Albuterol Dosing: When to Use 0.63 mg vs 0.83 mg
Use 0.63 mg for children under 5 years of age and 0.83 mg (or higher doses like 1.25-2.5 mg) for children 5 years and older and adults. 1
Age-Based Dosing Algorithm
Children Under 5 Years
- Standard dose: 0.63 mg/3 mL nebulizer solution every 4-6 hours as needed for bronchospasm 1
- For acute exacerbations: 0.63 mg every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- For severe exacerbations, this dose may be doubled to approximately 1.25 mg 1
Children 5 Years and Older Through Adults
- Standard dose: 2.5 mg (not 0.83 mg) administered three to four times daily by nebulization 2
- The 0.83% concentration solution delivers 2.5 mg in 3 mL 2
- For acute exacerbations: 2.5 mg every 20 minutes for 3 doses, then every 1-4 hours as needed 1
Critical Dosing Distinction
The key difference is not between 0.63 mg and 0.83 mg as discrete doses, but rather:
- 0.63 mg refers to the actual milligram dose for young children (delivered from a 0.021% concentration solution) 1
- 0.83% refers to the concentration of the solution used for older children and adults, which delivers 2.5 mg per 3 mL vial 2
Weight-Based Considerations
- Children weighing < 15 kg should use the 0.5% concentration solution (not the 0.083% solution) to allow for doses less than 2.5 mg 2
- Children weighing ≥ 15 kg can use the standard 2.5 mg dose from the 0.083% concentration solution 2
Common Pitfall to Avoid
Do not confuse concentration percentages with actual milligram doses. The 0.083% solution is designed to deliver 2.5 mg per vial for older children and adults, while younger children require the lower 0.63 mg dose from a different concentration solution 1, 2. Using the wrong concentration could result in significant underdosing or overdosing.
Alternative Delivery Method
For children under 5 years who cannot tolerate nebulization, metered-dose inhaler (MDI) with spacer and face mask can deliver 1-2 puffs (90 mcg per puff) every 4-6 hours, or 4-8 puffs every 15-20 minutes for acute exacerbations 1. The spacer with face mask is mandatory for children under 4 years to ensure adequate drug delivery 1.