What is the recommended dose of Levosalbutamol (albuterol) for adults and children?

Recommended Dosing of Levosalbutamol (Albuterol) for Adults and Children

For adults, the recommended dose of levosalbutamol via nebulizer is 1.25-2.5 mg every 20 minutes for 3 doses, then 1.25-5 mg every 1-4 hours as needed, while for children the recommended dose is 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed. 1

Nebulizer Dosing

Adults:

• Nebulizer solution (0.63 mg/3 mL, 1.25 mg/0.5 mL, 1.25 mg/3 mL)
• Initial dose: 1.25-2.5 mg every 20 minutes for 3 doses
• Maintenance: 1.25-5 mg every 1-4 hours as needed
• For continuous nebulization: Not evaluated with levosalbutamol 1

Children:

• Nebulizer solution (0.63 mg/3 mL, 1.25 mg/0.5 mL, 1.25 mg/3 mL)
• Initial dose: 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses
• Maintenance: 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed 1

Metered-Dose Inhaler (MDI) Dosing

Adults:

• MDI (45 mcg/puff)
• 4-8 puffs every 20 minutes up to 4 hours, then every 1-4 hours as needed 1

Children:

• MDI (45 mcg/puff)
• 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1

Clinical Considerations

Efficacy

• Levosalbutamol is the active (R)-enantiomer of racemic albuterol
• Levosalbutamol administered at half the mg dose of racemic albuterol provides comparable efficacy and safety 1
• Studies in children aged 2-5 years showed significant bronchodilation with levosalbutamol compared to placebo 2
• In adults with mild-to-moderate asthma, 100 mcg of levosalbutamol via MDI produced similar bronchodilation as 200 mcg of racemic salbutamol 3

Administration Guidelines

• For optimal delivery via nebulizer, dilute aerosols to minimum of 3 mL at gas flow of 6-8 L/min
• Use large volume nebulizers for continuous administration
• For mild-to-moderate exacerbations, MDI plus valved holding chamber (VHC) is as effective as nebulized therapy with appropriate administration technique 1

Special Populations

• For children under 5 years, levosalbutamol doses of 0.31 mg and 0.63 mg t.i.d. have been studied and found to be generally well-tolerated 2
• Children weighing more than 40 kg should be dosed as adults 1

Safety Profile

• Side effects are generally mild and transient, including tremor (1%), palpitation (0.9%), and vomiting (0.7%) 4
• Monitor for tachycardia, which may occur with higher doses 5
• The risk/benefit ratio of levosalbutamol has been reported to be superior to that of racemic salbutamol 6

Common Pitfalls and Caveats

1. Dosing Errors: Ensure correct dosing based on patient age and weight. Children weighing more than 40 kg should receive adult dosing.

2. Administration Technique: Proper technique with MDIs is crucial for effective delivery. Use of a valved holding chamber/spacer improves delivery, especially in children.

3. Monitoring Response: Assess clinical response after initial doses. If symptoms persist or worsen despite appropriate dosing, consider alternative or additional therapies.

4. Overuse Warning: Increasing use of levosalbutamol (>2 days/week) may indicate inadequate asthma control and need for adjustment of controller medications 5.

5. Continuous Nebulization: Unlike racemic albuterol, levosalbutamol has not been evaluated by continuous nebulization 1.

Levosalbutamol provides effective bronchodilation at half the dose of racemic albuterol with potentially fewer side effects, making it a valuable option for both adult and pediatric patients with asthma and other bronchospastic conditions.