Recommended Dose of Nebulised Levosalbutamol in Children
The recommended dose of nebulised levosalbutamol (levalbuterol) in children is 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed, up to a maximum of 5 mg per dose. 1
Dosing Guidelines by Age
For children aged 3-11 years with acute asthma exacerbations:
For very young children (under 5 years):
- Half doses may be appropriate when initiating therapy 1
Comparison to Racemic Albuterol (Salbutamol)
- Levosalbutamol is the pure R-isomer of racemic albuterol 2
- Levosalbutamol is administered at approximately half the milligram dose of racemic albuterol for comparable efficacy 1
- Typical racemic albuterol dose for comparison:
- 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses 1
Clinical Efficacy and Safety Considerations
- Levosalbutamol provides comparable or better improvement in FEV1 compared to racemic albuterol 2
- Beta-mediated side effects (heart rate changes, potassium and glucose alterations) appear to be lower for equipotent doses of levosalbutamol compared to racemic albuterol 2
- Plasma levels of levosalbutamol are dose-dependent and correlate with pharmacodynamic effects 2
Administration Guidelines
- Nebulized levosalbutamol should be delivered via oxygen-driven nebulizer when possible 1
- For optimal delivery, dilute aerosols to a minimum of 3 mL at gas flow of 6-8 L/min 1
- Use large volume nebulizers for continuous administration if needed 1
Special Situations
- For severe or life-threatening asthma exacerbations:
Important Caveats
- Levosalbutamol has not been evaluated by continuous nebulization in most studies 1
- Monitor for tachycardia, tremor, and other beta-adrenergic side effects 2
- For children who cannot use nebulizers effectively, consider metered dose inhaler with spacer as an alternative delivery method 1
- Adjust dosing frequency based on clinical response and side effects 1