Dosage and Frequency of MDI Levosalbutamol in Adults
For adults, the recommended dosage of MDI levosalbutamol is 45 mcg per puff, with 4-8 puffs administered every 20 minutes for up to 3 doses, then every 1-4 hours as needed. 1
Standard Dosing Guidelines
- The standard MDI levosalbutamol (45 mcg/puff) dosing follows the same pattern as albuterol MDI dosing according to national asthma guidelines 1
- For acute asthma exacerbations, 4-8 puffs should be administered every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- Levosalbutamol is administered in half the milligram dose of albuterol for comparable efficacy and safety 1, 2
- A single dose of 100 mcg levosalbutamol via MDI produces similar bronchodilator response as 200 mcg of racemic salbutamol (albuterol) 2
Administration Technique
- For optimal delivery, MDI should be used with a valved holding chamber (VHC) 1
- Proper inhalation technique is critical for effective medication delivery 3
- In mild-to-moderate exacerbations, MDI with proper administration technique and coaching by trained personnel is as effective as nebulized therapy 1
Maintenance Therapy
- For routine maintenance therapy in stable asthma, the typical dosage is 1-2 puffs (45-90 mcg) every 4-6 hours as needed 2, 4
- The maximum recommended daily dose should not exceed 12 puffs (540 mcg) in 24 hours 4
Special Considerations
- For severe exacerbations, consider adding ipratropium bromide MDI (8 puffs every 20 minutes for up to 3 hours) to levosalbutamol therapy 1
- Monitor for side effects including tremor (1%), palpitations (0.9%), and tachycardia, which are generally mild and transient 5
- The risk/benefit ratio of levosalbutamol is reported to be superior to that of racemic salbutamol 4
Comparative Efficacy
- Studies show that levosalbutamol 100 mcg via MDI produces equivalent bronchodilation to 200 mcg of racemic salbutamol over a 6-hour period 2
- The time to onset of action, maximum bronchodilator response, and duration of effect are similar between levosalbutamol and racemic salbutamol 2
- There is no evidence supporting the use of higher doses than recommended, as studies show no additional clinical benefit but increased risk of side effects 3, 6