Levosalbutamol Syrup Dosing Recommendations
Oral Levosalbutamol is NOT the Preferred Route
Inhaled levosalbutamol via nebulization or metered-dose inhaler is strongly preferred over oral syrup formulations because it delivers medication directly to the airways, minimizing systemic absorption and reducing side effects such as tachycardia, tremor, and hypokalemia. 1
Why Inhaled Route is Superior
- Direct airway delivery achieves therapeutic bronchodilation with significantly lower systemic drug exposure compared to oral administration 1
- Reduced cardiovascular effects including less tachycardia and palpitations 2, 3
- Lower risk of tremor and hypokalemia due to minimal systemic absorption 1
- Oral formulations result in higher plasma drug levels and greater systemic side effects without additional therapeutic benefit 4
Recommended Inhaled Dosing (Use This Instead)
Nebulized Levosalbutamol
- 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
- Children ≥ 20 kg and adults: 0.63–1.25 mg per dose every 20 minutes for 3 doses, then every 1–4 hours as needed 1
- Dilute each dose in 2–3 mL normal saline for adequate nebulization 1
Metered-Dose Inhaler with Spacer
- Use formulation delivering 45 µg per puff (approximately half the dose of racemic albuterol) 1
- 4–8 puffs every 20 minutes for 3 doses, then every 1–4 hours as needed 1
- Always use a spacer or holding chamber for optimal lung deposition 1
Key Dosing Principle
Levosalbutamol achieves comparable bronchodilator efficacy at approximately half the milligram dose of racemic salbutamol because it contains only the therapeutically active (R)-enantiomer, eliminating the inactive and potentially harmful (S)-enantiomer 1, 5, 3
Safety Monitoring During Treatment
- Monitor heart rate, respiratory rate, oxygen saturation, and clinical response with each dose 1
- Maintain oxygen saturation > 92% throughout therapy 1
- Re-evaluate clinical response 15–30 minutes after each dose 1
- Watch for overdose signs: tachycardia (heart rate > 124 bpm in children), tremors, or hypokalemia 2
Special Clinical Context: Pre-operative Use
For children < 6 years with upper respiratory infections undergoing general anesthesia:
- Administer nebulized levosalbutamol 30 minutes before induction 6, 1
- Dose: 1.25 mg for children < 20 kg; 2.5 mg for children ≥ 20 kg (approximately half the racemic salbutamol dose) 1
- This reduces peri-operative cough and bronchospasm by approximately 50% 6
Common Pitfalls to Avoid
- Do not prescribe oral levosalbutamol syrup when inhaled formulations are available—the oral route offers no therapeutic advantage and increases systemic side effects 1, 4
- Do not use adult racemic salbutamol doses as a reference—levosalbutamol requires only half the milligram dose 1, 5
- Do not administer without proper monitoring—even inhaled levosalbutamol can cause tachycardia and tremor if dosed excessively 2, 7