Levosalbutamol (Levalbuterol) Dosage Guidelines for Children
The recommended dose of levosalbutamol (levalbuterol) for children 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 when administered via nebulizer. 1
Nebulizer Solution Dosing
- For nebulizer solution (available as 0.63 mg/3 mL, 1.25 mg/0.5 mL, 1.25 mg/3 mL), administer 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses during acute exacerbations 1
- For maintenance therapy, use 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed 1
- Levalbuterol provides comparable efficacy and safety when administered at one-half the mg dose of racemic albuterol 1
- Continuous nebulization has not been formally evaluated with levalbuterol, unlike with racemic albuterol 1
Metered Dose Inhaler (MDI) Dosing
- For MDI (45 mcg/puff), follow the same dosing pattern as albuterol MDI 1
- Children should receive 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 2
- Using a valved holding chamber (spacer) with proper technique is as effective as nebulized therapy for mild-to-moderate exacerbations 1
Age-Specific Considerations
- For children under 4 years: Limited data available; levalbuterol nebulizer solution should be used with caution 1
- For children 4-11 years: Starting dose should be 0.31 mg via nebulizer for mild to moderate persistent asthma 3
- For children with severe asthma: Higher doses may be more effective as a dose-response relationship has been observed 3
Clinical Advantages of Levalbuterol
- Levalbuterol has demonstrated greater efficacy than racemic salbutamol in terms of improvement in peak expiratory flow rate (PEFR), oxygen saturation (SpO2), and asthma scores 4
- Lower incidence of adverse effects like tachycardia and decreased serum potassium levels compared to racemic albuterol 4, 3
- Levalbuterol 0.31 mg has shown a more favorable safety profile with minimal effects on heart rate, QTc interval, and glucose levels compared to higher doses of racemic albuterol 3
Administration Techniques
- For optimal delivery via nebulizer, dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min 1
- Large volume nebulizers should be used for continuous administration if needed 2
- Ipratropium bromide may be mixed with levalbuterol in the same nebulizer for severe exacerbations 1
Monitoring and Safety Considerations
- Monitor for common beta-agonist side effects including tachycardia, skeletal muscle tremor, hypokalemia, headache, and hyperglycemia 1
- Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention 2
- Regular use exceeding twice weekly for symptom control indicates poor asthma control and need for controller medication adjustment 2
- Beta-mediated side effects appear to be dose-dependent but generally lower with levalbuterol compared to equivalent doses of racemic albuterol 5