Levolin (Levosalbutamol) Nebulization Dosing for Children
For children with acute asthma exacerbations, administer levosalbutamol 0.075 mg/kg (minimum dose 1.25 mg) via nebulizer every 20 minutes for 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed. 1, 2
Weight-Based Dosing Protocol
- Initial treatment: 0.075 mg/kg (minimum 1.25 mg) nebulized every 20 minutes for the first 3 doses 1, 2
- Maintenance dosing: 0.075-0.15 mg/kg every 1-4 hours based on clinical response 1, 2
- Maximum single dose: 5 mg per treatment 2
- For very young children under 5 years, consider starting with the lower end of the dosing range 2
Key Dosing Advantage
Levosalbutamol provides equivalent bronchodilation at half the milligram dose of racemic albuterol, meaning 0.63 mg levosalbutamol equals 1.25 mg racemic albuterol in efficacy. 1, 3, 2 This is because levosalbutamol contains only the therapeutically active R-isomer, while racemic albuterol contains 50% inactive S-isomer. 4, 5
Proper Administration Technique
- Dilute the dose to a minimum of 3 mL total volume with normal saline for optimal aerosol delivery 3, 6, 2
- Use oxygen-driven nebulizer when possible at 6-8 L/min gas flow 2
- Ensure properly fitted face mask covering both nose and mouth 6
- Treatment typically takes 10 minutes to complete 7
Severe Exacerbations
For moderate-to-severe cases, add ipratropium bromide 0.25 mg to the first 3 levosalbutamol doses to reduce hospitalization rates. 3, 2 The combination can be mixed in the same nebulizer. 1
Safety Profile Advantages
Levosalbutamol demonstrates fewer cardiovascular side effects compared to equivalent doses of racemic albuterol, particularly less tachycardia and QTc prolongation. 8, 5 The 0.31 mg dose in children aged 4-11 years showed no significant difference from placebo for heart rate changes, QTc interval, or glucose elevation. 5
Common side effects to monitor include:
Clinical Response Monitoring
Reassess after each 20-minute treatment cycle using respiratory rate, heart rate, oxygen saturation, and clinical asthma score. 8 Response to treatment is a better predictor of hospitalization need than initial severity. 3, 6
Alternative Delivery Method
For mild-to-moderate exacerbations, an MDI with spacer (4-8 puffs of 45 mcg levosalbutamol every 20 minutes) is equally effective when proper technique is used. 3, 2 However, nebulizers are preferred for severe exacerbations or when children cannot cooperate with spacer devices. 1, 7
Important Caveat
Levosalbutamol has not been adequately studied for continuous nebulization protocols, so stick with intermittent dosing schedules. 1, 3, 2