VOLMAX
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VOLMAX (VOLMAX).
Beta-2 adrenergic receptor agonist; stimulates adenylate cyclase, increasing cyclic AMP, leading to bronchodilation.
| Metabolism | Hepatic, via CYP3A4 and conjugation; extensive first-pass metabolism. |
| Excretion | Renal: 60-70% (unchanged and metabolites); fecal: 15-25%; biliary: <5%. |
| Half-life | Terminal elimination half-life: 4-6 hours. Clinical context: requires twice-daily dosing in asthma. |
| Protein binding | 40-50% bound to albumin. |
| Volume of Distribution | 1.5-2.0 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Oral: 40-60% (first-pass metabolism). |
| Onset of Action | Oral: 30-60 minutes (bronchodilation). |
| Duration of Action | 12 hours (sustained bronchodilation from extended-release formulation). |
Adults: 4-8 mg orally every 12 hours (sustained-release); maximum 16 mg every 12 hours.
| Dosage form | TABLET, EXTENDED RELEASE |
| Renal impairment | No specific guidelines; use with caution in severe renal impairment (CrCl <30 mL/min) due to potential for increased systemic exposure. |
| Liver impairment | Child-Pugh Class A: no adjustment; Class B: reduce dose by 50%; Class C: avoid use. |
| Pediatric use | Children 2-5 years: 0.1 mg/kg/dose every 12 hours (max 4 mg/dose); 6-12 years: 2-4 mg every 12 hours; >12 years: same as adult. |
| Geriatric use | Start at lower end of dosing range (2-4 mg every 12 hours) due to decreased renal function and increased sensitivity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for VOLMAX (VOLMAX).
| Breastfeeding | Excreted into breast milk; M/P ratio not established. Limited human data. May cause infant tachycardia or irritability. Use caution; consider alternative therapies or monitor infant for adverse effects. |
| Teratogenic Risk | FDA Pregnancy Category C. First trimester: No well-controlled studies; potential for fetal tachycardia and hypoglycemia based on beta-2 agonist class effects. Second and third trimesters: May cause fetal tachycardia, hypoglycemia, and maternal hyperglycemia; risk of premature labor inhibition. Use only if benefit outweighs risk. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to albuterol or any component","Tachyarrhythmias"]
| Precautions | ["Paradoxical bronchospasm","Cardiovascular effects (tachycardia, arrhythmia, hypertension)","Hypokalemia","Hyperglycemia","Immediate hypersensitivity reactions"] |
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| Fetal Monitoring |
| Monitor maternal blood pressure, heart rate, serum glucose, and electrolytes. Fetal heart rate monitoring during labor if used for tocolysis; assess for signs of pulmonary edema in prolonged use. |
| Fertility Effects | No known adverse effects on fertility in animal studies; no human data available. Beta-2 agonists may theoretically inhibit uterine contractions but no direct impact on conception. |