of albuterol sulfate syrup than usual, this may be a marker of destabilization of asthma and requires reevaluation of the patient and treatment regimen, giving special consideration to the possible need for anti-inflammatory treatment, e.g., corticosteroids. paradoxical bronchospasm albuterol sulfate syrup can produce paradoxical bronchospasm, which may be life threatening. if paradoxical bronchospasm occurs, albuterol sulfate syrup should be discontinued immediately and alternative therapy instituted. use of anti-inflammatory agents the use of beta-adrenergic agonist bronchodilators alone may not be adequate to control asthma in many patients. early consideration should be given to adding anti-inflammatory agents, e.g., corticosteroids. immediate hypersensitivity reactions immediate hypersensitivity reactions may occur after administration of albuterol, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, and oropharyngeal edema. albuterol, like other beta-adrenergic agonists, can produce a significant cardiovascular effect in some patients, as measured by pulse rate, blood pressure, symptoms, and/or electrocardiographic changes. rarely, erythema multiforme and stevens-johnson syndrome have been associated with the administration of albuterol sulfate in children.

tepwise up to a maximum of 8 mg four times a day as tolerated. children over 6 years to 14 years of age who fail to respond to the initial starting dosage of 2 mg four times a day: for children over 6 years to 14 years of age who fail to respond to the initial starting dosage of 2 mg four times a day, the dosage may be cautiously increased stepwise, but not to exceed 24 mg/day (given in divided doses). children 2 to 5 years of age who do not respond satisfactorily to the initial dosage: for children from 2 to 5 years of age who do not respond satisfactorily to the initial starting dosage, the dosage may be increased stepwise to 0.2 mg/kg of body weight three times a day, but not to exceed a maximum of 4 mg (2 teaspoonfuls) given three times a day. elderly patients and those sensitive to beta-adrenergic stimulators: the initial dosage should be restricted to 2 mg three or four times a day and individually adjusted thereafter.

reaction percent incidence central nervous system excitement 20% nervousness 15% hyperkinesia 4% sleeplessness 2% emotional lability 1% fatigue 1% cardiovascular tachycardia 2% pallor 1% gastrointestinal gastrointestinal symptoms 2% loss of appetite 1% ophthalmologic conjunctivitis 1% cases of urticaria, angioedema, rash, bronchospasm, hoarseness, oropharyngeal edema, and arrhythmias (including atrial fibrillation, supraventricular tachycardia, extrasystoles) have been reported after the use of albuterol sulfate syrup. in addition, albuterol, like other sympathomimetic agents, can cause adverse reactions such as hypertension, angina, vomiting, vertigo, central nervous system stimulation, unusual taste, and drying or irritation of the oropharynx. the reactions are generally transient in nature, and it is usually not necessary to discontinue treatment with albuterol sulfate syrup. in selected cases, however, dosage may be reduced temporarily; after the reaction has subsided, dosage should be increased in small increments to the optimal dosage.

from cells, especially from mast cells. albuterol has been shown in most controlled clinical trials to have more effect on the respiratory tract, in the form of bronchial smooth muscle relaxation, than isoproterenol at comparable doses while producing fewer cardiovascular effects. albuterol is longer acting than isoproterenol in most patients by any route of administration because it is not a substrate for the cellular uptake processes for catecholamines nor for catechol- o -methyl transferase. preclinical intravenous studies in rats with albuterol sulfate have demonstrated that albuterol crosses the blood brain barrier and reaches brain concentrations amounting to approximately 5.0% of the plasma concentrations. in structures outside the brain barrier (pineal and pituitary glands), albuterol concentrations were found to be 100 times those in the whole brain. studies in laboratory animals (minipigs, rodents, and dogs) have demonstrated the occurrence of cardiac arrhythmias and sudden death (with histologic evidence of myocardial necrosis) when beta-agonists and methylxanthines are administered concurrently. the clinical significance of these findings is unknown. pharmacokinetics albuterol is rapidly absorbed after oral administration of 10 ml of albuterol sulfate syrup (4 mg of albuterol) in normal volunteers. maximum plasma concentrations of about 18 ng/ml of albuterol are achieved within 2 hours, and the drug is eliminated with a half-life of about 5 hours. in other studies, the analysis of urine samples of patients given 8 mg of tritiated albuterol orally showed that 76% of the dose was excreted over three days, with the majority of the dose being excreted within the first 24 hours. sixty percent of this radioactivity was shown to be the metabolite. feces collected over this period contained 4% of the administered dose. clinical trials in controlled clinical trials in patients with asthma, the onset of improvement in pulmonary function, as measured by maximum midexpiratory flow rate (mmef) and forced expiratory volume in 1 second (fev 1 ), was within 30 minutes after a dose of albuterol sulfate syrup, with peak improvement occurring between 2 and 3 hours. in a controlled clinical trial involving 55 children, clinically significant improvement (defined as maintaining a 15% or more increase in fev 1 and a 20% or more increase in mmef over baseline values) continued to be recorded up to 6 hours. no decrease in the effectiveness was reported in one uncontrolled study of 32 children who took albuterol sulfate syrup for a 3-month period.