Levalbuterol Inhaler Dosing
For levalbuterol metered-dose inhaler (MDI), adults and adolescents ≥12 years should use 2 puffs (45 mcg/puff, total 90 mcg) every 4-6 hours as needed, with the option to double the dose for mild exacerbations. 1
Standard MDI Dosing by Age
Adults and Adolescents (≥12 years)
- Routine dosing: 2 puffs (45 mcg/puff = 90 mcg total) every 4-6 hours as needed 1
- Acute exacerbations: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 2
- May double the usual dose for mild exacerbations 1
Children (5-11 years)
- Acute symptoms: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 2
- Follow the same dosing pattern as albuterol MDI 2
Children (<5 years)
- Use with caution due to limited data available 2
- Children <4 years may not generate sufficient inspiratory flow to activate certain inhaler devices 1
Key Administration Points
Always prime the inhaler by releasing actuations before first use 1. Using a valved holding chamber (spacer) with proper technique is as effective as nebulized therapy for mild-to-moderate exacerbations 2.
Equivalency to Racemic Albuterol
Levalbuterol provides comparable efficacy and safety when administered at one-half the mg dose of racemic albuterol 2. This means 90 mcg of levalbuterol (2 puffs at 45 mcg/puff) is equivalent to 180 mcg of racemic albuterol (2 puffs at 90 mcg/puff) 3.
Monitoring and Safety
When to Seek Medical Attention
- Regular use exceeding twice weekly for symptom control indicates poor asthma control and need for controller medication adjustment 2
- Increasing use or lack of expected effect indicates diminishing asthma control requiring immediate medical attention 2
Common Side Effects to Monitor
Monitor for beta-agonist side effects including tachycardia, skeletal muscle tremor, hypokalemia, headache, and hyperglycemia 2. Long-term safety data (up to 52 weeks) demonstrates that regular use of levalbuterol HFA MDI at 90 mcg four times daily is well tolerated with no deterioration of lung function 3.
Critical Pitfalls to Avoid
Do not use levalbuterol MDI more frequently than every 4-6 hours for routine dosing 1. Periodically clean the HFA actuator, as the drug may plug the orifice 1. The safety and efficacy of levalbuterol when mixed with other drugs have not been established 4.