What is the recommended dose of Ventoline (albuterol) in pediatric patients?

Pediatric Ventoline (Albuterol) Dosage Recommendations

For pediatric patients, the recommended dose of Ventoline (albuterol) via nebulizer is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed. 1

Age-Based Dosing Guidelines

Children 2-12 Years of Age:

• Standard nebulization dose: 2.5 mg administered 3-4 times daily 2
• For children weighing <15 kg who require <2.5 mg/dose, albuterol inhalation solution 0.5% should be used instead of 0.083% solution 2
• For acute exacerbations: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed 1

Children Under 2 Years:

• Safety and effectiveness have not been established in children below 2 years of age 2
• However, clinical studies have shown that cumulative dosing with albuterol HFA 180 mcg or 360 mcg via MDI with spacer and face mask in children younger than 2 years did not result in significant safety issues 3

Delivery Methods and Techniques

Nebulizer Administration:

• Dilute albuterol in a minimum of 2-3 mL of saline solution for adequate nebulization 1
• Administer over approximately 5-15 minutes 2
• Oxygen is the preferred gas source for nebulization 1

Continuous Nebulization (for severe exacerbations):

• Dose: 0.5 mg/kg/hour up to 10-15 mg/hour 1
• Dilute in 25-30 mL of saline for 1 hour of nebulization 1
• No optimal weight-based dose of continuous albuterol has been definitively established, with studies showing similar outcomes across dosage ranges from 0.07-0.29 mg/kg/h to 0.76-3.2 mg/kg/h 4

MDI Administration:

• Always use a spacer/holding chamber with MDI for all pediatric patients 1
• For children under 4 years, ensure proper face mask fit over both nose and mouth 1

Monitoring and Safety Considerations

• Monitor respiratory rate, work of breathing, and oxygen saturation during treatment 1

• Watch for potential side effects:

  • Tachycardia and ventricular heart rate increases (particularly with higher doses) 5, 1
  • Electrolyte disturbances (hypokalemia) 1
  • Agitation 1

• Continuous monitoring is essential for patients receiving high doses or continuous nebulization 1

Special Situations

For Bronchospasm Resistant to Epinephrine (e.g., in anaphylaxis):

• Use nebulized albuterol 2.5-5 mg in 3 mL of saline, and repeat as necessary 5

For Severe Asthma Exacerbation:

• If symptoms persist despite appropriate albuterol dosing, consider adding ipratropium bromide 1
• Consider systemic corticosteroids at 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1

Clinical Pearls

• Albuterol syrup formulation may have better bioavailability than tablets in children, with peak effect at 4 hours (vs. 2 hours for tablets) 6
• The 4 mg syrup dose four times daily has been shown to be effective in children 6-14 years of age 6
• Levalbuterol (single-isomer R-albuterol) at doses of 0.31 mg or 0.63 mg TID has been shown to be well-tolerated and effective in children aged 2-5 years 7
• If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this often indicates worsening asthma requiring reassessment 2

Remember that proper delivery technique is crucial for ensuring optimal medication deposition in the lungs, particularly in younger children who may have difficulty with coordination during administration.