Short-acting Beta Agonist

Aka: Short-acting Beta Agonist, SABA, Inhaled Beta Adrenergic Agonist, Inhaled Beta Agonist, Inhaled Bronchodilator, Bronchodilator, Proventil, Inhaled Terbutaline, Brethaire, Pirbuterol, Maxair

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II. Indications

  1. Short acting Bronchodilator agents for rescue use only

III. Mechanism

  1. Inhaled Bronchodilators target Beta 2 Adrenergic Receptors on Bronchial Smooth Muscle
    1. Increase cAMP messenger levels
    2. cAMP relaxes Bronchial Smooth Muscles resulting in bronchodilation
  2. Adverse effects (e.g. Tachycardia) are related to Beta 1 Adrenergic Receptor activity

IV. Medications: Short Acting Bronchodilators - Common Use

  1. Albuterol Inhaler (Ventolin, Proventil, ProAir HFA, ProAir RespiClick)
    1. See Hydrofluoroalkane Inhaler (HFA Inhaler) for technique
    2. Rescue Inhaler: 2 puffs every 4 to 6 hours as needed
    3. Exercise Induced Asthma: 2 puffs used 10 to 30 minutes before Exercise
    4. Severe COPD or Asthma Exacerbation
      1. Use 6 to 8 puffs every 1-2 hours (max) OR
      2. Use 2 puffs every 20 minutes as needed for up to 3 doses every 1 to 4 hours
  2. Albuterol Nebulizer
    1. Dilute Albuterol solution (5 mg/ml) in Normal Saline (NS) as described above
    2. Weight <10 kg or age under 12 months (0.15 mg/kg)
      1. Albuterol 1.25 mg (0.25 cc) in 2 cc NS q1-4 hours
    3. Weight 10-35 kg or age 12 months to adult (Typical, standard dose)
      1. Albuterol 2.5 mg (0.5 cc) in 2 cc NS q1-4 hours
    4. Weight >35 kg or age over 10 years (High Dose)
      1. Albuterol 5.0 mg (1.0 cc) in 2 cc NS q1-4 hours
      2. Standard dose of 2.5 mg is used instead in most cases
    5. Continuous Nebulizer
      1. Dose 10 to 15 mg/hour until improvement (typically first hour)
      2. Intensive monitoring including telemetry within emergency department or ICU
  3. Levalbuterol Inhaler (age 4 years and older)
    1. See Hydrofluoroalkane Inhaler (HFA Inhaler) for technique
    2. Take 2 puffs up to every 4 to 6 hours
    3. Generic in 2016
  4. Levalbuterol (Xopenex) Nebulizer
    1. Indicated for Age over 12 years
    2. Age >=12 years: 0.63 (up to maximum of 1.25 mg) nebulized every 6 to 8 hours as needed
    3. Age 6 to 11 years: 0.31 mg nebulized every 8 hours as needed

V. Medications: Short Acting Bronchodilators - Uncommon Use

  1. Terbutaline (Brethaire)
    1. Dose: 2 puffs q4-6 hours
    2. Not as potently dosed as others
    3. Use for patients sensitive to adrenergic effects
  2. Pirbuterol (Maxair)
    1. Dose: 2 puffs q4-6 hours
  3. Isoproterenol
    1. Dose: 2 puffs q3-4 hours
  4. Isoetharine
    1. Dose: 2 puffs q4 hours
  5. Metaproterenol
    1. Dose: 2 puffs q4-6 hours
  6. Bitolterol
    1. Dose: 2 puffs q4-6 hours

VI. Adverse Effects

  1. Tachycardia
  2. Palpitations
  3. Tremor
  4. Anxiousness
  5. Headache
  6. Nausea
  7. Transient Hypokalemia
  8. Tachyphylaxis (see precautions below)

VII. Precautions

  1. Avoid Scheduled short acting MDI use
    1. Loss of indicator for worsening Asthma
    2. Delays use of Inhaled Corticosteroid
    3. Increases airway hyper-reactivity
    4. Greater allergen exposure
      1. Treats only acute phase reaction
    5. Regular use associated with increased mortality
      1. Inhaled Terbutaline may be more risk than other preparations
    6. Acute Coronary Syndrome risk in those with CAD risk
      1. Au (2002) Chest 121:846-51 [PubMed]
  2. Monitoring Use
    1. Most Metered Dose Inhalers supply 100-120 two spray doses
    2. Four times daily dosing will last one month
    3. In well controlled Asthma, Inhaler will last one year

VIII. Efficacy

  1. Beta Agonists have reduced activity in severely acidotic or hypoxic patients
  2. Reduced efficacy of Bronchodilators in the 20% of patients with arginine Genotype
    1. Israel (2001) Int Arch Allergy Immunol 124:183-6 [PubMed]
    2. Wechsler (2005) Am J Respir Crit Care Med 172(1):12-8 [PubMed]
  3. References
    1. Delgado (2003) Arch Pediatr Adolesc Med 157:76-80 [PubMed]
    2. Mandelberg (1997) Chest 112:1501-5 [PubMed]
    3. Newman (2002) Chest 121:1036-41 [PubMed]

IX. Drug Interactions

  1. Increased Sympathomimetic effects
    1. MAO Inhibitors
    2. Tricyclic Antidepressants
  2. Decreased beta Agonist effects
    1. Beta Blockers

X. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 88
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. (2022) Comparison of Asthma Medications, Presc Lett, #381217
  4. (2022) Inhaled Medications for COPD, Presc Lett, #381116
  5. (2020) Drugs for COPD, Med Lett Drug Ther 62: 137-44
  6. (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200

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Related Studies

Cost: Medications

proventil (on 5/18/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PROVENTIL HFA 90 MCG INHALER Generic $3.23 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Ontology: Adrenergic beta-Agonists (C0001644)

Definition (MSH) Drugs that selectively bind to and activate beta-adrenergic receptors.
Concepts Pharmacologic Substance (T121)
MSH D000318
SnomedCT 349920008, 373227004
English beta Adrenergic Receptor Agonists, Adrenergic beta Agonist, Adrenergic beta Agonists, Adrenergic beta Receptor Agonist, Adrenergic beta Receptor Agonists, Adrenergic beta-Agonist, Adrenergic beta-Receptor Agonist, Adrenergic beta-Receptor Agonists, Agonist, Adrenergic beta-Receptor, Agonist, beta-Adrenergic, Agonist, beta-Adrenergic Receptor, Agonists, Adrenergic beta-Receptor, Agonists, beta-Adrenergic, Agonists, beta-Adrenergic Receptor, Receptor Agonist, beta-Adrenergic, Receptor Agonists, beta Adrenergic, Receptor Agonists, beta-Adrenergic, Receptors Agonists, Adrenergic beta, beta Adrenergic Agonist, beta Adrenergic Agonists, beta Adrenergic Receptor Agonist, beta-Adrenergic Agonist, beta-Adrenergic Receptor Agonist, beta-Adrenergic Receptor Agonists, beta-Agonist, Adrenergic, beta-Agonists, Adrenergic, beta-Receptor Agonist, Adrenergic, beta-Receptor Agonists, Adrenergic, Beta-Adrenergic Agonist, ADREN BETA AG, ADREN BETA RECEPT AGON, BETA ADREN AG, BETA ADREN AGON, ADREN BETA RECEPT AG, RECEPT AGON BETA ADREN, RECEPT AGON ADREN BETA, BETA ADREN RECEPT AG, ADRENERGIC RECEPTOR AGONISTS BETA, ADRENERGIC AGONISTS BETA, ADREN BETA AGON, BETA ADREN RECEPT AGON, beta-Adrenergic Agonists, Betamimetics, antiadrenergic beta receptor agents (medication), antiadrenergic beta receptor agents, adrenergic beta receptor agonists, Adrenergic beta-Agonists, beta-adrenergic receptor agonists, beta adrenergic agonist, beta-adrenergic agonist, beta-adrenergic agonists, agonists beta adrenergic receptor, beta adrenergic agonists, Adrenergic beta agonists, Beta-adrenoceptor agonist, Beta-adrenoceptor agonist (product), Beta-adrenoceptor agonist (substance), Beta-adrenergic Agonists
Swedish Adrenerga betastimulerare
Czech receptory adrenergní beta - agonisté
Portuguese Agonistas beta-Adrenérgicos, Agonistas dos Receptores Adrenérgicos beta, Agonistas Adrenérgicos beta, beta-Agonistas Adrenérgicos, Agonistas dos Receptores beta-Adrenérgicos, Agonistas dos beta-Receptores Adrenérgicos
Finnish Beeta-agonistit
French Agonistes beta-adrénergiques, Agonistes des adrénorécepteurs bêta, Bêta-adrénergiques, Bêta-stimulants, Sympathomimétiques bêta, Agoniste bêta-adrénergique, Agonistes bêta-adrénergiques, Agonistes des récepteurs bêta-adrénergiques, Bêta-mimétiques
Russian ADRENERGICHESKIE BETA-AGONISTY, ADRENORETSEPTOROV-BETA AGONISTY, BETA-ADRENORETSEPTOROV AGONISTY, ADRENERGICHESKIKH BETA-RETSEPTOROV AGONISTY, АДРЕНЕРГИЧЕСКИЕ БЕТА-АГОНИСТЫ, АДРЕНЕРГИЧЕСКИХ БЕТА-РЕЦЕПТОРОВ АГОНИСТЫ, АДРЕНОРЕЦЕПТОРОВ-БЕТА АГОНИСТЫ, БЕТА-АДРЕНОРЕЦЕПТОРОВ АГОНИСТЫ
Spanish Agonistas beta-Adrenérgicos, Agonistas de los beta-Receptores Adrenérgicos, Agonistas Adrenérgicos beta, Agonistas de los Receptores Adrenérgicos beta, Agonistas de los Receptores beta-Adrenérgicos, beta-Agonistas Adrenérgicos, agonista beta adrenérgico (producto), agonista beta adrenérgico (sustancia), agonista beta adrenérgico, agonista betadrenérgico (sustancia), agonista betadrenérgico
German ADRENERGE AGONISTEN BETA, Adrenerge Beta-Agonisten, Beta-Adrenomimetika, Beta-Rezeptorenagonisten
Polish Agoniści adrenergiczni beta, Beta-mimetyki, Agoniści receptora adrenergicznego beta
Japanese β-アドレナリン作動性受容体作用薬, β-作動剤, β-作動薬, β-作用薬, β-刺激薬, β-受容体作用薬, アドレナリンベータアゴニスト, アドレナリン作用性ベータ受容体作用薬, ベータアドレナリン作用性受容体作用薬, β作動薬, β刺激剤, β刺激薬, β受容体刺激薬, アドレナリン作用性ベータ受容体作用剤, アドレナリン作用性ベータ受容体作用物質, アドレナリン作用性ベータ受容器作用物質
Italian Beta-agonisti adrenergici
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bronchodilator Agents (C0006280)

Definition (NCI_NCI-GLOSS) A type of drug that causes small airways in the lungs to open up. Bronchodilators are inhaled and are used to treat breathing disorders, such as asthma or emphysema.
Definition (MSH) Agents that cause an increase in the expansion of a bronchus or bronchial tubes.
Definition (CSP) agent that causes an expansion of the lumen of a bronchus or bronchiole.
Concepts Pharmacologic Substance (T121)
MSH D001993
SnomedCT 116091006, 300900000, 373241008, 353866001, 372580007
LNC LP31460-6
English Agents, Bronchodilator, Bronchodilator Agents, Agents, Bronchial-Dilating, Bronchial Dilating Agents, Bronchial-Dilating Agents, Bronchodilators, lumen dilator, bronchodilators, bronchodilator agents, bronchodilators (medication), bronchodilator, Bronchodilator (product), Bronchodilator agents (substance), Bronchodilator agents, Bronchodilator preparations, Bronchodilator, Bronchodilator (substance), Bronchodilator preparations (product), Bronchodilator preparations (substance)
French Agents bronchodilatateurs, Bronchodilatateurs
Swedish Bronkvidgande medel
Czech bronchodilatancia
Finnish Bronkodilataattorit
Russian BRONKHORASSHIRIAIUSHCHIE SREDSTVA, БРОНХОРАСШИРЯЮЩИЕ СРЕДСТВА
Japanese 気管支拡張剤, 気管支拡張薬
Croatian BRONHODILATORI
Polish Leki rozszerzające oskrzela, Środki broncholityczne
Portuguese Dilatadores Brônquicos, Efeito Broncodilatador, Agentes Broncodilatadores, Dilatadores Bronquiais, Fármacos Broncodilatadores, Broncodilatadores
Spanish Dilatadores Bronquiales, Broncodilatadores, agentes broncodilatadores, broncodilatador (producto), agentes broncodilatadores (sustancia), Agentes Broncodilatadores, Efecto Broncodilatador, Fármacos Broncodilatadores, broncodilatador (sustancia), broncodilatador, preparaciones con broncodilatadores (producto), preparaciones con broncodilatadores (sustancia), preparaciones con broncodilatadores
German Bronchienerweiternde Mittel, Bronchodilatatoren
Italian Broncodilatatori
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: pirbuterol (C0071129)

Definition (NCI) A short-acting, beta-adrenergic receptor agonist with bronchodilator activity. Pirbuterol selectively binds to beta-2 adrenergic receptors in bronchial smooth muscle, thereby activating intracellular adenyl cyclase, an enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3',5'-adenosine monophosphate (cAMP). Increased cAMP levels cause relaxation of bronchial smooth muscle, relieve bronchospasms, improve mucociliary clearance and inhibit the release of mediators of immediate hypersensitivity from cells, especially from mast cells.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C009118
SnomedCT 108611006, 372516006
English pirbuterol, pyrbuterol, pirbuterol (medication), pirbuterol [Chemical/Ingredient], PIRBUTEROL, Pirbuterol, Pirbuterol (product), Pirbuterol (substance)
Spanish pirbuterol (producto), pirbuterol (sustancia), pirbuterol
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Proventil (C0699770)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D000420
French Proventil
English proventil, Proventil
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Brethaire (C0701015)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D013726
English brethaire, AstraZeneca Brand of Terbutaline, Brethaire, Terbutaline AstraZeneca Brand
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Maxair (C0721597)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C009118
English Maxair, 3M brand of pirbuterol acetate, maxair
Derived from the NIH UMLS (Unified Medical Language System)

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