What is the appropriate oral levosalbutamol dose for children, including weight‑based dosing, minimum dose, dosing interval, and age‑specific limits?

Oral Levosalbutamol Dosing in Pediatric Patients

Oral levosalbutamol is not recommended for pediatric patients, as inhaled delivery via nebulizer or metered-dose inhaler is strongly preferred and provides superior bronchodilation with fewer systemic side effects. 1

Why Oral Route Should Be Avoided

• Nebulized or MDI delivery is the standard of care for acute bronchospasm in children, offering better therapeutic outcomes and reduced adverse effects compared to oral formulations 1
• Oral salbutamol has been shown to provide no significant benefit over placebo in reducing symptom duration in pediatric respiratory conditions, while causing tremors in some patients 2
• The inhaled route delivers medication directly to the airways, minimizing systemic absorption and associated side effects like tachycardia and hypokalemia 3, 1

Recommended Inhaled Levosalbutamol Dosing Instead

Nebulized Levosalbutamol (Preferred Route)

For acute asthma exacerbations:

• Children <20 kg: 0.31 mg per dose every 20 minutes for 3 doses, then 0.31-0.63 mg every 1-4 hours as needed 1, 4
• Children ≥20 kg: 0.63-1.25 mg per dose every 20 minutes for 3 doses, then every 1-4 hours as needed 3, 1
• Dilute in 2-3 mL of saline solution for adequate nebulization 1

Key dosing principle: Levosalbutamol provides comparable efficacy at half the milligram dose of racemic salbutamol 1, 5

Metered-Dose Inhaler with Spacer

• All ages: 45 mcg per puff (approximately half the dose of racemic albuterol at 90 mcg/puff) 3
• Administer 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• Always use with a spacer/holding chamber for proper delivery 1

Clinical Evidence Supporting Inhaled Over Oral Route

• Studies demonstrate that levosalbutamol is more effective than racemic salbutamol in improving respiratory parameters (SpO2, PEFR, asthma scores) while causing less tachycardia and fewer electrolyte disturbances 6, 7
• In children aged 2-5 years, nebulized levosalbutamol (0.31-0.63 mg) was well-tolerated and produced significant bronchodilation compared to placebo 4
• The 0.63 mg dose of levosalbutamol showed equivalent bronchodilator response to 2.5 mg racemic salbutamol in this age group 4

Safety Monitoring During Treatment

• Monitor heart rate, respiratory rate, oxygen saturation, and clinical response with each dose 1
• Maintain oxygen saturation >92% during treatment 1
• Reassess clinical response 15-30 minutes after each dose 1
• Watch for adverse effects: tachycardia, tremors, and hypokalemia indicate potential overdosing 1

Special Considerations

For preoperative use in children <6 years with upper respiratory infections:

• Administer nebulized levosalbutamol 30 minutes before general anesthesia 3, 1
• Dose: 1.25 mg for children <20 kg; 2.5 mg for children ≥20 kg (half the racemic salbutamol dose) 3, 1
• This reduces perioperative respiratory adverse events by approximately 50% 3, 1