Albuterol vs Ventolin

Our complete guide comparing Albuterol to Ventolin. The post compares medical application, dosage and intake methods, side effects and interactions of both drugs. You will also find here some information on how to use metered dose inhaler and nebulizer solution.

What would you do if your child had an asthma attack? Without wasting a single second, you would rush to grab an inhaler. We all know that inhalers are the best things known that can provide instant relief from asthma attack within no time. But, what makes these inhalers so magical? These are the drugs contained within these inhalers that tend to provide instant relief from asthma attacks.

You might have heard about albuterol and ventolin inhalers. These are the commonly used inhalers for the symptomatic relief of those lung diseases or conditions that are associated with bronchospasm, a condition in which the airway passages of lungs get narrowed. 

Albuterol

Albuterol is a bronchodilator drug that belongs to group of drugs called beta-2 agonists. It acts by relaxing the bronchial smooth muscles and dilating the air passages. This increases the air flow in the lungs and makes the breathing easier. Albuterol has been widely used for treating obstructive lung diseases. The IUPAC name for albuterol is RS)-4-[2-(tert-butylamino)-1-hydroxyethyl]-2-(hydroxymethyl)phenol.

Albuterol comes under following brand names:

• Accuneb
• Pro air
• Proventil

Medical applications

Since albuterol is a bronchodilator, it is used for symptomatic relief of the following obstructive lung diseases:

Asthma

Asthma is a chronic lung disease characterized by reversible attacks of bronchospasm, wheezing and shortness of breath. It is actually a chronic inflammatory lung disease that is triggered by allergy to air borne particles like dust and pollens. Lungs of asthmatic patients are highly sensitive to the inhaled air borne allergens because when asthmatic patient are exposed to allergens present in the air, their body considers them as a threat and launches a strong allergic response in the lungs in order to eradicate these allergens. This leads to the inflammation and swelling of air passages, with increased mucus production that clogs the air passages. Allergic inflammation also causes constriction of bronchial smooth muscles which results in bronchospasm or narrowing of respiratory passages. All these sequences then end up with an attack of asthma with cough, wheezing, chest tightness and shortness of breath. Albuterol cannot interfere with the inflammation but, it does help to relax the bronchial smooth muscle which opens up the air passages and improves the air flow (1, 2, 3).

COPD

COPD term stands for chronic obstructive pulmonary diseases that are a group of lung disorders, including emphysema and chronic bronchitis. Tobacco smoke and environmental pollutant are the main culprits behind these diseases. In patients with COPD, the prolonged exposure to tobacco causes permanent inflammatory changes in the air passages. The irritation of lining of air passages causes thickening of their walls, increased mucus production and constriction of bronchial smooth muscles. This causes narrowing of air passages that makes it difficult for air to flow in and out of the lungs, leading to chronic bouts of cough and shortness of breath. Albuterol improves the airflow in such patients by relaxing the bronchial smooth muscles and relieving the bronchospasm. However, albuterol can just provide temporary relief from bronchospasm for a few hours because it cannot cause reversal of permanent destructive changes that have occurred to the air passages. In COPD it is frequently used with other drugs, such as ipratropium, for better effects (4).

Dosage and intake methods

Albuterol is effective for providing quick relief from acute bronchospasm. The commonly used preparations or formulations of albuterol are metered dose aerosol inhalers and liquid solutions that can be used with the help of nebulizer. No doubt, albuterol provides prompt reduction in symptoms of bronchospasm but, unfortunately, most of us do not know the proper use of inhaler or nebulizer liquid. Therefore, chances of drug over dosage are quite high with the use of inhalers or nebulizer liquids. Inhalers and nebulizer solutions come in different strengths, so care should be taken while measuring the correct dosage before using this drug. Here are the recommended dosages of albuterol for adults and children;

Recommended dosage for adults

• For acute attack of asthma, the recommended dose of albuterol inhaler is 2 puffs every 4-6 hours as per need of the individual. For nebulizer solution, the recommended dose is 2.5mg every 6-8 hours or 3-4 times per day as per need.
• For prevention of exercise induced asthma, the recommended dose of inhaler is 2 puffs 15-20 minutes before doing exercise.
• For treatment of chronic obstructive lung diseases (COPD), the recommended dose of inhaler is about 2 puffs every 4-6 hours. For nebulizer solution, the safe dose is 2.5mg every 6-8 hours or 3-4 times per day.

Recommended dosage for children

Children are prone to suffer from drug over dosage. That is why more precautions should be taken while using inhaler or nebulizer solutions in children, especially the children who are below the age of 2 years. Here are the recommended dosages for children:

• For children under the age of 2 year, the dose is calculated according to weight of the child. The recommended safe dose is 0.1 to 0.15mg/kg/dose given through nebulizer. The dose can be repeated every 4-6 hours depending on the child’s response, but the maximum dose should not exceed 2.5 mg three to four times per day.  Giving higher doses than this can result in unwanted side effects in children.
• For children between 2-4 years of age, the recommended dose of albuterol is 1.25 to 2.5mg per dose, with the repetition of dose every 4-6 hours as per need of the child. Albuterol in the children of this age group should be given through nebulizer solution. The use of albuterol inhaler should be avoided because young children are uncooperative and cannot breathe in through inhaler properly.
• For children between 5-12 years of age, both inhaler albuterol and nebulizer solution can be used. The recommended dose for inhaler is 1-2 puffs every 4-6 hours. Nebulizer solution can be given 2.5mg three to four times per day as per need or condition of the child.

How to use metered dose inhaler?

Before using the inhalers, follow the instructions below to achieve the maximum benefit of the medicine:

• Remove the cap covering the mouthpiece and look for any dust particles present within mouthpiece. If there are dirt particles remove them first.
• If you have not used your inhaler for the last 2 weeks or you are using it for first time, then you may need to prime it first. Shake the inhaler well. Then release 4 test sprays away from your face. Now your inhaler is ready to use.
• Shake the inhaler well every time before using it.
• Now hold the inhaler in such a way that its canister points upward. Put the mouthpiece in your mouth and close your lips around.
• Press the canister once and breathe in slowly and deeply while doing so.
• Hold your breath for 30 seconds, if possible. Then remove the inhaler and breathe out slowly.
• If you want to take 2 puffs, again shake the inhaler and repeat the same steps.
• Once you are done, rinse your mouth with water to remove the residual drug particles deposited in the mouth.
• After using the inhaler, cover the mouthpiece with its cap.

How to use nebulizer solution?

Nebulizer is a machine that produces mist of albuterol solution that can be inhaled through a face mask. Here are steps to use nebulizer solution:

• Take one vial of albuterol solution and look if it is clear and colorless. If not, do not use the solution.
• Now cut the vial from top and add required or recommended amount of solution in the nebulizer reservoir. Add 1-2 ml of normal saline in it to dilute the solution as will help in forming the mist.
• Connect the nebulizer reservoir to a face mask.
• Sit in upright position and put on the face mask. Now switch on the machine.
• The mist will start coming out of face mask. Keep breathing this mist slowly and deeply for 10-15 minutes, until the mist stops coming from the machine.
• Switch off the machine. Detach the face mask and wash it with water.
• Rinse your mouth with water to remove any extra drug deposited in the mouth.

Precautions

Keep following precautions in mind while using albuterol inhalers or solutions:

• If any allergic reaction occurs after using albuterol, discontinue its use and talk to the doctor for a better alternative.
• You must wash your inhaler every week to remove the dirt particles. Remove the canister first and then run the water through mouthpiece for 30 seconds. Let it dry and then reinsert the canister.
• Do not forget to prime the inhaler if you are using it after a long time.
• Read the label before using albuterol and do not take more than recommended amount.
• If you miss the dose, take it as soon as you remember it. But if you’re near the time for next dose, then skip the dose and continue according to your planned dose.
• Tell your doctor first if you have any history of blood pressure or heart disease because albuterol can aggravate the heart problems.
• Patients having diabetes and thyroid problems should take albuterol after consulting the doctor.
• Pregnant and lactating women also need to tell doctor before using albuterol.

Mechanism of albuterol

The lungs bronchi are divided into hundreds of small terminal bronchioles and alveoli (air sacs). These terminal bronchioles and alveoli are richly supplied with blood vessels and are the main site of gas exchange. In obstructive lung diseases, these tiny respiratory passages get constricted due inflammation which reduces the air flow and makes it difficult for one to breath. Surrounding these air passages or bronchioles are the smooth muscles that can cause the changes in the diameter of air passages by contracting and relaxing. These bronchial muscles contain an abundant amount of beta-2 receptors. These beta 2 receptors are the main target of albuterol. Albuterol causes stimulation of beta 2 receptors, which lead to the activation of enzyme named as adenyl cyclase. This enzyme increases the intracellular production of cyclic AMP. The purpose of this AMP is to reduce the intracellular concentration of calcium ions, which are mainly responsible for constriction of bronchial smooth muscles. Once the intracellular level of calcium is reduced, the bronchial smooth muscles begin to relax and there is increase in diameter of respiratory passages. Thus, by relaxation of bronchial smooth muscles, the airflow in lungs is improved that provides rapid relief from the attack of bronchospasm.

Actions after intake; pharmacokinetics

Pharmacokinetics of albuterol are divided into following four phases (5):

Absorption

After inhalation, about 20 percent of the drug is absorbed through lungs. The remaining drug stays in the mouth and pharynx. The action of inhaled drug start within 30-minutes and reaches maximum after 20-30 minutes. The peak plasma concentration of inhaled albuterol reaches within 2 hours. The total duration of action of drug is about 4-6 hours.

Distribution

Plasma protein binding percentage of albuterol is only 10 percent.

Metabolism

It is extensively metabolized through hepatic enzymes and through sulfotranferase enzymes present in GI tract.

Excretion

Excretion is mainly through urine. Both metabolic products and unchanged drug are excreted through urine. Some amount is also excreted through feces. Plasma half life of albuterol is about 3-6 hours.

Overdosage

Seek immediate medical help if you have following symptoms of albuterol drug toxicity or over dosage:

• Skin rashes, hives or itching
• Irregular fast pounding heart beat
• Chest pain or palpitations
• Swelling of face, lips and throat
• Tremors
• Muscle weakness
• Headache
• Worsening of bronchospasm
• Dry mouth
• Dizziness or light headedness
• Extreme fatigue
• Fainting

Side effects

Following are the side effects of albuterol (6, 7):

Common or less serious side effects

• Dry mouth
• Nausea
• Legs cramps and tremors
• Muscle weakness
• Mild headache or dizziness
• Difficulty in sleep
• Nervousness

Rare or serious side effects

• Worsening of symptoms
• Difficulty in swallowing and breathing
• Skin rashes or hives
• Hoarseness
• Swelling of lips, face and throat
• Chest pain and irregular heart beats
• Muscle pain
• Severe dizziness or confusion

Drug interactions

Albuterol may interact with other drugs you take. Always tell your physician about medicines you take before taking albuterol and ask him/her for advice (8).

• Albuterol should not be used with diuretics because they cause severe hypokalemia and muscle weakness.
• When used with monoamine oxidase inhibitors or tricyclic antidepressants, the chances of cardiovascular problems are increased.
• Avoid taking herbal and vitamin supplements along with this drug as they cause drug interactions.

Ventolin

Ventolin is the brand name for albuterol sulphate or salbutamol sulphate. Albuterol is the generic name used in USA while salbutamol is the international generic name. Generic albuterol inhalers have now been replaced by HFA inhalers because they used to contain harmful propellants like chlorofluorocarbons- the chemicals that damage the ozone layer and are not eco friendly. New HFA inhalers are a better alternative because the propellants they use are more eco friendly. Also these inhalers produce a fine mist that is easily to breath as compared to the harsh mist produced by CFC inhalers. Ventolin is a perfect example of new HFA inhaler, containing sulphate derivative of albuterol. The IUPAC name for albuterol sulphate is RS)-4-[2-(tert-butylamino)-1-hydroxyethyl]-2-(hydroxymethyl)phenol.

Other brand names of albuterol sulphate are:

• Ventolin HFA
• Proventil HFA
• Pro air HFA

Medical applications

Ventolin is used to relieve bronchospasm associated with following medical conditions:

• Asthma
• Exercise induced asthma
• Chronic obstructive pulmonary diseases.

Dosage and intake methods

If you want an instant and effective relief from bronchospasm, then always take ventolin in the recommended amount. Taking drug in lower than recommended amount will not be enough to provide you effective relief. On the other hand, taking more than recommended will cause more harm than good. Following recommended dosages of ventolin will help you calculate the accurate dose:

Recommended dosage for adults

• For asthma, 1-2 puffs of inhaler can be taken every 4-6 hours. And for ventolin solution, the recommended dose is 2.5mg/dose three to four time per day.
• For prevention of exercise induced asthma, take 1-2 puffs of ventolin inhaler before 15-20 minutes of exercise.
• For chronic obstructive pulmonary diseases, take 1-2 puffs of ventolin inhaler every 4-6 hours as per need. Or you can take 2.5mg of ventolin solution through nebulizer 3-4 times per day.

Recommended dosage for children

• For children below the age of 2 year, the recommended dose is 0.5-0.15mg/kg/dose that can be repeated every 4-6 hours.
• For children of 2-4 years of age, the recommended dose of ventolin solution should be 1.25mg to 2.5 mg every 4-6 hours.
• For children of 5-12 years of age, 1-2 puffs of inhaler can be taken three to four times a day or 2.5mg of ventolin solution can be given through nebulizer three to four times per day as per response and need of the child.

Precautions

Keep following precautions in mind before using ventolin:

• Read the label of medicine first and then follow the instruction. As different formulations of ventolin have different strengths so measure the correct dose according as mentioned on the label.
• Do learn the right technique to use inhaler and nebulizer.
• Do not forget to wash your inhaler once in week.
• Stop taking ventolin if you experience any allergic reaction to it.
• People having heart problems and high blood pressure must take it carefully as ventolin can aggravate their problem.
• If you experience worsening of symptoms or shortness of breath after taking ventolin, discontinue its use and seek medical help.
• Patients having epilepsy should avoid taking ventolin as it can trigger seizures in these patients.
• If you are having diabetes or thyroid problem, talk to your doctor before using ventolin.
• Pregnant and lactating women should also consult doctor before taking ventolin.

Mechanism of ventolin

Ventolin or albuterol sulphate is beta 2 agonist. It acts on the beta 2 receptors of bronchial smooth muscles and causes their relaxation. When the bronchial smooth muscles are relaxed, the diameter of respiratory air passages are increased which helps reduce the resistance and improve the airflow. When airflow is improved through respiratory passages, the patient begins to feel the relief from his symptoms.

Actions after intake, pharmacokinetics

Pharmacokinetic properties of ventolin are as follows:

Absorption

After inhalation, only 20 percent of the drug reaches lungs and the rest of its remains deposited in mouth and throat. Action of drug begins within 3-5 minutes with peach reaches within 15-30 minutes. The peak plasma level reaches within 2 hours after inhalation. The effect of this drug lasts for 4-6 hours.

Distribution

After absorption, the drug is distributed throughout the body. However, it cannot cross blood brain barrier. Plasma protein binding percentage of this drug is 10 percent.

Metabolism

Metabolism of ventolin takes place in liver and GI tract through hepatic enzymes and GI sulfotransferase enzymes respectively.

Excretion

The main route of excretion is through urine. Both metabolites and unchanged products are excreted through urine. Plasma half life is about 3-5 hours.

Overdosage

Get the medical help immediately if you observe following symptoms of ventolin over dosage:

• Skin allergic reaction including skin rashes and hives
• Difficulty in breathing
• Swelling of face, lips or throat
• Difficulty in swallowing
• Extreme fatigue or muscle pain
• Tremors
• Headache, nervousness or severe dizziness
• Chest pain, palpitations or pounding heart beats
• Fainting

Side effects

Side effects of ventolin are:

Common side effects

• Dry mouth
• Nausea
• Muscle cramps or weakness
• Mild headache
• Trembling of hands and feet

Rare side effects

• Difficulty in swallowing or breathing
• Swelling of lips and throat
• Wheezing or chest tightness
• Hoarseness
• Palpitations or irregular heart beats
• Skin rashes or hives
• Extreme muscle weakness or pain
• Severe dizziness or fainting.

Drug interactions

Ventolin may interact with other drugs you take. Always tell your physician about medicines you take before taking albuterol and ask him/her for advice.

• Ventolin should not be taken with diuretics as they both can cause hypokalemia and muscle weakness.
• When taken with MOA inhibitors and antidepressant drugs, the risks of cardiovascular side effects are increased many folds.
• Digoxin should be avoided while giving ventolin as hypokalemia induced by ventolin can potentiate digoxin toxicity.
• Do not take herbal or vitamin supplement without asking the doctor.
• Use of other beta 2 agonist along with ventolin tends to enhance the risk of serious side effects.

Conclusion

Both albuterol and ventolin have the same mechanism of action and efficacy but Ventolin HFA is a much safer choice as compared to generic formulation of albuterol because they are more eco friendly and have fewer side effects compared to CFC albuterol formulations. However you should always follow the advice of your physician and ask him for his opinion before using any of these medicines.