What is the recommended dose of Levosalbutamol (Levalbuterol) for inhalation?

Recommended Dosage of Levosalbutamol (Levalbuterol) for Inhalation

The recommended dose of levosalbutamol (levalbuterol) for inhalation is half the dose of racemic albuterol, specifically 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses during acute exacerbations, 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, 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
• Dilute aerosols to a minimum of 3 mL at a gas flow of 6-8 L/min for optimal delivery 1
• For continuous/prolonged nebulization in severe cases: 0.25 mg/kg per hour up to 5-7.5 mg/hour (half the dose of racemic albuterol) 2, 1

Metered Dose Inhaler (MDI) Dosing

• For MDI administration: 2-4 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed (half the dose of racemic albuterol) 2, 1
• A spacer/holding chamber must be used when administering metered-dose inhaler treatments for optimal delivery 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

• Adults: 1.25 mg via nebulizer every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• Children: 0.075 mg/kg (minimum dose 1.25 mg) via nebulizer every 20 minutes for 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed 1
• For children under 4 years, levosalbutamol nebulizer solution should be used with caution due to limited data available 1

Clinical Evidence and Rationale

• Levosalbutamol is the therapeutically active (R)-enantiomer of racemic salbutamol 3
• Clinical studies have shown that 100 mcg levosalbutamol produces similar bronchodilator effects as 200 mcg racemic salbutamol, confirming the half-dose equivalence 4
• The bronchodilator effects of salbutamol are attributed entirely to the (R)-enantiomer (levosalbutamol), while the (S)-enantiomer has been shown to possess bronchospastic and pro-inflammatory effects in some studies 3, 4

Monitoring and Safety Considerations

• Monitor for common beta-agonist side effects including tachycardia, skeletal muscle tremor, hypokalemia, headache, and hyperglycemia 1, 5
• Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention 1
• Regular use exceeding twice weekly for symptom control indicates poor asthma control and need for controller medication adjustment 1
• Oxygen is the preferred gas source for nebulization. Supplemental oxygen may be needed when compressed air-driven nebulizers are used 2

Special Considerations

• Ipratropium bromide may be mixed with levosalbutamol in the same nebulizer for severe exacerbations 1
• In hospitalized patients with acute asthma or COPD, levosalbutamol can be administered every 6-8 hours, requiring fewer total nebulizations compared to racemic albuterol given every 1-4 hours 6
• Individual response to bronchodilator therapy varies widely, with only a minority of patients requiring high-dose therapy 7