What is the recommended dose of salbutamol (albuterol) syrup for pediatric patients?

Pediatric Salbutamol Syrup Dosage

The recommended dose of salbutamol (albuterol) syrup for pediatric patients is 0.1 mg/kg administered three times daily, with specific weight-based dosing of 2 mg three times daily for children weighing at least 15 kg and 1 mg three times daily for children under 15 kg. 1

Weight-Based Dosing Guidelines

• For children weighing less than 15 kg: 1 mg three times daily 1, 2
• For children weighing 15 kg or more: 2 mg three times daily 1, 2
• Maximum frequency should not exceed four times daily 1

Age-Specific Considerations

• For children 2-6 years old: 1-2 mg every 8 hours has been shown to be safe and effective 2
• For children under 2 years: Limited data exists, but weight-based dosing of 0.1 mg/kg is generally applied 1

Administration Recommendations

• Administer salbutamol syrup at regular intervals rather than as needed for optimal control of symptoms 1
• If a previously effective dosage regimen fails to provide usual relief, seek medical advice immediately as this may indicate worsening respiratory condition 1
• Regular use exceeding twice weekly for symptom control indicates poor control and need for controller medication adjustment 3

Alternative Delivery Methods

• For acute management, nebulized salbutamol is often preferred with the following dosing:
  • Children weighing less than 20 kg: 2.5 mg per nebulization 4
  • Children weighing more than 20 kg: 5 mg per nebulization 4
• Metered-dose inhaler: 4-8 puffs (90 μg per puff) every 15-20 minutes for 3 doses, then every 1-4 hours as needed 4

Monitoring and Safety Considerations

• Monitor for common side effects including tachycardia, skeletal muscle tremor, and hyperactivity 1
• Only one patient in a study of children aged 2-6 years experienced side effects at the 2 mg dose, suggesting good overall tolerability 2
• Increasing use or lack of expected effect indicates diminishing control and need for medical attention 1

Special Situations

• For children with upper respiratory infections under age 6 requiring anesthesia, nebulized salbutamol (2.5 mg for <20 kg, 5 mg for >20 kg) administered 30 minutes before induction can reduce perioperative respiratory complications by approximately 50% 4
• For severe asthma exacerbations unresponsive to oral or inhaled therapy, intravenous salbutamol may be considered starting at 0.2 μg/kg/min after a loading dose of 1 μg/kg/min over 10 minutes 5, 6

Comparison with Levalbuterol

• Levalbuterol is the R-isomer of racemic albuterol and is effective at half the dose of racemic albuterol 4, 3
• When using levalbuterol instead of racemic albuterol, the dose should be halved 3