Salbutamol: Difference between revisions

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{{Short description|Short-acting bronchodilator used for acute asthma}}

{{drugbox

| verifiedrevid = 417082603

| IUPAC_name = (''RS'')-4-[2-(''tert''-butylamino)-1-hydroxyethyl]-2-(hydroxymethyl)phenol

| image = Salbutamol Enantiomers Structural Formulae.png|(RS)-Salbutamol

{{infobox drug

| imagename = 1 : 1 mixture (racemate)

| Verifiedfields = changed

| width = 200

| Watchedfields = changed

| image2 = RS-salbutamol-from-xtal-3D-balls.png

| verifiedrevid = 418791908

| width2 = 200

| image = Salbutamol.svg

| imagename = 1 : 1 mixture (racemate)

| width = 200

| drug_name = Salbutamol

| image2 = RS-salbutamol-from-xtal-3D-balls.png

| CASNo_Ref = {{cascite|correct|CAS}}

| alt =

| UNII_Ref = {{fdacite|correct|FDA}}

| caption = Salbutamol (top), (''R'')-(−)-salbutamol (center) and (''S'')-(+)-salbutamol (bottom)

| UNII = QF8SVZ843E

| chirality = [[Racemic mixture]]

| ChEMBL_Ref = {{ebicite|correct|EBI}}

| USAN = Albuterol

| ChEMBL = 714

| KEGG_Ref = {{keggcite|correct|kegg}}

| KEGG = D02147

| pronounce =

| InChI = 1/C13H21NO3/c1-13(2,3)14-7-12(17)9-4-5-11(16)10(6-9)8-15/h4-6,12,14-17H,7-8H2,1-3H3

| tradename = Ventolin, Proventil, ProAir, others<ref name=brands/>

| InChIKey = NDAUXUAQIAJITI-UHFFFAOYAW

| Drugs.com = {{drugs.com|monograph|albuterol}}

| StdInChI_Ref = {{stdinchicite|correct|chemspider}}

| MedlinePlus = a607004

| StdInChI = 1S/C13H21NO3/c1-13(2,3)14-7-12(17)9-4-5-11(16)10(6-9)8-15/h4-6,12,14-17H,7-8H2,1-3H3

| DailyMedID = Albuterol

| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}

| pregnancy_AU = A

| StdInChIKey = NDAUXUAQIAJITI-UHFFFAOYSA-N

| pregnancy_AU_comment = <ref>{{cite web| title=Prescribing medicines in pregnancy database | author=Thereaputic Goods Administration | publisher=Australian Government | url=https://www.tga.gov.au/prescribing-medicines-pregnancy-database| date=19 December 2018 }}</ref><ref name="Drugs.com Pregnancy">{{cite web | title=Albuterol Use During Pregnancy | website=Drugs.com | date=8 March 2019 | url=https://www.drugs.com/pregnancy/albuterol.html | access-date=21 December 2019}}</ref>

| CAS_number = 18559-94-9

| pregnancy_category =

| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}

| routes_of_administration = [[Oral administration|By mouth]], [[Inhaler|Inhalational]], [[Intravenous therapy|Intravenous]]

| ChemSpiderID = 1999

| class = [[Beta2-adrenergic agonist]]

| ATC_prefix = R03

| ATC_suffix = AC02

| ATC_supplemental = {{ATC|R03|CC02}}

| ATC_supplemental = {{ATC|R03|CC02}} {{ATC|R03|AK04}} {{ATC|R03|AK13}} {{ATC|R03|AL02}}

| PubChem = 2083

| IUPHAR_ligand = 558

| DrugBank = APRD00553

| ~~C=13~~ | ~~H=21~~ | ~~N=1~~ | O=3

| =

| legal_AU_comment = <ref>{{cite web|title=Poisons Standard October 2017|url=https://www.legislation.gov.au/Details/F2017L01285/Html/Text#_Toc471222305| author=Thereaputic Goods Administration | publisher=Australian Government}}</ref>

| molecular_weight = 239.311

| legal_BR =

| bioavailability =

| legal_BR_comment =

| protein_bound =

| legal_CA = Rx-only

| metabolism = [[Liver|Hepatic]]

| legal_CA_comment = <ref>{{cite web|title=Prescription Drug List|date=23 October 2014|publisher=Government of Canada|url=https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/prescription-drug-list/list.html}}</ref><ref>{{cite web | title=Respiratory health | website=[[Health Canada]] | date=9 May 2018 | url=https://www.canada.ca/en/services/health/drug-health-products/drug-medical-device-highlights-2017/approved-drugs/respiratory-health.html | access-date=13 April 2024}}</ref>

| elimination_half-life = 1.6 hours

| legal_DE =

| excretion = [[Renal]]

| ~~pregnancy_AU~~ = A

| =

| legal_NZ = Prescription only

| pregnancy_US = C

| legal_UK = POM

| pregnancy_category =

| legal_UK_comment =

| smiles = OCc1cc(ccc1O)C(O)CNC(C)(C)C

| legal_US = Rx-only

| legal_AU = S3

| legal_US_comment =

| legal_CA =F (prescription)<ref>Health Canada</ref>

| legal_EU =

| legal_UK = POM

| legal_EU_comment =

| legal_US = Rx-only

| legal_UN =

| legal_status =

| legal_UN_comment =

| routes_of_administration = Oral, inhalational, [[Intravenous therapy|IV]]

| legal_status =

| metabolism = [[Liver]]

| elimination_half-life = 3.8–6 hrs (inhaled); 5–7.2 hrs (pill)<ref name=AHFS2015/>

| excretion = [[Kidney]]

| onset = <15 min (inhaled), <30 min (pill)<ref name=AHFS2015/>

| duration_of_action = 3–6 hrs (inhaled); up to 8 hrs (pill)<ref name=AHFS2015/>

| CAS_number_Ref = {{cascite|correct|??}}

| CAS_number = 18559-94-9

| CAS_supplemental =

| PubChem = 2083

| PubChemSubstance = 46505312

| IUPHAR_ligand = 558

| DrugBank_Ref = {{drugbankcite|changed|drugbank}}

| DrugBank = DB01001

| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}

| ChemSpiderID = 1999

| UNII_Ref = {{fdacite|correct|FDA}}

| UNII = QF8SVZ843E

| KEGG_Ref = {{keggcite|correct|kegg}}

| KEGG = D02147

| ChEBI_Ref = {{ebicite|changed|EBI}}

| ChEBI = 2549

| ChEMBL_Ref = {{ebicite|correct|EBI}}

| ChEMBL = 714

| NIAID_ChemDB =

| PDB_ligand =

| synonyms =

| IUPAC_name = (''RS'')-4-[2-(''tert''-Butylamino)-1-hydroxyethyl]-2-(hydroxymethyl)phenol

| C = 13

| H = 21

| N = 1

| O = 3

| SMILES = CC(C)(C)NCC(C1=CC(=C(C=C1)O)CO)O

| StdInChI_Ref = {{stdinchicite|correct|chemspider}}

| StdInChI = 1S/C13H21NO3/c1-13(2,3)14-7-12(17)9-4-5-11(16)10(6-9)8-15/h4-6,12,14-17H,7-8H2,1-3H3

| StdInChI_comment =

| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}

| StdInChIKey = NDAUXUAQIAJITI-UHFFFAOYSA-N

| density =

| density_notes =

| melting_point =

| melting_high =

| melting_notes =

| boiling_point =

| boiling_notes =

| solubility =

| sol_units =

| specific_rotation =

}}

'''Salbutamol''' ([[International Nonproprietary Name|INN]]) or '''albuterol''' ([[United States Adopted Name|USAN]]) is a short-acting [[beta2-adrenergic receptor agonist|β2-adrenergic receptor agonist]] used for the relief of [[bronchospasm]] in conditions such as [[asthma]] and [[chronic obstructive pulmonary disease]]. It is marketed by [[GlaxoSmithKline]] as '''Ventolin''', '''Aerolin''' or '''Ventorlin''', depending on the market; by [[Cipla]] as '''Asthalin''' and '''Asthavent'''; by [[Schering-Plough]] as '''Proventil''' and by [[Teva Pharmaceutical Industries|Teva]] as '''ProAir'''.

'''Salbutamol''', also known as '''albuterol''' and sold under the brand name '''Ventolin''' among others,<ref name=brands/> is a medication that [[bronchodilator|opens up the medium and large airways in the lungs]].<ref name=AHFS2015>{{cite web|url=https://www.drugs.com/monograph/albuterol.html|title=Albuterol|website=Drugs.com|publisher=The American Society of Health-System Pharmacists|archive-url=https://web.archive.org/web/20151208181121/http://www.drugs.com/monograph/albuterol.html|archive-date=8 December 2015|url-status=live|access-date=2 December 2015}}</ref> It is a short-acting [[Beta2-adrenergic agonist|β2 adrenergic receptor agonist]] that causes relaxation of airway [[smooth muscle]].<ref name="AHFS2015" /> It is used to treat [[asthma]], including [[asthma attacks]] and [[exercise-induced bronchoconstriction]], as well as [[chronic obstructive pulmonary disease]] (COPD).<ref name=AHFS2015/> It may also be used to treat [[hyperkalemia|high blood potassium levels]].<ref name=Mah2005>{{cite journal | vauthors = Mahoney BA, Smith WA, Lo DS, Tsoi K, Tonelli M, Clase CM | title = Emergency interventions for hyperkalaemia | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD003235 | date = April 2005 | volume = 2005 | pmid = 15846652 | doi = 10.1002/14651858.CD003235.pub2 | pmc = 6457842 }}</ref> Salbutamol is usually used with an [[metered-dose inhaler|inhaler]] or [[nebulizer]], but it is also available in a pill, liquid, and [[intravenous]] solution.<ref name=AHFS2015/><ref name=starkey>{{cite journal | vauthors = Starkey ES, Mulla H, Sammons HM, Pandya HC | title = Intravenous salbutamol for childhood asthma: evidence-based medicine? | journal = Archives of Disease in Childhood | volume = 99 | issue = 9 | pages = 873–7 | date = September 2014 | pmid = 24938536 | doi = 10.1136/archdischild-2013-304467 | s2cid = 2070868 | url = https://derbyhospitals-nhs.archive.knowledgearc.net/bitstream/handle/123456789/297/%2814%29%20Arch%20Dis%20Child.pdf?sequence=1&isAllowed=y | archive-url = https://web.archive.org/web/20170908175627/https://derbyhospitals-nhs.archive.knowledgearc.net/bitstream/handle/123456789/297/%2814%29%20Arch%20Dis%20Child.pdf?sequence=1&isAllowed=y | url-status = dead | archive-date = 8 September 2017 }}</ref> Onset of action of the inhaled version is typically within 15 minutes and lasts for two to six hours.<ref name=AHFS2015/>

Salbutamol was the first selective β2-receptor agonist to be marketed — in 1968. It was first sold by Allen and Hanburys under the brand name Ventolin. The drug was an instant success, and has been used for the treatment of asthma ever since.<ref>{{cite journal | url = http://www.pharmj.com/pdf/articles/pj_20071013_landmarkdrugs01.pdf | title = Ventolin remains a breath of fresh air for asthma sufferers, after 40 years | journal = The Pharmaceutical Journal | volume = 279 | issue = 7473| pages =404-–405}}</ref>

Common side effects include shakiness, headache, [[tachycardia|fast heart rate]], dizziness, and feeling anxious.<ref name=AHFS2015/> Serious side effects may include worsening [[bronchospasm]], [[irregular heartbeat]], and [[hypokalemia|low blood potassium levels]].<ref name=AHFS2015/> It can be used during [[pregnancy]] and [[breastfeeding]], but safety is not entirely clear.<ref name=AHFS2015/><ref>{{cite book| vauthors = Yaffe SJ |title=Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk|date=2011|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins |location=Philadelphia |isbn=9781608317080 |page=32 |edition=9th |url=https://books.google.com/books?id=OIgTE4aynrMC&pg=PA32 |url-status=live|archive-url=https://web.archive.org/web/20151208061118/https://books.google.ca/books?id=OIgTE4aynrMC&pg=PA32 |archive-date=8 December 2015}}</ref>

'''Salbutamol sulfate''' is usually given by the inhaled route for direct effect on bronchial smooth muscle. This is usually achieved through a [[metered dose inhaler]] (MDI), [[nebulizer]] or other proprietary delivery devices (e.g. Rotahaler or Autohaler). In these forms of delivery, the maximal effect of salbutamol can take place within five to twenty minutes of dosing, though some relief is immediately seen. It can also be given orally as an [[inhalant]] or [[intravenous]]ly.

Salbutamol was patented in 1966 in Britain and became commercially available in the UK in 1969.<ref>{{cite book| vauthors = Landau R |title=Pharmaceutical innovation: revolutionizing human health |date=1999 |publisher=Chemical Heritage Press |location=Philadelphia |isbn=9780941901215 |page=226 |url=https://books.google.com/books?id=IH4lPs6S1bMC&pg=PA226 |url-status=live |archive-url= https://web.archive.org/web/20151208072936/https://books.google.ca/books?id=IH4lPs6S1bMC&pg=PA226 |archive-date=8 December 2015}}</ref><ref name=Fis2006>{{cite book | vauthors = Fischer J, Ganellin CR | title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=9783527607495 |page=542 |url= https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA542}}</ref> It was approved for medical use in the United States in 1982.<ref name=AHFS2015/> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> Salbutamol is available as a [[generic medication]].<ref name=AHFS2015/> In 2022, it was the seventh most commonly prescribed medication in the United States, with more than 59{{nbsp}}million prescriptions.<ref>{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}</ref><ref>{{cite web | title = Albuterol Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Albuterol | access-date = 30 August 2024 }}</ref>

==~~Clinical~~ ~~use~~==

== ==

Salbutamol is typically used to treat [[bronchospasm]] (due to any cause—allergic [[asthma]] or exercise-induced), as well as [[chronic obstructive pulmonary disease]].<ref name=AHFS2015 /> It is also one of the most common medicines used in rescue inhalers (short-term bronchodilators to alleviate [[asthma attacks]]).<ref name=webmd>{{Cite web | vauthors = Hatfield H | title=Asthma: The Rescue Inhaler -- Now a Cornerstone of Asthma Treatment | work=WebMD | access-date=27 June 2017 | url=http://www.webmd.com/asthma/features/asthma-rescue-inhaler-cornerstone-asthma-treatment | url-status=live | archive-url=https://web.archive.org/web/20170716061632/http://www.webmd.com/asthma/features/asthma-rescue-inhaler-cornerstone-asthma-treatment | archive-date=16 July 2017 }}</ref>

As a β2 agonist, salbutamol also has use in [[obstetrics]]. Intravenous salbutamol can be used as a [[tocolytic]] to relax the [[uterus|uterine]] [[smooth muscle]] to delay [[Preterm birth|premature labor]]. While preferred over agents such as [[atosiban]] and [[ritodrine]], its role has largely been replaced by the calcium channel blocker [[nifedipine]], which is more effective and better tolerated.<ref name="rossi">{{cite book|title=Australian Medicines Handbook| vauthors = Rossi S |publisher=AMH|year=2004|isbn=978-0-9578521-4-3}}</ref>

Salbutamol is specifically indicated in the following conditions:

*Acute [[asthma]]

*Symptom relief during maintenance therapy of asthma and other conditions with reversible or irreversible airways obstruction (including [[Chronic obstructive pulmonary disease|COPD]] and [[bronchitis]])

*Protection against exercise-induced asthma

*Can be aerosolized with a [[nebulizer]] for patients with [[cystic fibrosis]], along with [[ipratropium|ipratropium bromide]], [[acetylcysteine]], and [[pulmozyme]].

*Subtypes of [[congenital myasthenic syndrome]]s associated to mutations in [[Dok-7]].

Salbutamol has been used to treat acute [[hyperkalemia]], as it stimulates potassium flow into cells, thus lowering the potassium in the blood.<ref name=Mah2005/>

As a β2-agonist, salbutamol also finds use in [[obstetrics]]. Intravenous salbutamol can be used as a [[tocolysis|tocolytic]] to relax the [[uterus|uterine]] [[smooth muscle]] to delay [[premature labor]]. While preferred over agents such as [[atosiban]] and [[ritodrine]], its role has largely been replaced by the calcium-channel blocker [[nifedipine]], which is more effective, better tolerated and orally administered.<ref name=rossi>{{cite book | isbn = 0957852142 | title = [[Australian Medicines Handbook]] | last = Rossi | first =S | year = 2004 | publisher = AMH}}</ref>

Two recent studies have suggested that salbutamol reduces the symptoms of newborns and adolescents with [[myasthenia gravis]] and [[transient neonatal myasthenia gravis]].<ref name="pmid26791147">{{cite journal | vauthors = Allen NM, Hacohen Y, Palace J, Beeson D, Vincent A, Jungbluth H | title = Salbutamol-responsive fetal acetylcholine receptor inactivation syndrome | journal = Neurology | volume = 86 | issue = 7 | pages = 692–4 | date = February 2016 | pmid = 26791147 | pmc = 4762416 | doi = 10.1212/WNL.0000000000002382 | url = }}</ref><ref name="pmid37186601">{{cite journal | vauthors = Allen NM, O'Rahelly M, Eymard B, Chouchane M, Hahn A, Kearns G, Kim DS, Byun SY, Nguyen CE, Schara-Schmidt U, Kölbel H, Marina AD, Schneider-Gold C, Roefke K, Thieme A, Van den Bergh P, Avalos G, Álvarez-Velasco R, Natera-de Benito D, Cheng MH, Chan WK, Wan HS, Thomas MA, Borch L, Lauzon J, Kornblum C, Reimann J, Mueller A, Kuntzer T, Norwood F, Ramdas S, Jacobson LW, Jie X, Fernandez-Garcia MA, Wraige E, Lim M, Lin JP, Claeys KG, Aktas S, Oskoui M, Hacohen Y, Masud A, Leite MI, Palace J, De Vivo D, Vincent A, Jungbluth H | title = The emerging spectrum of fetal acetylcholine receptor antibody-related disorders (FARAD) | journal = Brain: A Journal of Neurology | volume = 146 | issue = 10 | pages = 4233–4246 | date = October 2023 | pmid = 37186601 | pmc = 10545502 | doi = 10.1093/brain/awad153 | url = }}</ref>

In an emergency, EMS providers consider the administration of salbutamol when they see active wheezing, bronchospasm and a past diagnosis of asthma. The drug is most often administered through a nebulizer with 6-8 liters per minute of oxygen. A normal dose is 2.5mg in 3 mL of respiratory saline.

==Adverse effects==

== Structure activity relationship ==

The most common side effects are fine [[tremor]], [[anxiety]], [[headache]], [[muscle cramps]], [[dry mouth]], and [[palpitation]].<ref name=BNF57>{{cite book |title=British National Formulary |publisher=[[BMJ Publishing Group Ltd]] and [[Royal Pharmaceutical Society of Great Britain|Royal Pharmaceutical Society Publishing]] |location=London |date=March 2008 |edition=57 |chapter=3.1.1.1 Selective beta2 agonists – side effects |isbn=978-0-85369-778-7 |chapter-url-access=registration |chapter-url=https://archive.org/details/britishnationalf0000unse_k4e9 }}</ref> Other symptoms may include [[tachycardia]], [[Heart arrhythmia|arrhythmia]], [[Flushing (physiology)|flushing of the skin]], [[myocardial ischemia]] (rare), and disturbances of sleep and behaviour.<ref name=BNF57/> Rarely occurring, but of importance, are allergic reactions of [[Paradoxical reaction|paradoxical]] bronchospasms, [[urticaria]] (hives), [[angioedema]], [[hypotension]], and collapse. High doses or prolonged use may cause [[hypokalemia]], which is of concern especially in patients with [[kidney failure]] and those on certain [[diuretics]] and [[xanthine]] derivatives.<ref name=BNF57/>

The tertiary butyl group in salbutamol (or albuterol) makes it more selective for β2-receptors. The drug is sold as a racemic mixture mainly because the S isomer blocks metabolism pathways while the R isomer shows activity.<ref>{{cite web | url = http://pharmaxchange.info/notes/medicinal_chemistry/adrenergics_cholinergics.html | title = Medicinal Chemistry of the Peripheral Nervous System - Adrenergics and Cholinergic their Biosynthesis, Metabolism and Structure Activity Relationships| first = Akul | last = Mehta | accessdate = 2010-10-20}}</ref>

Salbutamol metered dose inhalers have been described as the "single biggest source of carbon emissions from [[National Health Service|NHS]] medicines prescribing" due to the propellants used in the inhalers. Dry powder inhalers are recommended as a low-carbon alternative.<ref>{{cite news |title=Primary care networks incentivised to switch patients to more environmentally friendly inhalers |url=https://pharmaceutical-journal.com/article/news/primary-care-networks-incentivised-to-switch-patients-to-more-environmentally-friendly-inhalers? |access-date=16 October 2021 |publisher=Pharmaceutical Journal |date=3 September 2021}}</ref>

==Side effects / health consequences==

The most common side effects are of fine [[tremor]], [[nervousness]], [[headache]], [[muscle cramps]], [[dry mouth]], and [[palpitation]].<ref name=BNF57>{{cite book |author= |title=British National Formulary |publisher=[[BMJ Publishing Group Ltd]] and [[Royal Pharmaceutical Society of Great Britain|Royal Pharmaceutical Society Publishing]] |location=London |year=2008 |month=March |edition=57 |chapter=3.1.1.1 Selective beta2 agonists -- side effects |pages=|isbn=0-85369-778-7 |oclc= |doi= |accessdate=2009-04-04}}</ref> Other symptoms may be [[tachycardia]] (rapid heart rate), [[arrhythmia]]s, [[Flushing (physiology)|flushing]], [[myocardial ischemia]], and disturbances of sleep and behaviour.<ref name=BNF57/> Rarely occurring, but of importance, are allergic reactions of [[paradoxical]] [[bronchospasm]], [[urticaria]], [[angioedema]], [[hypotension]], and [[Collapse (medical)|collapse]], while high doses may cause [[hypokalaemia]] (low potassium levels), especially in patients with [[renal failure]] and those on certain diuretics and xanthine derivatives.<ref name=BNF57/>

[[File:Ventolin 2mg.JPG|thumb|Ventolin 2mg tablets made by GSK (Turkey)]]

==Pharmacology==

==Diet and bodybuilding use==

The tertiary [[butyl group]] in salbutamol makes it more selective for β2 receptors,<ref name="Lemke2013">{{cite book|url=https://books.google.com/books?id=Sd6ot9ul-bUC&pg=PA1315|title=Foye's Principles of Medicinal Chemistry| vauthors = Lemke TL, Williams DA, Roche VF, Zito SW |date=2013|publisher=Lippincott Williams & Wilkins|isbn=9781609133450|location=Philadelphia, PA|pages=1314–1320|oclc=748675182|url-status=live|archive-url=https://web.archive.org/web/20170908175627/https://books.google.com/books?id=Sd6ot9ul-bUC&pg=PA1315|archive-date=8 September 2017}}</ref> which are the predominant receptors on the bronchial [[smooth muscle]]s. Activation of these receptors causes [[adenylyl cyclase]] to convert ATP to [[Cyclic adenosine monophosphate|cAMP]], beginning the [[signalling cascade]] that ends with the inhibition of [[myosin]] phosphorylation and lowering the intracellular concentration of calcium ions (myosin phosphorylation and calcium ions are necessary for muscle contractions). The increase in cAMP also inhibits inflammatory cells in the airway, such as [[basophil]]s, [[eosinophil]]s, and most especially [[mast cell]]s, from releasing inflammatory mediators and cytokines.<ref name=rxlist /><ref>{{Cite book | vauthors = Papich MG | title=Saunders Handbook of Veterinary Drugs | chapter=Albuterol Sulfate | location=St. Louis, Mo | date=2007 | edition=2nd | publisher=Saunders/Elsevier | isbn=9781416028888 | pages=10–11}}</ref> Salbutamol and other β2 receptor agonists also increase the conductance of channels sensitive to calcium and potassium ions, leading to [[Hyperpolarization (biology)|hyperpolarization]] and relaxation of bronchial smooth muscles.<ref name=chemm>{{cite web | publisher = US Department of Health and Human Services | title=Albuterol - Medical Countermeasures Database | work=CHEMM | access-date=23 June 2017 | date=28 April 2017 | url=https://chemm.nlm.nih.gov/countermeasure_albuterol.htm | url-status=live | archive-url=https://web.archive.org/web/20170803045423/https://chemm.nlm.nih.gov/countermeasure_albuterol.htm | archive-date=3 August 2017 }}</ref>

Salbutamol is taken by some as an alternative to [[clenbuterol]] for purposes of fat burning,<ref>{{cite journal |author=Carter WJ, Lynch ME |title=Comparison of the effects of salbutamol and clenbuterol on skeletal muscle mass and carcass composition in senescent rats |journal=Metab. Clin. Exp. |volume=43 |issue=9 |pages=1119–25 |year=1994 |month=September |pmid=7916118 |doi= 10.1016/0026-0495(94)90054-X }}</ref> and/or as a performance enhancer. Abuse of the drug may be confirmed by detection of its presence in plasma or urine, typically in the 10-500 µg/L range.<ref name="R. Baselt, 2008, pp. 33-35">{{cite book | first = R. | last = Baselt | title = Disposition of Toxic Drugs and Chemicals in Man| edition = 8th | publisher = Biomedical Publications, | year = 2008| pages = 33–35 | isbn = 0962652369 }}</ref>

Salbutamol is either filtered out by the kidneys directly or is first metabolized into the 4′-''O''-sulfate, which is excreted in the urine.<ref name=starkey />

== Doping ==

Clinical studies show no compelling evidence that salbutamol and other β2-agonists can increase performance in healthy athletes.<ref>{{cite journal | last1 = Davis | first1 = E | last2 = Loiacono | first2 = R | last3 = Summers | first3 = R J | title = The rush to adrenaline: drugs in sport acting on the β-adrenergic system | journal = British Journal of Pharmacology | volume = 154 | issue = 3 | pages = 584 | year = 2008 | pmid = 18500380 | pmc = 2439523 | doi = 10.1038/bjp.2008.164}}</ref> In spite of this, salbutamol requires "a declaration of Use in accordance with the International Standard for Therapeutic Use Exemptions" under the current [[World Anti-Doping Agency|WADA]] prohibited list.<ref>{{cite web | url = http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/WADA_Prohibited_List_2010_EN.pdf | title = THE 2010 PROHIBITED LIST INTERNATIONAL STANDARD| publisher = WADA| accessdate = 2010-10-20}}</ref>

==Chemistry==

According to two small and limited studies, performed on 8 and 16 subjects, respectively, salbutamol increases the performance even for a person without asthma.<ref>{{cite journal | last1 = Collomp | first1 = K | last2 = Candau | first2 = R | last3 = Lasne | first3 = F | last4 = Labsy | first4 = Z | last5 = Préfaut | first5 = C | last6 = De Ceaurriz | first6 = J | title = Effects of short-term oral salbutamol administration on exercise endurance and metabolism. | url = http://jap.physiology.org/cgi/content/full/89/2/430 | journal = Journal of applied physiology (Bethesda, Md. : 1985) | volume = 89 | issue = 2 | pages = 430–6 | year = 2000 | pmid = 10926623 }}</ref><ref>{{cite journal | url = http://www.pponline.co.uk/encyc/salbutamol.html | title = Salbutamol: Ergogenic effects of salbutamol| accessdate = 2010-10-20}}</ref><ref>{{cite journal | last1 = Van Baak | first1 = MA | last2 = De Hon | first2 = OM | last3 = Hartgens | first3 = F | last4 = Kuipers | first4 = H | title = Inhaled salbutamol and endurance cycling performance in non-asthmatic athletes. | journal = International journal of sports medicine | volume = 25 | issue = 7 | pages = 533–8 | year = 2004 | pmid = 15459835 | doi = 10.1055/s-2004-815716}}</ref>

[[File:(R)- and (S)-salbutamol.svg|thumb|right|(''R'')-(−)-salbutamol (top) and (''S'')-(+)-salbutamol (bottom)]]

Salbutamol is sold as a [[racemate|racemic mixture]]. The (''R'')-(−)-[[enantiomer]] ([[Cahn–Ingold–Prelog priority rules|CIP nomenclature]]) is shown in the image at right (top), and is responsible for the pharmacologic activity; the (''S'')-(+)-enantiomer (bottom) blocks metabolic pathways associated with elimination of itself and of the pharmacologically active enantiomer (''R'').<ref>{{cite web|url=http://pharmaxchange.info/notes/medicinal_chemistry/adrenergics_cholinergics.html|title=Medicinal Chemistry of the Peripheral Nervous System – Adrenergics and Cholinergics their Biosynthesis, Metabolism, and Structure Activity Relationships| vauthors = Mehta A |archive-url= https://web.archive.org/web/20101104022742/http://pharmaxchange.info/notes/medicinal_chemistry/adrenergics_cholinergics.html |archive-date=4 November 2010|url-status=dead|access-date=20 October 2010}}</ref> The slower metabolism of the (''S'')-(+)-enantiomer also causes it to accumulate in the lungs, which can cause airway hyperreactivity and inflammation.<ref name=merck>{{Cite web | title=Inhalation Therapy of Airway Disease | work=Merck Veterinary Manual | access-date=22 June 2017 | url=http://www.merckvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-respiratory-system/inhalation-therapy-of-airway-disease | url-status=live | archive-url=https://web.archive.org/web/20170625203315/http://www.merckvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-respiratory-system/inhalation-therapy-of-airway-disease | archive-date=25 June 2017 }}</ref> Potential formulation of the ''R'' form as an [[enantiopure drug]] is complicated by the fact that the stereochemistry is not stable, but rather the compound undergoes racemization within a few days to weeks, depending on [[pH]].<ref>{{cite journal |journal= Biol Pharm Bull |date= 1 September 2017 |volume= 40 |issue= 9 |pages= 1374–1380 |doi= 10.1248/bpb.b17-00067 |title= Study of pH Stability of ''R''-Salbutamol Sulfate Aerosol Solution and Its Antiasthmatic Effects in Guinea Pigs |vauthors= Liu Q, Li Q, Han T, Hu T, Zhang X, Hu J, Hu H, Tan W |pmid= 28652557|doi-access= free }}</ref>

The direct separation of Salbutamol [[enantiomer]]s and the control of enantiomeric purity has been described by [[thin-layer chromatography]].<ref name="pmid20074739">{{cite journal | vauthors = Bhushan R, Tanwar S | title = Different approaches of impregnation for resolution of enantiomers of atenolol, propranolol and salbutamol using Cu(II)-L-amino acid complexes for ligand exchange on commercial thin layer chromatographic plates | journal = Journal of Chromatography A | volume = 1217 | issue = 8 | pages = 1395–8 | date = February 2010 | pmid = 20074739 | doi = 10.1016/j.chroma.2009.12.071 }}</ref>

===Detection of use===

Salbutamol may be quantified in blood or plasma to confirm a diagnosis of poisoning in hospitalized patients or to aid in a forensic investigation. Urinary salbutamol concentrations are frequently measured in competitive sports programs, for which a level in excess of 1000 μg/L is considered to represent abuse. The window of detection for urine testing is on the order of just 24 hours, given the relatively short elimination half-life of the drug.<ref name="R. Baselt, 2008, pp. 33-35"/><ref>{{cite journal | author = Berges, Rosa | author2 = S | author3 = V | author4 = F | author5 = M | author6 = F | author7 = M | author8 = D | title = Discrimination of Prohibited Oral Use of Salbutamol from Authorized Inhaled Asthma Treatment | url = http://www.clinchem.org/cgi/content/abstract/46/9/1365 | journal = Clinical Chemistry | volume = 46 | issue = 9 | pages = 1365 | year = 2000 | pmid = 10973867 }}</ref><ref>{{cite journal |doi = 10.1097/00042752-200409000-00018 |last1 = Schweizer | first1 = C | last2 = Saugy | first2 = M | last3 = Kamber |first3 = M | first4 =M | title = Doping test reveals high concentrations of salbutamol in a Swiss track and field athlete | journal = Clin. J. Sport Med. | volume = 14 |issue = 5 | pages = 312–315 | year = 2004 | url = http://journals.lww.com/cjsportsmed/Abstract/2004/09000/Doping_Test_Reveals_High_Concentrations_of.18.aspx |pmid = 15377972}}</ref>

==History==

==Ban of CFC-containing inhalers==

Salbutamol was discovered in 1966, by a team led by [[David Jack (scientist)|David Jack]] at the [[Allen and Hanburys]] laboratory (now a subsidiary of [[GlaxoSmithKline|Glaxo]]) in [[Ware, Hertfordshire]], England, and was launched as Ventolin in 1969.<ref name=SirDavidJack_telegraph>

[[Image:Salbutamol2.JPG|thumb|The components of a salbutamol inhaler]]

{{cite news|title=Sir David Jack, who has died aged 87, was the scientific brain behind the rise of the pharmaceuticals company Glaxo|url=https://www.telegraph.co.uk/news/obituaries/finance-obituaries/8897458/Sir-David-Jack.html|newspaper=The Telegraph|date=17 November 2011|url-status=live|archive-url=https://web.archive.org/web/20111125011155/http://www.telegraph.co.uk/news/obituaries/finance-obituaries/8897458/Sir-David-Jack.html|archive-date=25 November 2011}}</ref>

{{Globalize/North America|section |date=December 2009|discuss=Talk:Salbutamol#Globalize }}

The [[Food and Drug Administration (United States)|U.S. Food and Drug Administration]] (FDA) in April 2005 mandated all (including salbutamol) inhalers containing [[chlorofluorocarbons]] (CFCs) were to be prohibited in the United States as of December 31, 2008.<ref>{{cite journal| url=http://www.sciam.com/article.cfm?id=unlikely-victims-of-banning-cfcs | title=Unlikely Victims of Banning CFCs—Asthma Sufferers | magazine=Scientific American |date = August 2008| author=Emily Harrison}}</ref> CFC inhalers had previously been given "essential use" status, exempting it from a CFC-production ban; however, in accordance with the [[Montreal Protocol]], they will be phased out; in many other countries, patients have been transitioned to non-CFC based inhalers using [[hydrofluoroalkane]] (HFA) propellant. Pharmaceutical manufacturers were expected to produce adequate supplies of alternative (HFA) inhalers by 2009.{{Citation needed|date=May 2008}}

The [[1972 Munich Olympics]] were the first Olympics where anti-doping measures were deployed, and at that time β2 agonists were considered to be stimulants with high risk of abuse for doping. Inhaled salbutamol was banned from those games, but by 1986 was permitted (although oral β2 agonists were not). After a steep rise in the number of athletes taking β2 agonists for asthma in the 1990s, Olympic athletes were required to provide proof that they had asthma in order to be allowed to use inhaled β2 agonists.<ref name=Fitch2006>{{cite journal | vauthors = Fitch KD | title = beta2-Agonists at the Olympic Games | journal = Clinical Reviews in Allergy & Immunology | volume = 31 | issue = 2–3 | pages = 259–68 | date = 2006 | pmid = 17085798 | doi = 10.1385/CRIAI:31:2:259 | s2cid = 71908898 }}</ref>

One drawback of this transition to HFA inhalers is that, due to patent restrictions, all HFA salbutamol inhalers are "brand-name" (ProAir, Proventil, and Ventolin). They cost approximately $20 more per inhaler than existing generic CFC salbutamol inhalers. These new formulations are patented. An industry consortium was formed to spread the costs of the FDA safety studies to get propellants such as 134a and 227 approved.<ref>{{cite web| url =http://www.ipacmdi.com/index.html | title = IPAC - International Pharmaceutical Aerosol Consortium}}</ref>

In February 2020, the U.S. [[Food and Drug Administration]] (FDA) approved the first generic of an albuterol sulfate inhalation aerosol for the treatment or prevention of bronchospasm in people four years of age and older with reversible obstructive airway disease and the prevention of exercise-induced bronchospasm in people four years of age and older.<ref name="FDA Albuterol PR">{{cite press release | title=FDA approves first generic of ProAir HFA | website=U.S. [[Food and Drug Administration]] (FDA) | date=24 February 2020 | url=http://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-proair-hfa | access-date=24 February 2020}} {{PD-notice}}</ref><ref>{{cite web | title=Albuterol Sulfate: FDA-Approved Drugs | website=U.S. [[Food and Drug Administration]] (FDA) | url=https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=203760 | access-date=26 February 2020}}</ref> The FDA granted approval of the generic albuterol sulfate inhalation aerosol to Perrigo Pharmaceutical.<ref name="FDA Albuterol PR" />

Generic HFA salbutamol inhalers are not expected to reach the United States market until after 2012 due to existing patents.<ref>{{cite web| url =http://www.pharmacist.com/AM/Template.cfm?Section=Search1&template=/CM/HTMLDisplay.cfm&ContentID=12192 | title = HFA inhalers replacing generic albuterol inhalers, driving up costs| publisher = pharmacist.com}}</ref>

In April 2020, the FDA approved the first generic of Proventil HFA (albuterol sulfate) metered dose inhaler, 90 μg per inhalation, for the treatment or prevention of bronchospasm in patients four years of age and older who have reversible obstructive airway disease, as well as the prevention of exercise-induced bronchospasm in this age group.<ref name="FDA Proventil PR">{{cite press release | title=FDA Approves First Generic of a Commonly Used Albuterol Inhaler to Treat and Prevent Bronchospasm | website=U.S. [[Food and Drug Administration]] (FDA) | date=8 April 2020 | url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-commonly-used-albuterol-inhaler-treat-and-prevent-bronchospasm | access-date=10 April 2020}} {{PD-notice}}</ref> The FDA granted approval of this generic albuterol sulfate inhalation aerosol to Cipla Limited.<ref name="FDA Proventil PR" />

Salbutamol is widely used, and accounts for anywhere from 78% of all bronchodilator prescriptions in 2005 to 85% in 2008.<ref>IMS Health Sales & Prescription data for all inhalers sales and prescriptions (July 2008)</ref> However, patients in the United States who cannot tolerate the HFA salbutamol inhalers will not have a single salbutamol alternative available to them domestically after December 31, 2008.<ref>{{cite web| url =http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116903.htm | title =FDA Advises Patients to Switch to HFA-Propelled Albuterol Inhalers Now CFC-propelled inhalers no longer available as of Dec. 31, 2008| accessdate = 2010-10-20}}</ref> The FDA did not approve any alternatives to HFA and there are few standard inhaled lung medications in the United States that come in dry powder inhaler (DPI) versions. Noticeably missing is salbutamol in DPI form in the United States, although it is available in most of the rest of the world in salbutamol DPIs.

==Society and culture==

==Synthesis==

In 2020, generic versions were approved in the United States.<ref name="FDA Albuterol PR" /><ref name="FDA Proventil PR" />

[[File:SalbutRxn.svg|800px]]

===Names===

{{cite journal | last1 = Collin | first1 = David T. | last2 = Hartley | first2 = David. | last3 = Jack | first3 = David. | last4 = Lunts | first4 = Lawrence H. C. | last5 = Press | first5 = J. C. | last6 = Ritchie | first6 = Alexander C. | last7 = Toon | first7 = Paul. | title = Saligenin analogs of sympathomimetic catechol amines | journal = Journal of Medicinal Chemistry | volume = 13 | issue = 4 | pages = 674 | year = 1970 | pmid = 5452431 | doi = 10.1021/jm00298a022}}

[[File:Ventolin 2mg.JPG|thumb|Ventolin 2 mg tablets made by GSK (Turkey)]]

Salbutamol is the [[international nonproprietary name]] (INN) while albuterol is the [[United States Adopted Name]] (USAN).<ref>{{cite web |title=Salbutamol |url=https://pubchem.ncbi.nlm.nih.gov/compound/Salbutamol#section=Pharmacology | work = PubChem | publisher = U.S. National Library of Medicine }}</ref> The drug is usually manufactured and distributed as the [[sulfate]] [[Salt (chemistry)|salt]] (salbutamol sulfate).

It was first sold by [[Allen & Hanburys]] (UK) under the brand name Ventolin, and has been used for the treatment of asthma ever since.<ref>{{cite journal |url= http://www.pharmj.com/pdf/articles/pj_20071013_landmarkdrugs01.pdf |title= Ventolin remains a breath of fresh air for asthma sufferers, after 40 years |journal= The Pharmaceutical Journal |volume= 279 |issue= 7473 |pages= 404–405|archive-url=https://web.archive.org/web/20071015201448/http://www.pharmj.com/pdf/articles/pj_20071013_landmarkdrugs01.pdf|archive-date=15 October 2007}}</ref> The drug is marketed under many names worldwide.<ref name="brands">{{Cite web|url=https://www.drugs.com/international/salbutamol.html|title=Salbutamol|website=Drugs.com|archive-url=https://web.archive.org/web/20160330054502/http://www.drugs.com/international/salbutamol.html|archive-date=30 March 2016|url-status=live|access-date=11 April 2016}}</ref>

==See also==

*[[Epinephrine]]

*[[Beclometasone dipropionate]]

*[[Ipratropium]]

*[[Ipratropium/salbutamol]]

*[[Levalbuterol]]

==~~References~~==

====

Albuterol and other beta-2 adrenergic agonists are used by some recreational bodybuilders.<ref>{{cite journal | vauthors = Jessen S, Reitelseder S, Kalsen A, Kreiberg M, Onslev J, Gad A, Ørtenblad N, Backer V, Holm L, Bangsbo J, Hostrup M | title = β2-Adrenergic agonist salbutamol augments hypertrophy in MHCIIa fibers and sprint mean power output but not muscle force during 11 weeks of resistance training in young men | journal = Journal of Applied Physiology | volume = 130 | issue = 3 | pages = 617–626 | date = March 2021 | pmid = 33357007 | doi = 10.1152/japplphysiol.00553.2020 | s2cid = 229695809 | url = https://findresearcher.sdu.dk/ws/files/178570378/japplphysiol.00553.2020.pdf }}</ref><ref>{{cite journal | vauthors = Ip EJ, Doroudgar S, Lau B, Barnett MJ | title = Anabolic steroid users' misuse of non-traditional prescription drugs | journal = Research in Social & Administrative Pharmacy | volume = 15 | issue = 8 | pages = 949–952 | date = August 2019 | pmid = 31303195 | doi = 10.1016/j.sapharm.2018.07.003 | s2cid = 81614300 }}</ref>

===~~Additional notes~~===

======

{{As of|2011}} there was no evidence that an increase in physical performance occurs after inhaling salbutamol, but there are various reports for benefit when delivered orally or intravenously.<ref>{{cite journal | vauthors = Pluim BM, de Hon O, Staal JB, Limpens J, Kuipers H, Overbeek SE, Zwinderman AH, Scholten RJ | title = β₂-Agonists and physical performance: a systematic review and meta-analysis of randomized controlled trials | journal = Sports Medicine | volume = 41 | issue = 1 | pages = 39–57 | date = January 2011 | pmid = 21142283 | doi = 10.2165/11537540-000000000-00000 | s2cid = 189906919 }}</ref><ref>{{cite journal | vauthors = Davis E, Loiacono R, Summers RJ | title = The rush to adrenaline: drugs in sport acting on the beta-adrenergic system | journal = British Journal of Pharmacology | volume = 154 | issue = 3 | pages = 584–97 | date = June 2008 | pmid = 18500380 | pmc = 2439523 | doi = 10.1038/bjp.2008.164 }}</ref> In spite of this, salbutamol required "a declaration of Use in accordance with the International Standard for Therapeutic Use Exemptions" under the 2010 [[World Anti-Doping Agency|WADA]] prohibited list. This requirement was relaxed when the 2011 list was published to permit the use of "salbutamol (maximum 1600 micrograms over 24 hours) and salmeterol when taken by inhalation in accordance with the manufacturers' recommended therapeutic regimen."<ref>{{cite web |url= http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/WADA_Prohibited_List_2010_EN.pdf |title= The 2010 Prohibited List International Standard |publisher= WADA |access-date= 20 October 2010 |url-status= dead |archive-url= https://web.archive.org/web/20130911050811/http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/WADA_Prohibited_List_2010_EN.pdf |archive-date= 11 September 2013 }}</ref><ref>{{cite web |url= http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/To_be_effective/WADA_Prohibited_List_2011_EN.pdf |title= The 2011 Prohibited List International Standard |publisher= WADA |access-date= 22 May 2012 |url-status= live |archive-url= https://web.archive.org/web/20120513015917/http://www.wada-ama.org/Documents/World_Anti-Doping_Program/WADP-Prohibited-list/To_be_effective/WADA_Prohibited_List_2011_EN.pdf |archive-date= 13 May 2012 }}</ref>

Abuse of the drug may be confirmed by detection of its presence in plasma or urine, typically exceeding 1,000 ng/mL. The window of detection for urine testing is on the order of just 24 hours, given the relatively short elimination half-life of the drug,<ref name="R. Baselt, 2008, pp. 33-35">{{cite book |vauthors = Baselt R |title= Disposition of Toxic Drugs and Chemicals in Man |edition= 8th |publisher= Biomedical Publications |year= 2008 |pages= 33–35 |isbn= 978-0-9626523-6-3 }}</ref><ref>{{cite journal | vauthors = Bergés R, Segura J, Ventura R, Fitch KD, Morton AR, Farré M, Mas M, de La Torre X | title = Discrimination of prohibited oral use of salbutamol from authorized inhaled asthma treatment | journal = Clinical Chemistry | volume = 46 | issue = 9 | pages = 1365–75 | date = September 2000 | doi = 10.1093/clinchem/46.9.1365 | pmid = 10973867 | url = http://www.clinchem.org/cgi/content/abstract/46/9/1365 | archive-url = https://web.archive.org/web/20110717111432/http://www.clinchem.org/cgi/content/abstract/46/9/1365 | url-status = live | archive-date = 17 July 2011 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Schweizer C, Saugy M, Kamber M | title = Doping test reveals high concentrations of salbutamol in a Swiss track and field athlete | journal = Clinical Journal of Sport Medicine | volume = 14 | issue = 5 | pages = 312–5 | date = September 2004 | pmid = 15377972 | doi = 10.1097/00042752-200409000-00018 | s2cid = 30402521 }}{{closed access}}</ref> estimated at between 5 and 6 hours following oral administration of 4 mg.<ref name=rxlist>{{cite web| title= Albuterol Sulfate| work= Rx List: The Internet Drug Index| url= http://www.rxlist.com/albuterol-sulfate-drug/clinical-pharmacology.htm| access-date= 13 July 2014| url-status= live| archive-url= https://web.archive.org/web/20140718041226/http://www.rxlist.com/albuterol-sulfate-drug/clinical-pharmacology.htm| archive-date= 18 July 2014}}</ref>

# {{Cite journal |last1=Moore |first1=NG |last2=Pegg |first2=GG |last3=Sillence |first3=MN |title=Anabolic effects of the beta 2-adrenoceptor agonist salmeterol are dependent on route of administration |journal=Am. J. Physiol. |volume=267 |issue=3 Pt 1 |pages=E475–84 |year=1994 |month=September |pmid=7943228 |doi= |url=http://ajpendo.physiology.org/cgi/pmidlookup?view=reprint&pmid=7943228}}

# {{Cite journal |last1=Schiffelers |first1=SL |last2=Saris |first2=WH |last3=Boomsma |first3=F |last4=Van Baak |first4=MA |title=beta(1)- and beta(2)-Adrenoceptor-mediated thermogenesis and lipid utilization in obese and lean men |journal=J. Clin. Endocrinol. Metab. |volume=86 |issue=5 |pages=2191–9 |year=2001 |month=May |pmid=11344226 |doi= 10.1210/jc.86.5.2191|url=http://jcem.endojournals.org/cgi/pmidlookup?view=long&pmid=11344226}}

# {{Cite journal |last1=Van Baak |first1=MA |last2=Mayer |first2=LH |last3=Kempinski |first3=RE |last4=Hartgens |first4=F |title=Effect of salbutamol on muscle strength and endurance performance in nonasthmatic men |journal=Med Sci Sports Exerc |volume=32 |issue=7 |pages=1300–6 |year=2000 |month=July |pmid=10912897 |doi= 10.1097/00005768-200007000-00018|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0195-9131&volume=32&issue=7&spage=1300}}

# {{Cite journal |last1=Caruso |first1=JF |last2=Hamill |first2=JL |last3=De Garmo |first3=N |title=Oral albuterol dosing during the latter stages of a resistance exercise program |journal=J Strength Cond Res |volume=19 |issue=1 |pages=102–7 |year=2005 |month=February |pmid=15705021 |doi=10.1519/R-14793.1 |url=}}

# {{Cite journal |author=Caruso JF, Signorile JF, Perry AC, ''et al.'' |title=The effects of albuterol and isokinetic exercise on the quadriceps muscle group |journal=Med Sci Sports Exerc |volume=27 |issue=11 |pages=1471–6 |year=1995 |month=November |pmid=8587482 |doi= |url=}}

# {{Cite journal |last1=Martineau |first1=L |last2=Horan |first2=MA |last3=Rothwell |first3=NJ |last4=Little |first4=RA |title=Salbutamol, a beta 2-adrenoceptor agonist, increases skeletal muscle strength in young men |journal=Clin. Sci. |volume=83 |issue=5 |pages=615–21 |year=1992 |month=November |pmid=1335400 |doi= |url=}}S

# {{Cite journal |last1=Desaphy |first1=JF |last2=Pierno |first2=S |last3=De Luca |first3=A |last4=Didonna |first4=P |last5=Camerino |first5=DC |title=Different ability of clenbuterol and salbutamol to block sodium channels predicts their therapeutic use in muscle excitability disorders |journal=Mol. Pharmacol. |volume=63 |issue=3 |pages=659–70 |year=2003 |month=March |pmid=12606775 |doi= 10.1124/mol.63.3.659|url=http://molpharm.aspetjournals.org/cgi/pmidlookup?view=long&pmid=12606775}}

# {{Cite journal |last1=Maki |first1=KC |last2=Skorodin |first2=MS |last3=Jessen |first3=JH |last4=Laghi |first4=F |title=Effects of oral albuterol on serum lipids and carbohydrate metabolism in healthy men |journal=Metab. Clin. Exp. |volume=45 |issue=6 |pages=712–7 |year=1996 |month=June |pmid=8637445 |doi= 10.1016/S0026-0495(96)90136-5|url=}}

==~~External links~~==

====

Salbutamol has been studied in subtypes of [[congenital myasthenic syndrome]] associated with mutations in ''[[Dok-7]]''.<ref>{{cite journal | vauthors = Liewluck T, Selcen D, Engel AG | title = Beneficial effects of albuterol in congenital endplate acetylcholinesterase deficiency and Dok-7 myasthenia | journal = Muscle & Nerve | volume = 44 | issue = 5 | pages = 789–94 | date = November 2011 | pmid = 21952943 | pmc = 3196786 | doi = 10.1002/mus.22176 }}</ref>

*[http://www.drugs.com/MTM/V/Volmax.html Volmax Drug Information]

*[http://www.drugs.com/pdr/albuterol-sulfate.html Side Effects]

It has also been tested in a trial aimed at treatment of [[spinal muscular atrophy]]; it is speculated to modulate the [[alternative splicing]] of the ''[[SMN2]]'' gene, increasing the amount of the [[survival of motor neuron|SMN protein]], the deficiency of which is regarded as a cause of the disease.<ref>{{cite journal | vauthors = Van Meerbeke JP, Sumner CJ | title = Progress and promise: the current status of spinal muscular atrophy therapeutics | journal = Discovery Medicine | volume = 12 | issue = 65 | pages = 291–305 | date = October 2011 | pmid = 22031667 | url = http://www.discoverymedicine.com/James-P-Van-Meerbeke/2011/10/12/progress-and-promise-the-current-status-of-spinal-muscular-atrophy-therapeutics/ }}</ref><ref>{{cite journal | vauthors = Lewelt A, Newcomb TM, Swoboda KJ | title = New therapeutic approaches to spinal muscular atrophy | journal = Current Neurology and Neuroscience Reports | volume = 12 | issue = 1 | pages = 42–53 | date = February 2012 | pmid = 22134788 | pmc = 3260050 | doi = 10.1007/s11910-011-0240-9 }}</ref>

* [http://druginfo.nlm.nih.gov/drugportal/dpdirect.jsp?name=Albuterol U.S. National Library of Medicine: Drug Information Portal - Albuterol]

Albuterol increases [[energy expenditure]] by 10-15 percent at a therapeutic dose for asthma and around 25 percent at a higher, oral dose. In several human studies, albuterol increased lean body mass, reduced fat mass, and caused [[lipolysis]]; it has been studied for use as an anti-obesity and anti-muscle wasting medication when taken orally.<ref>{{cite journal | vauthors = Hostrup M, Onslev J | title = The beta2 -adrenergic receptor - a re-emerging target to combat obesity and induce leanness? | journal = The Journal of Physiology | volume = 600 | issue = 5 | pages = 1209–1227 | date = March 2022 | pmid = 34676534 | doi = 10.1113/JP281819 | s2cid = 239457357 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Hostrup M, Jacobson GA, Jessen S, Lemminger AK | title = Anabolic and lipolytic actions of beta2 -agonists in humans and antidoping challenges | journal = Drug Testing and Analysis | volume = 12 | issue = 5 | pages = 597–609 | date = May 2020 | pmid = 31960603 | doi = 10.1002/dta.2728 | s2cid = 210842115 }}</ref>

==Veterinary use==

Salbutamol's low toxicity makes it safe for other animals and thus is the medication of choice for treating acute airway obstruction in most species.<ref name=merck /> It is usually used to treat bronchospasm or coughs in cats and dogs and used as a bronchodilator in horses with [[recurrent airway obstruction]]; it can also be used in emergencies to treat asthmatic cats.<ref>{{cite book | vauthors = Plumb DC | title=Plumb's Veterinary Drug Handbook | chapter=Albuterol Sulfate | location=Stockholm, Wisconsin; Ames, Iowa | date=2011 | edition=7th | publisher=Wiley | isbn=9780470959640 | pages=24–25}}</ref><ref>{{cite book | vauthors = Clarke KW, Trim CM | title= Veterinary Anaesthesia E-Book | date=28 June 2013 | publisher=Elsevier Health Sciences | isbn=9780702054235 | page=612 | url=https://books.google.com/books?id=hZh5AAAAQBAJ&pg=PA612 | url-status=live | archive-url=https://web.archive.org/web/20170908175627/https://books.google.com/books?id=hZh5AAAAQBAJ&pg=PA612 | archive-date=8 September 2017 }}</ref>

Toxic effects require an extremely high dose, and most overdoses are due to dogs chewing on and puncturing an inhaler or nebulizer vial.<ref>{{Cite book | vauthors = Cote E | title=Clinical Veterinary Advisor - E-Book: Dogs and Cats | chapter=Albuterol Toxicosis | date=9 December 2014 | publisher=Elsevier Health Sciences | isbn=9780323240741 | pages=45–46 | chapter-url=https://books.google.com/books?id=NmziBQAAQBAJ&pg=PR120 | url-status=live | archive-url=https://web.archive.org/web/20170908175627/https://books.google.com/books?id=NmziBQAAQBAJ&pg=PR120 | archive-date=8 September 2017 }}</ref>

== References ==

[[Category:~~Alcohols~~]]

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[[Category:Sympathomimetic amines]]

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