Levosalbutamol Syrup Pediatric Dosing
For pediatric patients requiring levosalbutamol syrup, administer 0.075 mg/kg (minimum dose 1.25 mg) for acute asthma exacerbations, with initial treatment consisting of 1.25 mg every 20 minutes for 3 doses, followed by maintenance dosing of 0.075-0.15 mg/kg every 1-4 hours as needed. 1
Age-Specific Dosing Regimens
Children Aged 2-5 Years
- Acute exacerbations: Start with 1.25 mg every 20 minutes for 3 doses 1
- Maintenance therapy: 0.075-0.15 mg/kg every 1-4 hours as needed, with a minimum dose of 1.25 mg per administration 1
- Weight-based calculation applies, but never administer less than the 1.25 mg minimum even if calculated dose is lower 1
Children Aged ≥6 Years
- Acute exacerbations: 1.25 mg every 20 minutes for 3 doses initially 1
- Maintenance therapy: 0.075-0.15 mg/kg every 1-4 hours as needed 1
- For children weighing >30 kg, consider increasing to 2.5 mg per dose based on severity and clinical response 1
Critical Dosing Principles
Conversion from Racemic Salbutamol
- Levosalbutamol is administered at exactly half the milligram dose of racemic salbutamol to achieve equivalent bronchodilation 1
- Standard salbutamol dose of 0.15 mg/kg (minimum 2.5 mg) converts to levosalbutamol 0.075 mg/kg (minimum 1.25 mg) 1
- Never use equal milligram doses of levosalbutamol and salbutamol, as this doubles the intended beta-agonist effect and increases adverse effects 1
Administration Technique
- Dilute levosalbutamol solution to a minimum of 3 mL with normal saline for optimal nebulizer delivery 1
- Use a standard flow rate compressor (6-8 L/min) with a Venturi nebulizer 1
- Oxygen is the preferred gas source for nebulization, particularly during acute exacerbations 1
Treatment Algorithm for Acute Exacerbations
Initial Phase (First Hour)
- Administer 1.25 mg levosalbutamol via nebulizer 1
- Repeat every 20 minutes for a total of 3 doses 1
- Monitor respiratory rate, work of breathing, and oxygen saturation after each treatment 1
Subsequent Management Based on Response
- Mild-to-moderate exacerbations: Continue every 1-4 hours as needed based on clinical response 1
- Severe exacerbations: Consider hourly nebulization or continuous nebulization with intensive care monitoring 1
- Life-threatening features: Add ipratropium bromide 100 μg to each nebulizer solution, repeating every 6 hours until improvement 1
Safety Monitoring
Expected Adverse Effects
- Monitor for tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration 1
- These effects occur less frequently with levosalbutamol compared to racemic salbutamol due to absence of the (S)-enantiomer 2, 3
High-Risk Populations Requiring Caution
Clinical Outcomes and Efficacy
Levosalbutamol demonstrates superior efficacy compared to racemic salbutamol in pediatric acute asthma exacerbations, with significantly better improvements in respiratory rate (24.4±5.6 vs 27.6±5.3 per minute, p<0.05), heart rate (115.5±16.4 vs 124.5±12.0 per minute, p<0.05), oxygen saturation (97.2±1.8% vs 95.0±1.6%, p<0.05), and peak expiratory flow rate (159.6±30.7 vs 143.8±27.1 L/min, p<0.05) 2
Common Pitfalls to Avoid
- Do not use oral formulations when nebulized options are available—oral beta-agonists are slower acting, less effective, and have more systemic side effects 1
- Do not skip the minimum dose rule: Always administer at least 1.25 mg even when weight-based calculations suggest lower amounts 1
- Do not use levosalbutamol for long-term asthma control—it is indicated only for immediate symptom relief and exercise-induced bronchospasm prevention; controller medications (inhaled corticosteroids) are required for maintenance therapy 1
- Do not administer doses more frequently than every 20 minutes during the initial treatment phase without medical supervision, as this increases risk of adverse effects 1