Pulmonary - Beta2 Agonists

Short-acting Beta2 Agonists
albuterol (Proventil ®)	bitolterol (Tornalate ®)
levalbuterol (Xopenex ®)	pirbuterol (Maxair ®)
metaproterenol (Alupent ®)
Long-acting Beta2 Agonists
formoterol (Foradil ®)	salmeterol (Serevent ®)

Short-acting Beta2 Agonists

albuterol (Proventil ®)

Beta-2 Agonist.
Adult (usual):
Asthma: 1-2 puffs every 4-6 hours as needed. Maximum: 12 inhalations/day.
Prophylaxis of exercise-induced bronchospasm:
MDI: 2 puffs 5-30 minutes prior to exercise.
Nebulized 2.5 mg 3-4 times daily.
Tablets: 2-4 mg orally 3-4 times daily.
Sustained release tablets: 4-8 mg q12h (Maximum dose: 32 mg/day).

Acute treatment of bronchospasm:
MDI (90 mcg/puff): 4-8 puffs every 20 minutes for up to 4 hours, then every 1-4 hours as needed.
Nebulization: 2.5 mg (3ml) 3-4 times/day over 5-15 minutes.

Bronchospasm in ICU patients (acute): Nebulization: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, or 10-15 mg/hour continuously.

bitolterol (Tornalate ®)

(Beta-2 agonist):
Adult (usual):
Bronchospasm, acute: MDI 2 puffs separated by 1-3 minutes, follow with third as needed.
Bronchospasm, prevention: MDI, 2 puffs q8h, Maximum of 3 puffs q6h or 2 puffs q4h.
Bronchospasm, prevention: (intermittent flow nebulizer) 0.5-1 ml (1-2 mg) 3-4 times per day (Maximum of 8 mg/day). (continuous flow nebulizer) 1.25 ml (2.5 mg) 3-4 times/day. (Maximum of 14 mg/day).

Supplied [0.8% aerosol. 0.2% (2 mg/ml) inhalation Soln].

levalbuterol (Xopenex ®)

Beta-2 agonist.
Adult (usual):
Bronchospasm: MDI: Aerosol: 1-2 puffs every 4-6 hours.

Nebulization: 0.63 mg 3 times/day at intervals of 6-8 hours. Dosage may be increased to 1.25 mg 3 times/day with close monitoring for adverse effects. Most patients gain optimal benefit from regular use.

Levalbuterol (R-enantiomer of albuterol) has approximately 2-fold greater binding affinity compared to racemic albuterol, and approximately 100-fold greater binding affinity than S-albuterol. (Bronchodilatory effects of racemic albuterol are due to R-albuterol).

pirbuterol (Maxair ®)

Adult (usual): Asthma: 1-2 puffs every 4-6 hours (up to 12 puffs/day).

metaproterenol (Alupent ®)

Adult (usual):
Asthma, bronchospasm: 20 mg orally 3-4 times/day.

Oral aerosol inhalation: 2-3 puffs q3-4 hours (Max of 12 puffs/day).

Nebulizer: 0.3 ml (5%) in 2.5 ml NS q4-6 hours prn.

Long-acting Beta2 Agonists

formoterol (Foradil ®)

(Long-acting Beta-2 agonist):
Adult (usual):
Asthma (maintenance therapy): Oral inhalation - 12 mcg (1 capsule) q12h via aerolizer inhaler. (Maximum of 24 mcg/day).

COPD: Oral inhalation 12 mcg (1 capsule) q12h via aerolizer inhaler.

Exercise-induced bronchospasm (EIB): 12 mcg (1 capsule) at least 15 min before exercise as needed.

Supplied: [12 mcg capsule]

salmeterol (Serevent ®)

Serevent Diskus:
Asthma: usual dosage for adults and children 4 years of age and older is 1 inhalation (50 mcg) twice daily (morning and evening, approximately 12 hours apart). If symptoms arise in the period between doses, an inhaled, short-acting beta 2 -agonist should be taken for immediate relief.

COPD: usual dosage for adults is 1 inhalation (50 mcg) twice daily (morning and evening, approximately 12 hours apart).

Prevention of Exercise-Induced Bronchospasm (EIB): One inhalation at least 30 minutes before exercise. Additional doses should not be used for 12 hours after the administration of this drug. If regular, twice-daily dosing is not effective in preventing EIB, other appropriate therapy for EIB should be considered.

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David F. McAuley, Pharm.D., R.Ph. GlobalRPh Inc.

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