Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

Pharmacy Guide

Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.

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Salbulin Novolizer 100 micrograms / dose Inhalation Powder

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Salbutamol sulfate may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Salbutamol sulfate

Equivalent medicines (same active substance, strength and form)

Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

FOR Salbulin MDPI Novolizer is indicated in adults, adolescents and children aged 6 to 12 years. Salbulin MDPI Novolizer is a powder for inhalation containing the active substance salbutamol. Salbutamol belongs to a group of anti-asthmatic drugs known as bronchodilators which are used to relieve symptoms such as chest tightness, wheezing or cough caused by asthma or other conditions. Bronchodilators help the airways in your lungs to stay open. This makes it easier for air to get in and out. Salbutamol can also be used to prevent asthma symptoms brought on by exercise and other 'triggers' such as pollen. In asthma, fast-acting bronchodilators including Salbulin MDPI Novolizer should not be the main or only treatment. It is recommended that Salbulin MDPI Novolizer should always be prescribed with an inhaled corticosteroid (anti-inflammatory) medicine. For instructions for using the Novolizer Inhaler Device, see section 7 on the reverse side of this leaflet.

What you need to know before you take it

ING SALBULIN MDPI NOVOLIZER DO NOT take Salbulin MDPI Novolizer if: –

you are allergic (hypersensitive) to salbutamol, lactose or milk protein

Warnings and precautions Talk to your doctor before using Salbulin MDPI Novolizer if you can answer 'yes' to any of the following questions: –

do you have any heart or circulatory problems, particularly a recent heart attack or angina?

–

do you suffer from high blood pressure? have you been told you have an aneurysm (a swelling or dilation of a blood vessel)? do you have an overactive thyroid gland? do you suffer from diabetes which is difficult to control? do you have a tumour near your kidney (a phaeochromocytoma)? are you about to have an operation requiring a general anaesthetic? are you taking any other medicines and/or inhalers for your asthma either prescribed by a doctor or bought from a pharmacy?

Seek medical advice if you experience chest pain or other symptoms of worsening of your heart disease. Your doctor may wish to alter your treatment or monitor your condition more closely if any of the above apply to you. Care should be taken when treating acute asthma attacks or exacerbation of severe asthma as increased serum lactate levels, and rarely, lactic acidosis have been reported after the use of high doses of salbutamol. This is reversible on reducing the dose of salbutamol. If your inhaler fails to give relief for a duration of at least 3 hours, check with your doctor as soon as possible. Tell your doctor as soon as possible if your asthma gets worse of if this medicine does not provide as much relief from your asthma as before. Other medicines and Salbulin MDPI Novolizer Treatment with salbutamol may cause hypokalaemia (low potassium in your blood) which can be aggravated by some other drugs. These include other drugs for asthma, such as xanthine derivative (e.g. theophylline) or steroids (e.g. prednisolone), or drugs for other conditions such as water tablets (e.g. frusemide) or digoxin. You must mention to your doctor if you are taking any of these drugs, as your doctor may want to take a blood sample to monitor your potassium levels. If you are taking beta-blockers (e.g. atenolol) for high blood pressure or angina, or antidepressants (e.g. moclobemide, phenelzine, amitriptyline, clomipramide or imipramine) you should also tell your doctor. Some general anaesthetics may interact with salbutamol to cause heart problems and decrease blood pressure. Therefore, if you are having an operation, advise hospital staff that you are taking Salbulin MDPI Novolizer. Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines including inhalers and even those medicines not prescribed by your doctor and bought without a presctiption. Salbulin MDPI Novolizer with food and drink Food and drink are not known to alter the effectiveness of Salbulin MDPI Novolizer. Pregnancy, breast-feeding and fertility If you are pregnant or breast feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. During pregnancy, in particular during the first three months as well as towards the end, Salbulin MDPI Novolizer should be used only upon the express prescription of your treating physician and only then, if your doctor considers it to be absolutely necessary.

If taken during pregnancy salbutamol will pass through the placenta and may cause the heart rate of the foetus (unborn baby) to increase. However, there is no evidence that salbutamol causes any malformations. Salbutamol also passes into a mother's milk and may cause some side effects in a breast-fed infant (see section 4 below). Driving and using machines No studies on the ability to drive and use machines have been performed. Salbulin MDPI Novolizer contains milk sugar (lactose). You should not take Salbulin MDPI Novolizer if you are allergic to lactose. Normally, the content of lactose in a single dose does not cause any problems in persons with lactose intolerance. If you are concerned that you may have an intolerance, you must talk to your doctor.

How to take it

SALBULIN MDPI NOVOLIZER Always use this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are unsure. The label should remind you of how many actuations (puffs) to take and how often you should take them. Do not take more than your doctor has told you to. Your doctor or nurse should also have shown you how to use the Novolizer Device, but please read the instructions for using this device carefully before taking this medicine. These instructions can be found on the reverse of this leaflet. Salbutamol MDPI Novolizer should be used as required rather than regularly. The following information about the use of Salbulin MDPI Novolizer applies unless your doctor has instructed otherwise. Please also note that if you are changing from another salbutamol inhaler to Salbulin MDPI Novolizer you may find that you have to adjust your dose. Use in adults and adolescents above 12 years of age For relief of symptoms: Start with 1 puff; if needed the dose may be increased to 2 puffs. You should leave at least 1 minute between each puff. A further dose should not be taken within 4 hours. For prevention of exercise-induced asthma and wheezing before contact with a 'trigger': 2 puffs should be taken 10-15 minutes before exercise or contact with the 'trigger'. Maximum daily dose: 8 puffs in 24 hours Use in children 6-12 years of age For relief of symptoms: Start with 1 puff; if needed the dose may be increased to 2 puffs. You should leave at least 1 minute between each puff. A further dose should not be taken within 4 hours. For prevention of exercise-induced asthma and wheezing before contact with a 'trigger': 1 puff should be taken 10-15 minutes before exercise or contact with the 'trigger'. If needed this may be increased to 2 puffs. Maximum daily dose: 4 puffs Children below 6 years of age Salbulin MDPI Novolizer is not recommended for use in children below the age of 6 because there is insufficient information on safety and effectiveness in this age group. You must not take more puffs than your doctor advises. If your asthma is getting worse you should discuss your treatment with your doctor, as you may need additional medicine for your chest condition. The following may indicate your asthma is getting worse: –

You find that you need more puffs than usual

–

Relief of your chest tightness is not sufficient You notice that the relief is not lasting as long

IF YOUR BREATHING SUDDENLY BECOMES WORSE OR YOU ARE UNABLE TO TRIGGER THE NOVOLIZER DEVICE YOU MUST CONTACT YOUR DOCTOR IMMEDIATELY. If you have asthma your doctor may have instructed you on the use of a peak-flow meter. It is important to monitor your asthma and the effectiveness of the asthma treatments you have been given. If your asthma is active (for example you have frequent symptoms or flare ups, such as breathlessness that makes speaking, eating or sleeping difficult, cough, wheezing, tight chest or limited physical ability), you should tell your doctor right away who may start or increase a medicine to control your asthma such as an inhaled corticosteroid. Tell your doctor as soon as possible if your medicine does not seem to be working as well as usual (for example you need higher doses to relieve your breathing problems or your inhaler fails to give relief for at least 3 hours) as your asthma may be getting worse and you may need a different medicine. If you use Salbutamol MDPI Novolizer more than twice a week to treat your asthma symptoms, not including preventive use before exercise, this indicates poorly controlled asthma and may increase the risk of severe asthma attacks (worsening of asthma) that can have serious complications and may be life-threatening or even fatal. You should contact your doctor as soon as possible to review your asthma treatment. If you use a medicine against inflammation of your lungs daily, e.g., "inhaled corticosteroid", it is important to continue using it regularly, even if you feel better. If you inhale more doses than you should If you take more puffs than recommended you may notice that your heart beats faster than usual, you may feel shaky and hyperactive. These effects usually wear off in a few hours, but you should contact your doctor immediately. If you need to see another doctor or go to hospital If you see any other doctor or have to go to hospital for any reason, you should take all your inhalers and any other medicines with you including those bought without a prescription. If you have any further questions on the use of this product, ask your doctor or pharmacist.

Possible side effects

. Like all medicines, Salublin MDPI Novolizer can cause side effects, although not everybody gets them. The common side effects (may affect up to 1 in 10 people) you are most likely to notice when using Salbulin MDPI Novolizer include: unpleasant or unusual taste, irritation of the throat and mouth causing a cough, shakiness (usually in the hands), dizziness, restlessness, headache, sweating and feeling sick. Muscle cramp can also occur, but this is rare (may affect up to 1 in 1,000 people). These effects, if noticed will usually wear off within 2 weeks of treatment. Very rarely (may affect up to 1 in 10,000 people) inflammation of the kidney and a drop in blood platelets can occur. Sometimes some people may notice their heart beating faster or unevenly (palpitations) or feeling faint. These occur only rarely with inhaled salbutamol, but if you are affected tell your doctor.

Very rarely, some people may experience chest pain (due to heart problems such as angina). Tell your doctor as soon as possible, but do not stop using this medicine unless told to do so. As with all inhalers it is possible for the powder to make you wheezy immediately after inhalation. This occurs rarely. If this happens you must call your doctor immediately. Allergic reaction to salbutamol, although very rare (may affect up to 1 in 10,000 people), have been reported. These include: itchy rash, skin problems, swelling of the face, lips, eyes, mouth, tongue or throat which cause difficulty in swallowing or breathing, wheeziness, low blood pressure and light headed and collapse. If you notice any of these reactions, stop taking Salbulin MDPI Novolizer and contact your doctor immediately. Children using this medicine may rarely become hyperactive or excitable. They may also suffer sleep disturbance or hallucinations, although this is very rare. Lactose-monohydrate contains small amounts of milk proteins and can therefore cause allergic reactions. Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine.

How to store it

SALBULIN MDPI NOVOLIZER. Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the label, the carton and the cartridge container. The expiry date refers to the last day of that month. The cartridges containing Salbulin MDPI Novolizer should be kept in their sealed outer container until required for use. When the Novolizer device is in-use it should be stored in a dry place to ensure that the powder cartridge inside is protected from moisture. Regardless of whether the cartridge is empty or not after 6 months a new cartridge should be inserted. It is recommended that you keep a record of when you replace the cartridges to help you remember when you will need to insert a new one. The Novolizer device should be replaced after 2000 inhalations. Therefore, a maximum of 10 cartridges should be used with one device. In any event it is recommended that you replace this device at least once a year. Do not store above 30°C. Store in original package. Protect from moisture. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.

Contents of the pack and other information

What Salbulin MDPI Novolizer contains Salbulin MDPI Novolizer is a dry powder for inhalation. The active substance is salbutamol. Each actuation (puff) contains 100 micrograms of salbutamol (as sulphate). The other ingredient is Lactose monohydrate. What Salbulin MDPI Novolizer looks like and contents of pack

The following packs may be available: An Original sale pack which contains a Salbulin MDPI Novolizer dry powder inhaler device and Salbulin MDPI Novolizer drug cartridge sealed in a plastic container with aluminium foil. Each cartridge contains 200 inhalations (puffs). A Refill pack which contains either 1 or 2 Salbulin MDPI Novolizer drug cartridges sealed in a plastic container with aluminium foil. These are for use with the Salbulin MDPI Novolizer dry powder inhaler device. Each refill cartridge contains 200 inhalations (puffs). A Hospital pack with pack of 10 of original sales packs Not all pack sizes may be marketed. The Manufacturer of this product is: McDermott Laboratories T/A Mylan Dublin Respiratory Unit, 25 Baldoyle Industrial Estate, Grange Road, Baldoyle, Dublin 13, Ireland The Marketing Authorisation Holder is: Viatris Products Ltd., Station Close, Potters Bar, EN6 1TL, UK. This leaflet was last revised April 2026.

7. INSTRUCTIONS FOR USING THE NOVOLIZER DEVICE.

Introduction The Novolizer Device is a breath-actuated dry powder inhaler. It helps to make inhaling simple and reliable. It includes safety features to ensure that you take the correct dose and it is also environmentally friendly as it does not use chlorofluorocarbon (CFC) propellants. The following instructions for using the Novolizer Device are brief and east to understand, but it is recommended that children use this device under the supervision of an adult.

Please note that the Novolizer device supplied for use with Salbulin MDPI Novolizer must only be used with this medicine. Inserting a cartridge 1. When you first get the Novolizer Device you will need to put the cartridge containing the medicine into the device. To do this, gently squeeze the ribbed surfaces on both sides of the lid. Move the lid forwards (←) and off (↑).

2. Remove the protective aluminium foil from the cartridge box and take out the new cartridge. Only do this just before you need to use the cartridge.

3. Insert the cartridge into the Novolizer Device with the dosage counter facing the mouthpiece (↓). Do not press the dosage button while inserting the cartridge.

4. Replace the lid into the lid guides from above (↓) and push down flat towards the dosage button (→) until it clicks into place.

5. The Novolizer Device is now filled and ready for use. You can leave the cartridge in the Novolizer until '0' appears in the middle of the counter window; however, you must replace it with a new cartridge within 6 months of taking the cartridge out of its sealed outer container.

6. When the cartridge needs replacing remove the lid as described in step 1 and lift out the used cartridge. Insert a new cartridge following steps 2 to 5.

Using the Novolizer Device 1. When using the Novolizer Device always keep it horizontal. Remove the protective cap, by lightly squeezing the sides and sliding forwards (←).

2. To 'prime' the Novolizer Device push down hard on the large coloured button until it stops (↓) (see picture). You will hear a loud double click and the colour of the control window will change from red to green. You can now release the large button. The colour green in the control window indicates that the Novolizer Device is now primed and ready to use. The large button should only be pressed immediately before inhaling.

3. Breathe out deeply, but not into the Novolizer Device. Put your lips around the mouthpiece. Inhale the powder steadily, deeply and as rapidly as possible (to the maximum inhalation). During this breath you should hear a loud click. This click indicates that you have breathed in strongly enough for the Novolizer Device to work. Continue inhaling as strongly and deeply as you can. Hold your breath for a few seconds before breathing out slowly through your nose. If you need to take another dose repeat steps 2 and 3. Replace the protective cap on the mouthpiece.

4. The loud click and the colour change from green to red in the control window indicate that you have inhaled correctly. The figures in the top window show the number of inhalations (puffs) remaining. Each inhalation is counted, but please note that figures in the top window count down in steps of 20 until 60 puffs remain and then in steps of 10 when it is below 60. This cartridge MUST be replaced when either: –

'0' appears in the middle of the counter window or Every 6 months, even if the cartridge is not empty.

Please note: If there is no click and the colour in the control window does not change please repeat the procedure as described above. If you cannot manage to inhale correctly after several attempts, please consult your doctor, nurse or pharmacist.

Cleaning 1. You should clean your Novolizer Device regularly, or at least whenever you change the cartridge. To do this first remove the protective cap. Then twist the mouthpiece anticlockwise slightly (↑). It will become loose and you can remove it (←).

2. Now turn the Novolizer Device upside down. Loosen the dispensing slide and move it forwards (←) and upwards (↑). Any remaining powder can be removed from the dispensing slide by tapping it lightly. Clean the mouthpiece, the dispensing slide and the powder inhaler with a soft and dry lint-free cloth. DO NOT use water or detergent. 3. After cleaning, re-insert the dispensing slide by sliding down at angle ( into position (↓). You will hear a click as it fits into position.

) and press back

4. Insert the mouthpiece so that the small pin fits into the groove on the Novolizer Device just below the colour control window (→). Twist the mouthpiece clockwise (↓) so that it clicks into place. Finish by replacing protective cap. Replacement and Storage 1. The Novolizer Device can be refilled using new cartridges containing Salbulin MDPI Novolizer. It is ideal for long-term usage, but you must remember to replace your Novolizer Device after 2000 puffs (10 cartridges). In any event you must replace it within a year. Make sure your Novolizer Device is protected from moisture. Remember to replace the cartridge every 6 months even if it is not empty. This leaflet was last revised April 2026 ® Meda GmbH & Co. KG © Meda Pharmaceuticals Ltd.

Frequently asked questions about Salbulin Novolizer 100 micrograms / dose Inhalation Powder

How do I take Salbulin Novolizer 100 micrograms / dose Inhalation Powder?

Salbulin Novolizer 100 micrograms / dose Inhalation Powder comes as inhaler containing 100mcg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Salbulin Novolizer 100 micrograms / dose Inhalation Powder?

The active substance in Salbulin Novolizer 100 micrograms / dose Inhalation Powder is salbutamol sulfate.

Are there equivalent medicines to Salbulin Novolizer 100 micrograms / dose Inhalation Powder?

Medicines with the same active substance, strength and form include: Asthalin 100 micrograms Inhaler, Salamol CFC-Free MDI Inhaler 100mcg. They are interchangeable only if your prescriber or pharmacist says so.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Salbulin Novolizer 100 micrograms / dose Inhalation Powder, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Salbulin Novolizer 100 micrograms / dose Inhalation Powder without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Salbutamol sulfate (16 medicines)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Salbulin MDPI Novolizer 100 micrograms is indicated in adults, adolescents and children aged 6 to 12 years.

Salbulin MDPI Novolizer 100 micrograms is recommended for use in patients with reversible airways obstruction such as asthma for relief and prevention of bronchospasm. It should be used to relieve asthma symptoms when they occur and to prevent symptoms in circumstances known by the patient to precipitate symptoms, for example prior to exercise or allergen exposure.

Salbulin MDPI Novolizer 100 micrograms is particularly useful for the relief of symptoms of asthma, providing it does not delay the introduction and regular use of inhaled corticosteroid therapy.

In asthma, short acting beta-2 agonists including Salbulin MDPI Novolizer should not be the main or only treatment. It is recommended that short acting beta-2 agonists should be prescribed with concomitant inhaled corticosteroid (anti-inflammatory).

4.2. Posology and method of administration

Posology

The dose depends on the type, severity, and course of the disorder.

Adults (including older people and adolescents)

For the relief of acute asthma symptoms including bronchospasm a starting dose of one inhalation (100 micrograms) is recommended for adults; this dose may be increased to two inhalations if necessary.

For prevention of exercise-induced or allergen induced symptoms two inhalations (200 micrograms) should be taken 10-15 minutes prior to challenge.

The maximum on-demand use in any 24 hours should not exceed 8 inhalations (equivalent to 800 micrograms).

For chronic therapy, two inhalations up to four times a day.

Children (aged 6 to 12 years)

For the relief of acute asthma symptoms including bronchospasm a starting dose of one inhalation (100 micrograms) is recommended for children aged 6 years and above; this dose may be increased to two inhalations if necessary.

For prevention of exercise-induced or allergen induced symptoms one inhalation (100 micrograms) should be taken 10-15 minutes prior to challenge and a further inhalation (to a total of 200 micrograms), if necessary.

The maximum on-demand use in any 24 hours should not exceed 4 inhalations (equivalent to 400 micrograms).

Chronic therapy:

The usual dosage for children under the age of 6-12 years: up to two inhalations 4 times daily.

Children below 6 years of age

Salbulin MDPI Novolizer is not recommended for use in children below age 6 due to insufficient data on safety and efficacy.

For all patients:

When other salbutamol inhalers are replaced by Salbulin MDPI Novolizer 100 micrograms, it may be necessary to adjust the dosage regimen as the amount of salbutamol delivered to the lung may vary between different inhalers.

Reliance on such frequent supplementary use, or a sudden increase in dose, indicates poorly controlled or deteriorating asthma (see section 4.4).

Method of administration

Salbulin MDPI Novolizer 100 micrograms is for oral inhalation use only.

There should be an interval of at least 1 minute between 2 inhalations.

Instructions for using the Novolizer device (Powder inhaler device)

Figure

Refilling

1. Lightly press together the ribbed surface of both sides of the lid, move the lid forwards, and lift off.

2. Remove the protective aluminium foil from the cartridge container and take out the new cartridge.

3. Insert the cartridge into the Novolizer device with the dosage counter facing the mouthpiece.

4. Replace the lid into the side guides from above and push down flat towards the button until it snaps into place. The cartridge can be left in the Novolizer device until it is empty, but it must be replaced with a new cartridge within 6 months of removal from its sealed container.

Note: Salutamol MDPI Novolizer 100 micrograms cartridges may only be used in the Novolizer Powder inhaler.

Usage

1. The Novolizer device must be kept horizontal when it is being used.

2. Remove the protective cap.

3. Prime the Novolizer device by completely depressing the large coloured button. A loud double click will be heard and the colour of the control window will change from red to green. The coloured button should then be released. The colour green in the window indicates that the Novolizer device is primed and ready for use.

4. The patient should exhale (not into the powder inhaler).

5. The lips should be placed around the mouthpiece and the powder inhaled steadily, deeply and as rapidly as possible (to the maximum inhalation). During this breath a loud click should be heard, indicating that the inhalation was sufficiently strong. The patient should hold their breath for a few seconds and then continue breathing normally. If the patient needs to take more than 1 inhalation, steps 2 - 5 should be repeated.

6. The protective cap should be replaced.

7. The number of inhalations left is indicated by the dosage counter.

Note: The large coloured button should only be pressed immediately before inhalation.

It is not possible for the patient to administer a double inhalation in error using the Novolizer device. The clicking sound and the change of colour in the control window indicate that inhalation has been performed correctly. If the colour of the control window does not change then inhalation should be repeated. The Novolizer device cannot be primed a second time unless the inhalation has been performed correctly. If inhalation is not completed correctly after several attempts, then the patient should consult their doctor/physician.

Cleaning

The Novolizer device should be cleaned at regular intervals; at a minimum at least every time the cartridge is changed. Instructions for the patient on how to clean the Novolizer device can be found in the Patient Information Leaflet.

Note: In order to ensure correct use of the Novolizer device, patients should receive thorough instructions on how to use the Novolizer device and their inhaler technique checked to ensure that they are able to use it correctly. Children should only use this product under the supervision of an adult.

4.3. Contraindications

Hypersensitivity to the active substance salbutamol or to the excipient lactose monohydrate (which contains small amounts of milk proteins).

4.4. Special warnings and precautions for use

Patients should be warned that they may experience a different taste upon inhalation compared to their previous inhaler.

Bronchodilators should not be the only or main treatment in patients 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.

The use of brochodilators such as Salbulin MDPI Novolizer 100 micrograms should not delay the introduction and regular use of inhaled corticosteroid therapy. Daily patient self-assessment of asthma control following instructions on the use of Salbulin MDPI Novolizer 100 micrograms and any other drugs required for the management of asthma is important in order that the course of the disease can be followed and the success of both bronchodilator and anti-inflammatory therapy monitored. The patient should be instructed in the regular measurement of peak expiratory flow rate (PEFR) using a portable peak flow meter.

If asthma control does not improve satisfactorily or deteriorates, or if the short-acting relief bronchodilator treatment becomes less effective, or more inhalations than usual are required, medical advice must be sought in order that the clinical condition can be re-assessed and therapeutic management revised appropriately. In this situation anti-inflammatory therapy may be required, the dose of anti-inflammatory therapy may need to be increased, or a short course of oral glucocorticoids may be needed.

Failing to respond to treatment with salbutamol may signal a need for urgent medical advice or treatment.

Patients who are prescribed regular anti-inflammatory therapy (e.g., inhaled corticosteroids) should be advised to continue taking their anti-inflammatory medication even when symptoms decrease, and they do not require Salbutamol MDPI Novolizer.

Increasing use of bronchodilators and in particular short-acting inhaled beta2 adrenergic agonists to relieve symptoms indicates deterioration of asthma control, and patients should be warned to seek medical advice as soon as possible. Under these conditions, the patient's therapy plan should be reassessed.

Overuse of short-acting beta-agonists may mask the progression of the underlying disease and contribute to deteriorating asthma control, leading to an increased risk of severe asthma exacerbations and mortality.

Patients who take more than twice a week “as needed” salbutamol, not counting prophylactic use prior to exercise, should be re-evaluated (i.e., daytime symptoms, night-time awakening, and activity limitation due to asthma) for proper treatment adjustment as these patients are at risk for overuse of salbutamol.

Patients should be advised that a sudden and increasing deterioration of asthma symptoms can be life-threatening. Therefore, medical assistance must be sought immediately.

The dose and frequency of inhalation of short-acting beta 2 agonists should only be increased following medical advice and if a previously effective dose of inhaled salbutamol no longer provides relief for a duration of three hours following administration, the patient should be advised to promptly seek medical advice. Exceeding the prescribed dose can be dangerous (see section 4.9). If acute asthma symptoms are not relieved or gets even worse following a second inhalation, or if patients are unable to trigger the Novolizer device during an acute asthma attack, medical assistance should be sought immediately.

Potentially serious hypokalaemia may result from beta 2-agonist therapy, mainly from parenteral and nebulised administration. Particular caution is advised in acute severe asthma as this effect may be potentiated by hypoxia and by concomitant treatment with xanthine derivates, steroids, and diuretics. Serum potassium levels should be monitored in such situations.

Inhalation of high doses of salbutamol can increase the blood glucose level. Therefore, blood glucose levels in diabetic patients should be monitored closely.

In the following cases, salbutamol should only be used with caution and if strictly indicated:

- serious cardiac disorders, in particular recent myocardial infarction

- coronary heart disease, hypertrophic obstructive cardiomyopathy and tachyarrhythmia

- severe and untreated hypertension

- aneurysm

- hyperthyroidism

- diabetes which is difficult to control

- pheochromocytoma

There is some evidence from post-marketing data and published literature of rare occurrences of myocardial ischaemia associated with salbutamol. Patients with underlying severe heart disease (e.g. ischaemic heart disease, tachyarrhythmia or severe heart failure) who are receiving salbutamol for respiratory disease, should be warned to seek medical advice if they experience chest pain or other symptoms of worsening heart disease. Care should be taken when treating acute asthma attacks or exacerbation of severe asthma as increased serum lactate levels, and rarely, lactic acidosis have been reported after the use of high doses of salbutamol. This is reversible on reducing the dose of salbutamol.

This medicinal product contains lactose. The amount of lactose contained in Salbulin MDPI Novolizer does not normally cause problems in lactose intolerant people.

However, in patients with profound enzyme deficiency, lactose intolerance has been reported very rarely following inhalation of powder containing lactose.

Inhaled salbutamol preparations are not indicated for threatened abortion.

4.5. Interaction with other medicinal products and other forms of interaction

Salbutamol and non-selective beta -receptor blocking drugs should not usually be prescribed together. Administration of beta-receptor blocking drugs to patients with asthma may cause severe bronchoconstriction.

When administering halogenated anaesthetics, e.g. halothane, methoxyflurane or enflurane, to patients treated with salbutamol there is an increased risk of severe dysrhythmia and hypotension. Salbutamol should not be used for at least 6 hours prior to the use of halogenated anaesthetics.

Treatment with salbutamol can lead to hypokalaemia (see 4.4 Special warning and precautions for use and 4.8 Undesirable effects). This effect may be potentiated by the concomitant administration of other drugs, in particular xanthine derivatives, glucocorticoids, diuretics and cardiac glycosides (digoxin). Serum potassium levels should be monitored in these situations.

Monoamine oxidase inhibitors and tricyclic antidepressants may increase the risk of cardiovascular side effects.

4.6. Fertility, pregnancy and lactation

Pregnancy

Studies in animals have shown reproductive toxicity (see section 5.3). Safety in pregnant women has not been established. No controlled clinical trials with salbutamol have been conducted in pregnant women. Rare reports of various congenital anomalies following intrauterine exposure to salbutamol (including cleft palate, limb defects and cardiac disorders) have been received. Some of the mothers were taking multiple medications during their pregnancies. Salbutamol MDPI Novolizer should not be used during pregnancy unless clearly necessary.

Breast-feeding

As salbutamol is probably secreted in breast milk, its use in nursing mothers required careful consideration. It is not known whether salbutamol has a harmful effect on the neonate, and so its use should be restricted to situations where it is felt that the expected benefit to the mother is likely to outweigh any potential risk to the neonate.

Fertility

There is no information on the effects of salbutamol on human fertility. There were no adverse effects on fertility in animals (see section 5.3).

4.7. Effects on ability to drive and use machines

No studies on the effects on the ability to drive and use machines have been performed.

4.8. Undesirable effects

Up to 10% of patients may experience adverse reactions. These reactions are dose-dependent.

The most commonly reported adverse reactions are: taste alteration (bad, unpleasant and unusual taste), mouth and throat irritation, fine tremor (usually of the hands), nausea, sweating, restlessness, headache and dizziness. These undesirable effects may subside on continuation of treatment within 1-2 weeks.

As with other inhalation therapies, in rare cases paradoxical bronchospasm may occur, with an immediate increase in wheezing after dosing. Paradoxical bronchospasm should be treated immediately with an alternative fast-acting inhaled bronchodilator and Salbulin MDPI Novolizer 100 micrograms discontinued immediately. The patient should be assessed and, if necessary, alternative therapy instituted.

Hypersensitivity reactions such as rash, urticaria, dermatitis, pruritus and erythema have been observed. There have been very rare reports of angioedema (oedema of the face, lips, eyes and throat), bronchospasm, hypotension, collapse, thrombopenia and nephritis.

Tachycardia, with or without peripheral vasodilatation, may occur. In common with other β2 agonists, cardiac arrhythmias (including atrial fibrillation, supraventricular tachycardia and extrasystoles), palpitations, angina pectoris, and blood pressure effects have been reported in association with the use of salbutamol, usually in susceptible patients.

There are also reports of the stimulating effects on the central nervous system after inhalation of salbutamol which manifest themselves in hyperactive behaviour, sleeping disturbances and hallucinations. These observations were predominantly made in children up to 12 years of age.

Adverse events are listed below by system organ class and frequency. Frequencies are defined as:

Very common (≥ 1/10); Common (≥ 1/100, < 1/10); Uncommon (≥ 1/1,000, < 1/100); Rare (≥ 1/10,000, < 1/1,000); Very rare (< 1/10,000) ), Not known (cannot be estimated from the available data)

Organ System

Frequency

Adverse drug reaction

Blood and lymphatic system disorders

Very rare

Thrombopenia

Immune system disorders

Very rare

Hypersensitivity reaction

Metabolism and nutrition disorders

Rare

Hypokalaemia, hyperglycaemia, increase of insulin, free fatty acids, glycerol and ketone bodies

Psychiatric disorders

Common

Restlessness

Nervous system disorders

Common

Fine tremor, dizziness

Rare

Hyperactive behaviour

Very rare

Hyperexcitability, sleeping disturbances, hallucinations

Cardiac disorders

Rare

Tachycardia, cardiac arrhythmia (atrial fibrillation, supraventricular tachycardia, extrasystoles), palpitations, angina pectoris, blood pressure effects (lowering or increase)

Very rare

Myocardial ischaemia

Vascular disorders

Rare

Peripheral vasodilatation

Very rare

Collapse

Respiratory, thoracic and mediastinal disorders

Rare

Cough

Rare

Paradoxical bronchospasm

Gastrointestinal disorders

Common

Nausea, taste alteration

Skin and subcutaneous tissue disorders

Common

Sweating

Very rare

Pruritus, rash, erythema, urticaria, angioedema

Musculoskeletal disorders

Rare

Muscle cramps

Renal and urinary disorders

Very rare

Nephritis

General disorders and administration site condition

Common

Headache, application site reaction (mouth and throat irritation, burning sensation of the tongue)

Lactose-monohydrate contains small amounts of milk proteins and can therefore cause allergic reactions.

Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.

4.9. Overdose

Symptoms of an overdose

In the case of an overdose, the above-mentioned undesirable effects (see 4.8, Undesirable effects) occur very quickly and with increased severity. Typical symptoms include: tachycardia, palpitations, arrhythmia, restlessness, sleep disturbances, chest pain and vigorous tremor, especially the hands.

Occasionally, psychotic reactions were observed after excessive doses of salbutamol.

In the case of a salbutamol overdose there can be a shift of potassium into the intracellular space resulting in hypokalaemia, as well as hyperglycaemia, hyperlipidaemia and hyperketonaemia.

Management of an overdose

Treatment after an overdose of salbutamol is mainly symptomatic. The following measures may be considered, depending upon individual circumstances:

- If large amounts of the drug are swallowed, irrigation of the stomach should be considered. Activated charcoal and laxatives may reduce absorption.

- Cardiac symptoms can be treated with a cardioselective beta-blocker. However, attention should be given to an increased risk of bronchospasm in patients with asthma. ECG monitoring is indicated in such patients.

- If blood pressure is markedly reduced, volume substitution (e.g. plasma expanders) is recommended.

- If hypokalaemia develops electrolyte balance should be monitored and electrolytes administered if necessary.

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