Recommended Dosage of Levosalbutamol MDI for Adults
The recommended dosage of levosalbutamol metered-dose inhaler (MDI) for adults is 2-4 puffs (45 mcg per puff) every 4-6 hours as needed, which is half the dose of racemic albuterol. 1, 2
Dosing Guidelines
- Levosalbutamol (R-albuterol) MDI contains 45 mcg per puff, compared to racemic albuterol which contains 90 mcg per puff 3
- For regular maintenance therapy, 2-4 puffs every 4-6 hours as needed is recommended 1, 4
- For acute exacerbations, 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 3, 1
- Levosalbutamol is administered in half the milligram dose of racemic albuterol for comparable efficacy and safety 3, 2
Administration Technique
- Use of a valved holding chamber (spacer) is strongly recommended to improve medication delivery 5
- In mild-to-moderate exacerbations, MDI with spacer is as effective as nebulized therapy when proper technique is used 3, 1
- For optimal delivery, administer one puff at a time, with 30-60 seconds between puffs 5, 6
- Proper inhalation technique: exhale completely, place mouthpiece in mouth with lips sealed around it, press canister while taking a slow deep breath, hold breath for 10 seconds 5
Clinical Efficacy
- A single dose of 100 mcg levosalbutamol via MDI produces similar bronchodilator response as 200 mcg of racemic salbutamol in patients with stable asthma 2
- Levosalbutamol aims to provide equivalent control of symptoms to salbutamol but without the potential unfavorable effects associated with the (S)-enantiomer 4
- The time to onset of action, maximum bronchodilator response, and duration of effect are similar between levosalbutamol and racemic salbutamol 2
Monitoring and Precautions
- Monitor for common side effects including tachycardia, tremor, headache, palpitations, and anxiety 1, 6
- Watch for signs of overuse: increasing frequency of use may indicate worsening asthma control requiring additional controller medications 1
- Higher doses (beyond recommended) may produce greater side effects without significantly improving bronchodilation 6
- Consider monitoring heart rate, blood pressure, and potassium levels in patients receiving frequent or high doses 1, 6
Special Considerations
- For severe exacerbations not responding to initial MDI therapy, consider switching to nebulized therapy or adding other medications such as ipratropium bromide 1
- Patients with poor MDI technique may benefit from using a spacer device or switching to nebulized therapy 5, 7
- The therapeutic advantage of levosalbutamol over racemic albuterol may be more pronounced in patients who experience significant side effects with racemic albuterol 4