Levosalbutamol Pediatric Dosing
For pediatric patients, administer levosalbutamol (levalbuterol) at 0.075 mg/kg with a minimum dose of 1.25 mg via nebulizer for acute asthma exacerbations, given every 20 minutes for 3 doses initially, then 0.075-0.15 mg/kg (up to 5 mg) every 1-4 hours as needed for maintenance. 1, 2
Initial Treatment for Acute Exacerbations
Nebulizer dosing:
- 0.075 mg/kg (minimum 1.25 mg) every 20 minutes for 3 doses 1, 2
- This represents half the milligram dose of racemic albuterol for comparable efficacy 1, 3
- Dilute to a minimum of 3 mL with normal saline for optimal delivery 1, 3
- Use a standard flow rate compressor at 6-8 L/min with oxygen as the preferred gas source 1, 3
MDI dosing (alternative):
- 4-8 puffs every 20 minutes for 3 doses 2, 3
- Always use with a valved holding chamber (spacer) for proper technique 2, 3
- MDI delivery is as effective as nebulized therapy for mild-to-moderate exacerbations 2, 3
Maintenance Therapy
- 0.075-0.15 mg/kg (maximum 5 mg) every 1-4 hours as needed 1, 2
- Regular use exceeding twice weekly for symptom control indicates poor asthma control and requires controller medication adjustment 2, 3
Age-Specific Considerations
Children under 4 years:
- Use levosalbutamol with caution due to limited data 2, 3
- Consider using half doses of the standard minimum per British Thoracic Society recommendations 1
- In the 2-5 year age group, both 0.31 mg and 0.63 mg doses have been studied and found safe and effective 4
Children 6-11 years:
- Standard dosing of 0.31 mg, 0.63 mg, or 1.25 mg has been well-studied 5
- All doses showed significant bronchodilation compared to placebo 5
Severe Exacerbations
For life-threatening asthma features:
- Add ipratropium bromide 100 μg to the nebulizer solution 1
- Can be mixed with levosalbutamol in the same nebulizer 2, 3
- Repeat every 6 hours until improvement starts 1
Critical Monitoring Parameters
After each treatment, assess:
- Respiratory rate, work of breathing, and oxygen saturation 1
- Heart rate (watch for tachycardia, especially with frequent dosing) 1, 2
- Tremor, hypokalemia, headache, and hyperglycemia 2, 3
Important safety note: Levosalbutamol and racemic albuterol both cause dose-dependent increases in heart rate, with racemic albuterol 2.5 mg and levosalbutamol 0.63 mg causing significant ventricular heart rate increases, while levosalbutamol 0.31 mg does not 4
Key Clinical Pitfalls
- Increasing use or lack of expected effect signals diminishing asthma control and requires immediate medical attention 2, 3
- Use with caution in patients with cardiovascular disorders, convulsive disorders, hyperthyroidism, and diabetes mellitus 1
- Renal impairment reduces clearance by 67%, requiring caution with high doses 6
- Continuous nebulization should only be considered for very severe attacks with intensive care monitoring 1