Levosalbutamol (Levalbuterol) Syrup Pediatric Dosing
For pediatric patients with asthma, levosalbutamol syrup should be dosed at 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses during acute exacerbations, followed by 0.075-0.15 mg/kg every 1-4 hours as needed for maintenance therapy. 1, 2
Acute Exacerbation Dosing
- Initial treatment: Administer 0.075 mg/kg (minimum 1.25 mg) every 20 minutes for 3 doses via nebulizer 3, 1
- This dosing provides comparable efficacy to racemic albuterol at half the milligram dose 3, 1
- For optimal nebulizer delivery, dilute the solution to a minimum of 3 mL with normal saline at a gas flow of 6-8 L/min 1, 2
Maintenance Dosing
- After initial stabilization: Use 0.075-0.15 mg/kg (up to 5 mg maximum) every 1-4 hours as needed 1, 2
- The minimum dose remains 1.25 mg regardless of calculated weight-based dose 1, 2
Age-Specific Considerations
Children 2-5 Years
- Start with 0.31 mg three times daily for mild to moderate persistent asthma 4, 5
- This lower dose (0.31 mg) demonstrated the most favorable safety profile with minimal cardiovascular effects in young children 4, 5
- Children with severe disease may require the higher 0.63 mg dose 5
Children 4-11 Years
- 0.31 mg should be the starting dose for mild to moderate persistent asthma 5
- Can escalate to 0.63 mg for inadequate response or severe disease 5
- Both doses (0.31 mg and 0.63 mg) showed significant bronchodilation compared to placebo, with 0.31 mg being clinically comparable to 4-8 fold higher doses of racemic albuterol 5
Administration Technique
- Use oxygen as the preferred gas source for nebulization, particularly during acute exacerbations 2
- Levosalbutamol can be mixed with ipratropium bromide in the same nebulizer for severe exacerbations 1, 2
- For children under 4 years, use a face mask with the nebulizer 2
Safety Monitoring
- Monitor for tachycardia, skeletal muscle tremor, hypokalemia, headache, and hyperglycemia 1
- Critical caveat: Racemic albuterol 2.5 mg and levosalbutamol 0.63 mg both cause significant increases in ventricular heart rate, while levosalbutamol 0.31 mg does not differ from placebo for cardiovascular effects 4, 5
- All active beta-agonist treatments decrease serum potassium (range -0.3 to -0.6 mEq/L) 5
- Use with caution in patients with cardiovascular disorders, convulsive disorders, hyperthyroidism, and diabetes mellitus 2
Clinical Decision Points
- Increasing use or lack of expected effect indicates diminishing asthma control and necessitates medical attention 1
- Regular use exceeding twice weekly for symptom control indicates poor asthma control requiring controller medication adjustment 1
- Monitor clinical response after each treatment including respiratory rate, work of breathing, and oxygen saturation 2
Comparative Dosing
Levosalbutamol provides equivalent bronchodilation at approximately half the dose of racemic albuterol (e.g., levosalbutamol 0.63 mg ≈ albuterol 1.25 mg) 3, 1, 6