Levosalbutamol Oral Syrup Pediatric Dosing
Levosalbutamol oral syrup is not recommended for pediatric asthma management; nebulized or inhaled formulations are the standard of care. The available evidence exclusively addresses nebulized and inhaled levosalbutamol, with no guideline-supported oral syrup formulations for children. 1
Why Nebulized/Inhaled Routes Are Preferred
- Direct airway delivery provides rapid bronchodilation with lower systemic absorption and fewer adverse effects compared to oral formulations 1
- Oral beta-agonists have historically been used but are not included in current evidence-based guidelines for acute or maintenance asthma therapy in children 1
- The National Asthma Education and Prevention Program guidelines specifically recommend inhaled short-acting beta-agonists (SABAs) as first-line therapy, with no mention of oral formulations 1
Nebulized Levosalbutamol Dosing (The Recommended Alternative)
Acute Exacerbations
- Initial dose: 0.075 mg/kg (minimum 1.25 mg) every 20 minutes for 3 doses 1, 2
- Maintenance: 0.075-0.15 mg/kg every 1-4 hours as needed 1, 2
- For children unable to perform weight-based dosing, use 1.25 mg every 20 minutes for 3 doses initially 2
Key Dosing Principle
- Levosalbutamol is administered at half the milligram dose of racemic albuterol for comparable efficacy and safety 1, 2
- This means 0.63 mg levosalbutamol ≈ 1.25 mg racemic albuterol 3, 4
Administration Technique
- Dilute to a minimum of 3 mL with normal saline for optimal nebulizer delivery 2, 5
- Use standard flow rate of 6-8 L/min with oxygen as the preferred gas source 2, 6
- For children under 4 years, use a face mask with the nebulizer 1, 5
Metered-Dose Inhaler Alternative
- 4-8 puffs (45 mcg/puff) every 20 minutes for 3 doses, then every 1-4 hours as needed for acute exacerbations 1
- Must use with a valved holding chamber (spacer) and face mask for children under 4 years 1, 5
- MDI with spacer is as effective as nebulized therapy in mild-to-moderate exacerbations when properly administered 1, 6
Safety Monitoring
- Watch for tachycardia, tremor, and hypokalemia, especially with frequent dosing 2, 6
- Monitor heart rate, respiratory rate, work of breathing, and oxygen saturation after each treatment 2
- Use caution in patients with cardiovascular disorders, hyperthyroidism, and diabetes 2
Clinical Pitfall to Avoid
- Do not use oral salbutamol/albuterol formulations when nebulized or inhaled options are available—they are slower acting, less effective, and have more systemic side effects 1
- If a patient or caregiver requests "oral syrup," educate them that inhaled therapy is superior and provide proper training on nebulizer or MDI technique 1, 5