Pediatric dose 9f levosalbutamol nebulisation
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Levosalbutamol (Levalbuterol) Nebulization - Pediatric Dosing
Background
Levosalbutamol is the R-enantiomer of salbutamol (albuterol). It was developed on the premise that the R-enantiomer carries the bronchodilator activity while the S-enantiomer may cause adverse effects. However, current evidence (including from Tintinalli's Emergency Medicine) notes that levalbuterol is not more effective or safer than racemic salbutamol, and is considerably more expensive.
Dose by Age Group - Nebulization Solution
| Age Group | Routine Dose | Maximum Dose | Frequency |
|---|---|---|---|
| Infants & children <4 years | 0.31-1.25 mg | 1.25 mg | Every 4-6 hours as needed |
| Children 5-11 years | 0.31 mg | 0.63 mg | Every 8 hours (TID) |
| Children ≥12 years / Adolescents | 0.63 mg | 1.25 mg | Every 6-8 hours (TID) |
Note: The inhalation solution is not officially approved for children under 6 years by the FDA. Use in younger children should be on medical judgment only.
Acute Asthma Attack / Bronchospasm - Nebulization
| Age Group | Dose | Frequency |
|---|---|---|
| Infants & Children | 1.25 mg every 20 minutes x 3 doses | Then 1.25-5 mg every 1-4 hours as needed |
| Adolescents | 1.25-2.5 mg every 20 minutes x 3 doses | Then 1.25-5 mg every 1-4 hours as needed |
Weight-Based Dosing (used in some pediatric centers)
- 0.025-0.075 mg/kg/dose, max 1.25 mg per dose
- Every 4-8 hours for maintenance; every 20 minutes for acute exacerbations
Key Clinical Notes
- Available concentrations: 0.31 mg/3 mL, 0.63 mg/3 mL, 1.25 mg/3 mL (unit-dose vials)
- Racemic albuterol at 0.15 mg/kg/dose (max 5 mg) remains the standard of care for pediatric acute asthma per NHLBI guidelines and Rosen's Emergency Medicine - levosalbutamol offers no proven advantage
- Monitor for: tachycardia, tremor, hypokalemia, nervousness
- For children unable to use MDI with spacer, nebulization is preferred (face mask for <4 years, mouthpiece for older children)
Sources: Rosen's Emergency Medicine (9780323757898); Tintinalli's Emergency Medicine (9781260019933); FDA Prescribing Information (DailyMed); Asthma Initiative of Michigan guidelines
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