Oral Levosalbutamol Dosage for Infants and Children
The recommended oral levosalbutamol (levalbuterol) dose for infants and children is 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses during acute exacerbations, followed by 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed for maintenance therapy. 1
Dosing Guidelines by Age and Weight
- For infants and children, levosalbutamol should be administered at half the dose of racemic albuterol 2, 1
- For children under 4 years of age, use levosalbutamol with caution due to limited data available 1, 3
- For children 4-11 years with mild to moderate persistent asthma, start with 0.31 mg as the initial dose 4
- For children with severe asthma, higher doses may be more effective as a dose-response relationship has been observed 4
Administration Methods
Nebulizer Solution
- 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
- For optimal delivery, dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min 1
- Oxygen is the preferred gas source for nebulization 2
Metered Dose Inhaler (MDI)
- Children should receive 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 5
- Always use a valved holding chamber (spacer) with proper technique for optimal delivery 1
- MDI delivery with proper technique is as effective as nebulized therapy for mild-to-moderate exacerbations 1
Safety Considerations
- Monitor for common beta-agonist side effects including tachycardia, skeletal muscle tremor, hypokalemia, headache, and hyperglycemia 1, 4
- Levosalbutamol at 0.31 mg has shown fewer effects on heart rate, QTc interval, and glucose levels compared to racemic albuterol 4
- All doses may cause beta-mediated changes in heart rate, potassium, and glucose in a dose-dependent manner 6
- Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention 1
Clinical Efficacy
- Levosalbutamol provides comparable bronchodilation to 4-8 fold higher doses of racemic albuterol 4
- In children with severe asthma, a dose-response relationship has been observed, suggesting higher doses may be more beneficial 4
- Studies show levosalbutamol significantly improves airway function compared to placebo in children aged 4-11 years 5
- Levosalbutamol has demonstrated a more favorable safety profile compared to equivalent doses of racemic albuterol 4, 6
Important Caveats
- Regular use exceeding twice weekly for symptom control indicates poor asthma control and need for controller medication adjustment 1
- For infants and very young children, careful monitoring is essential as they may be more sensitive to beta-agonist effects 3
- Ipratropium bromide may be mixed with levosalbutamol in the same nebulizer for severe exacerbations 1
- The (R)-isomer in levosalbutamol is the therapeutically active component, while the (S)-isomer present in racemic albuterol may work in opposition to the therapeutic effects 7