Levosalbutamol Syrup Dosing
Levosalbutamol syrup is not the preferred formulation for bronchodilation in any age group—inhaled delivery via nebulizer or metered-dose inhaler should be used instead, as oral formulations produce inferior bronchodilation with significantly more systemic side effects. 1, 2
Why Inhaled Route is Strongly Preferred
Inhaled levosalbutamol delivers medication directly to the airways, minimizing systemic absorption and reducing side effects such as tachycardia, tremor, and hypokalemia. 3
Nebulized salbutamol or MDI with spacer/face mask is strongly preferred over oral syrup for acute bronchospasm, as inhaled delivery provides superior bronchodilation with fewer systemic side effects. 2
The evidence base for oral levosalbutamol syrup dosing is extremely limited, with no current guideline recommendations supporting its routine use. 1, 3, 2
If Oral Levosalbutamol Must Be Used (Not Recommended)
Dosing Based on Racemic Albuterol Equivalents
Levosalbutamol should be administered at half the dose of racemic albuterol when converting between formulations, as levosalbutamol achieves comparable bronchodilator efficacy at approximately half the milligram dose. 1, 3
Historical data on oral racemic salbutamol in young children (ages 2-6 years) showed safety at 1-2 mg every 8 hours, suggesting levosalbutamol oral doses would be 0.5-1 mg every 8 hours for this age group. 4
Age-Specific Considerations
For children under 4 years of age, levosalbutamol should be used with caution due to limited data available. 1
In children aged 2-5 years, nebulized levosalbutamol at 0.31 mg three times daily was well-tolerated and effective, further supporting that oral doses (if used) should not exceed equivalent systemic exposure. 5
Recommended Inhaled Alternatives
Nebulized Levosalbutamol (Preferred)
Children weighing < 20 kg: 0.31 mg per dose every 20 minutes for 3 doses during acute exacerbations; thereafter 0.31-0.63 mg every 1-4 hours as needed. 3
Children weighing ≥ 20 kg: 0.63-1.25 mg per dose every 20 minutes for 3 doses; thereafter every 1-4 hours as needed. 3
For children under 5 years: 0.31 mg/3 mL nebulizer solution every 4-6 hours as needed for routine bronchospasm. 1
Dilute the dose in 2-3 mL of saline solution to ensure adequate nebulization at 6-8 L/min flow rate. 3, 2
Metered-Dose Inhaler with Spacer (Equally Effective)
Administer 1-2 puffs (45 mcg/puff) every 4-6 hours as needed for routine bronchospasm using a metered-dose inhaler with a spacer. 1
For acute exacerbations: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed. 3
Always employ a spacer or holding chamber to ensure optimal lung deposition. 3
Critical Safety Monitoring
Monitor heart rate, respiratory rate, oxygen saturation, and clinical response with each administered dose. 3
Maintain oxygen saturation > 92% throughout therapy. 3
Watch for signs of overdose including tachycardia, tremors, hypokalemia, headache, and hyperglycemia. 1, 3
Increasing use or lack of expected effect indicates diminishing asthma control and need for medical attention. 1