What is the recommended pediatric dose of Ventolin (albuterol)?

Pediatric Dosing Guidelines for Ventolin (Albuterol)

The recommended pediatric dose of Ventolin (albuterol) via nebulizer is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed. 1, 2

Nebulizer Solution Dosing

• For children weighing less than 15 kg, use albuterol inhalation solution 0.5% instead of 0.083% solution 3
• For children weighing 15 kg or more, administer 2.5 mg (one 3 mL vial of 0.083% solution) three to four times daily 3
• For acute asthma exacerbations, administer 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed 2, 1
• For children weighing less than 20 kg, the recommended dose is 2.5 mg per dose 1
• For children weighing more than 20 kg, the recommended dose is 5 mg per dose 1

Metered-Dose Inhaler (MDI) Dosing

• When using MDI with spacer, administer 4-8 puffs (90 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed 2, 1
• For children under 5 years, the initial dose is 1-2 puffs every 4-6 hours as needed 4
• For children 5-11 years, the initial dose is 2 puffs every 4-6 hours as needed 4
• Always use a spacer/holding chamber when administering MDI treatments to young children 1, 4
• For children under 4 years, use a spacer with a face mask 4

Continuous Nebulization for Severe Exacerbations

• For severe status asthmaticus, administer 0.5 mg/kg per hour up to 10-15 mg/hour 2, 1, 4
• Dilute the solution in a larger amount of saline (usually 25-30 mL for 1 hour of nebulization) 4
• Higher doses (up to 3.7 mg/kg/hr) have been used in critical care settings with acceptable safety profiles, but should be reserved for severe cases unresponsive to standard therapy 5

Administration Considerations

• Dilute albuterol in 2-3 mL of saline solution for adequate nebulization 1
• Oxygen is the preferred gas source for nebulization 1, 4
• Nebulization should be administered over approximately 5 to 15 minutes 3
• Albuterol can be mixed with ipratropium bromide in the same nebulizer 2
• For severe exacerbations, consider adding ipratropium bromide to albuterol nebulization for the first 3 hours of treatment 4

Monitoring and Safety

• Monitor heart rate, respiratory rate, oxygen saturation, and clinical response when administering albuterol 1
• Watch for potential adverse effects including tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia, and headache 4
• Increasing use or lack of expected effect indicates diminishing asthma control 4
• If a previously effective dosage regimen fails to provide relief, seek medical advice immediately as this may indicate worsening asthma requiring reassessment 3

Special Considerations

• Levalbuterol (R-albuterol) may be used at half the dose of racemic albuterol with comparable efficacy and safety 2, 1
• For children with upper respiratory infections under age 6, preoperative nebulized albuterol (2.5 mg for <20 kg, 5 mg for >20 kg) administered 30 minutes before general anesthesia can reduce perioperative respiratory adverse events 1
• The safety and effectiveness of albuterol have been established in children 2 years of age or older 3
• Lower doses of albuterol via MDI (6-12 puffs in the first hour) have been shown to be effective for moderate to severe acute asthma, with similar safety profiles to higher doses 6