosis · severe hypersensitivity reactions (anaphylaxis, angioedema) · cardiac arrhythmias

Pregnancy and lactation

FDA category: C

Pregnancy: Considered safe during pregnancy due to extensive clinical experience. May cause transient fetal tachycardia. Lactation: Excreted in breast milk; an effect on the infant is unlikely at therapeutic inhaled doses.

Recent literature (PubMed)

Pharmacological interventions for the acute treatment of hyperkalaemia: A systematic review and meta-analysis.
Jessen MK, et al. · Resuscitation · 2025 · Relevance 5/5
Revisión sistemática y metaanálisis que evalúa las intervenciones para la hiperpotasemia aguda. Concluye que el salbutamol (inhalado o IV) es eficaz, reduciendo el potasio sérico en 0.7-1.2 mmol/L, apoyando su uso off-label para esta indicación potencialmente mortal.
Salbutamol in the Management of Asthma: A Review.
Marques L, et al. · Int J Mol Sci · 2022 · Relevance 4/5
Revisión exhaustiva sobre el salbutamol en el manejo del asma. Detalla su mecanismo de acción como relajante del músculo liso bronquial y revisa los perfiles farmacocinéticos, eficacia y efectos adversos de sus diferentes formulaciones (oral, IV, inhalada).
UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants.
Manti S, et al. · Ital J Pediatr · 2023 · Relevance 4/5
Guía de práctica clínica italiana actualizada para el manejo de la bronquiolitis en lactantes. Refuerza que el tratamiento es de soporte y desaconseja el uso de salbutamol, ya que la evidencia no muestra beneficios y sí potenciales daños.
Update on RYR1-related myopathies.
Ogasawara M, et al. · Curr Opin Neurol · 2024 · Relevance 2/5
Revisión sobre miopatías relacionadas con RYR1. Menciona que el salbutamol ha sido explorado como una terapia potencial para estas condiciones, pero su eficacia no ha sido probada de manera concluyente.
Breathe easy: inhalational therapy for feline inflammatory airway disease.
Barchilon M, et al. · J Feline Med Surg · 2023 · Relevance 1/5
Artículo de revisión sobre el uso de terapia inhalada, incluyendo salbutamol, para el tratamiento de enfermedades inflamatorias de las vías respiratorias en gatos (asma felina). Relevancia limitada para la práctica clínica humana.