Salbutamol-G Special Precautions

The management of asthma should normally follow a stepwise programme, and patient response should be monitored clinically and by lung function test.
Increasing use of short-acting inhaled β₂ agonist to control symptoms indicates deterioration of asthma control. Under this condition, the patient’s therapy plan should be reassessed. Sudden and progressive deterioration in asthma control is potentially life-threatening and consideration should be given to starting or increasing corticosteroids therapy. In patients considered at risk, daily peak flow monitoring may be instituted.
Patients should be warned that is either the usual relief is diminished or the usual duration of action reduced, they should not increase the dose or its frequency of administration, but should seek medical advice.
Salbutamol should be administered cautiously to patients with thyrotoxicosis.
In common with other β-adrenoceptor agonists, salbutamol can induce reversible metabolic changes, for example increased blood sugar levels. Diabetic patient may be unable to compensate for this and the development of ketoacidosis has been reported. Concurrent administration of corticosteroid can exaggerate this effect.
Tocolysis: Serious adverse reactions including death have been reported of salbutamol to women in labor. In mothers, these include increased heart rate, transient hyperglyceamia, hypokalaemia, cardiac arrhythmias, pulmonary oedema and myocardial ischaemia. Increased fetal heart rate and neonatal hypoglycaemia may occur as a result of maternal administration.
As maternal pulmonary oedema and myocardial ischaemia have been reported during or following treatment of premature labour with β₂ agonists, careful attention should be given to fluid balance and cardio-respiratory function, including ECG should be monitored. If signs of pulmonary oedema or myocardial ischaemia develop, discontinuation of treatment should be considered.
Bronchodilators should not be the only or main treatment in patient with severe or unstable asthma. Severe asthma requires regular medical assessment including lung function testing as patients are at risk of severe attacks and even death. Physicians should consider using oral corticosteroid therapy and/or the maximum recommended dose of inhaled corticosteroid in those patients.