Levolin (Levosalbutamol) Respule Dosing Per Kilogram in Children
For acute asthma exacerbations in children, administer levosalbutamol at 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg (up to 5 mg maximum) every 1-4 hours as needed. 1, 2
Initial Treatment Dosing
- Start with 0.075 mg/kg (minimum absolute dose of 1.25 mg) for the first three doses 1, 2
- Administer every 20 minutes for 3 consecutive doses during acute exacerbation 1, 2, 3
- This represents half the milligram dose of racemic albuterol (which would be 0.15 mg/kg), providing equivalent efficacy and safety 1, 2, 3
Maintenance Dosing After Initial Treatment
- Following the initial three doses, continue with 0.075-0.15 mg/kg every 1-4 hours as needed 1, 2
- Maximum single dose should not exceed 5 mg regardless of weight 1
- Adjust frequency based on clinical response, with goal of using the lowest effective dose 2
Continuous Nebulization for Severe Cases
- For life-threatening exacerbations requiring continuous therapy: 0.25 mg/kg/hour by continuous nebulization 1
- This approach requires intensive care monitoring 2
Critical Administration Requirements
- Dilute to minimum 3 mL total volume with normal saline for optimal nebulization 1, 2, 3
- Use oxygen as the preferred gas source at 6-8 L/min flow rate 1, 2, 3
- A standard flow rate compressor with Venturi nebulizer provides optimal delivery 2
Key Dosing Principle: Half-Dose Equivalence
The most critical concept is that levosalbutamol requires only half the milligram dose of racemic albuterol because it contains only the active (R)-enantiomer. 1, 2, 3, 4, 5
- 0.63 mg levosalbutamol = 1.25 mg racemic albuterol 1
- 1.25 mg levosalbutamol = 2.5 mg racemic albuterol 1, 5
- Using equivalent milligram-per-milligram dosing results in overdosing 3
Monitoring Requirements After Each Dose
- Assess respiratory rate, work of breathing, and oxygen saturation 2, 3
- Monitor heart rate for tachycardia 2, 3
- Watch for tremor and hypokalemia, especially with frequent or high-dose administration 2, 3
Adjunctive Therapy Considerations
- For life-threatening asthma features, consider adding ipratropium bromide 0.25 mg to the nebulizer solution 1
- Ipratropium can be mixed in the same nebulizer with levosalbutamol 1
- Repeat ipratropium every 20 minutes for 3 doses, then every 2-4 hours as needed 1
Common Pitfall to Avoid
Do not dose levosalbutamol at the same milligram-per-kilogram as racemic albuterol. This is the most frequent dosing error and results in administering twice the intended active drug. 3 Always remember that levosalbutamol doses are half those of racemic albuterol on a milligram basis. 1, 2, 3