Normal Nebulization Dose of Levosalbutamol in Children
The recommended nebulization dose of levosalbutamol (albuterol) in children is 2.5 mg for children weighing less than 20 kg and 5 mg for children over 20 kg. 1
Dosing Guidelines by Weight and Age
Standard Dosing
Alternative Weight-Based Dosing
- All children: 0.15 mg/kg per dose (minimum 2.5 mg) 2
- For acute exacerbations: This dose can be repeated every 20 minutes for up to 3 doses 2
Age-Based Considerations
- Children under 5 years: When using MDI with spacer instead of nebulization, 1-2 puffs (100-200 mcg) every 4-6 hours as needed 2
- Children 6-11 years: Lower doses of levosalbutamol (0.31 mg or 0.63 mg) have demonstrated efficacy comparable to higher doses of racemic albuterol 3
Administration Guidelines
- Administer nebulization 30 minutes before procedures requiring general anesthesia in children with upper respiratory infections 1
- Dilute medication in 2-3 mL of saline solution for adequate nebulization 2
- For continuous nebulization in severe cases: 0.5 mg/kg/hour up to 10-15 mg/hour 2
Clinical Efficacy
- Levosalbutamol has been shown to be more effective than racemic salbutamol in children with acute exacerbation of asthma 4
- Benefits include:
Monitoring and Safety Considerations
- Monitor for tachycardia, tremor, and hypokalemia, especially with repeated dosing 2
- Lower doses of levosalbutamol (0.31 mg) have shown a more favorable safety profile compared to racemic albuterol, with minimal effects on heart rate, QTc interval, and glucose levels 3
- All beta-agonists can decrease serum potassium levels, with higher doses causing greater reductions 3
Special Considerations
- For children with severe asthma, a dose-response relationship exists for levosalbutamol, suggesting higher doses may be more effective 3
- Starting dose for children 4-11 years with mild to moderate persistent asthma should be 0.31 mg 3
- Fixed-dose nebulization has been shown to be as effective as weight-based dosing in children with mild to moderate acute asthma 5
Practical Tip
When treating children with acute respiratory symptoms, using the standard dosing of 2.5 mg for children under 20 kg and 5 mg for those over 20 kg provides a simple, effective approach that balances efficacy and safety.