Pediatric Nebulized Levosalbutamol (Albuterol) Dosing Based on Weight
The recommended dose of nebulized levosalbutamol (R-albuterol) for pediatric patients is 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed. 1
Detailed Dosing Guidelines
Standard Dosing for Acute Asthma Exacerbations
- Initial treatment: 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses
- Continued treatment: 0.075-0.15 mg/kg every 1-4 hours as needed
- Maximum dose: Up to 5 mg for continued treatment
Weight-Based Dosing Considerations
- For children weighing less than 20 kg: 2.5 mg nebulized levosalbutamol 1, 2
- For children weighing 20 kg or more: 5 mg nebulized levosalbutamol 1, 2
Age-Specific Considerations
- Children 2-5 years old: 0.31 mg or 0.63 mg without regard to weight has been studied and found to be effective 3
- Children 6-11 years old: Doses of 0.31 mg, 0.63 mg, and 1.25 mg have shown significant bronchodilation 4
Administration Guidelines
Nebulizer Setup
- Use oxygen-driven nebulizer when possible, especially for moderate to severe exacerbations 2
- For optimal delivery, dilute aerosols to minimum of 3 mL at gas flow of 6-8 L/min 1
- For very young children, use a face mask with the nebulizer 2
Alternative Delivery Methods
- MDI with spacer: Can be used as an alternative to nebulization with equivalent efficacy
- MDI dosing: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 2
- Always use a valved holding chamber/spacer with pediatric patients 2
Clinical Pearls and Caveats
Efficacy Considerations
- Levosalbutamol is administered at half the milligram dose of racemic albuterol with comparable efficacy and safety 1
- Studies show that 100 mcg of levosalbutamol via MDI produces similar bronchodilation as 200 mcg of racemic salbutamol 5
Safety Considerations
- Monitor for tachycardia and tremors, especially with repeated dosing
- Beta-mediated side effects (heart rate changes, potassium and glucose alterations) are dose-dependent but generally lower with levosalbutamol compared to racemic albuterol at equipotent doses 4
- For severe exacerbations with impending respiratory failure, continuous nebulization (0.3 mg/kg/hr) may be more effective than intermittent dosing 6
Special Situations
- For children with upper respiratory infections before age 6, pretreatment with nebulized salbutamol is recommended to reduce the risk of perioperative respiratory adverse events 1
- Consider adding ipratropium bromide for moderate to severe exacerbations 7
Monitoring and Follow-up
- Assess clinical response through improvement in respiratory rate and work of breathing
- Maintain oxygen saturation >92% 2
- Schedule follow-up appointment with primary care provider or asthma specialist within 1-4 weeks after an acute exacerbation 1
By following these weight-based dosing guidelines for nebulized levosalbutamol, clinicians can effectively manage pediatric asthma exacerbations while minimizing potential adverse effects.