Levalbuterol Dosing and Administration Guidelines

Introduction to Levalbuterol Dosing

In acute exacerbations, levalbuterol can be administered at half the milligram dose of racemic albuterol for comparable efficacy, as recommended by the American Academy of Allergy, Asthma, and Immunology 1, 2

For children with acute exacerbations, the American Academy of Pediatrics recommends 0.075 mg/kg (minimum 1.25 mg) of levalbuterol, with a maximum dose of 1.25 mg 3
Initial treatment for children with acute exacerbations: 0.31-1.25 mg every 20 minutes for 3 doses, followed by maintenance of 0.31-1.25 mg every 1-4 hours as needed, according to the American Academy of Pediatrics 1, 2
Initial treatment for adults with acute exacerbations: 0.63-1.25 mg every 20 minutes for 3 doses, followed by maintenance of 0.63-1.25 mg every 1-4 hours as needed, as recommended by the American College of Allergy, Asthma, and Immunology 2

Levalbuterol HFA: 45 mcg/puff, with the same dosing schedule as albuterol MDI (4-8 puffs every 20 minutes for acute symptoms), as recommended by the American Academy of Allergy, Asthma, and Immunology 1
A spacer/valved holding chamber must be used, especially for children <4 years, according to the American Academy of Pediatrics 2

Levalbuterol administered at half the milligram dose of racemic albuterol provides comparable efficacy and safety, as established by the American College of Allergy, Asthma, and Immunology 1, 2, 4

Use oxygen as the preferred gas source for nebulization at 6-8 L/min flow rate, as recommended by the American Academy of Pediatrics 4, 3
Dilute to minimum 3 mL total volume with normal saline, according to the American Academy of Pediatrics 3

Monitor heart rate, respiratory rate, work of breathing, and oxygen saturation after each treatment, as recommended by the American Academy of Pediatrics 3
Watch for tachycardia, tremor, and hypokalemia, especially with frequent or high-dose administration, according to the American College of Allergy, Asthma, and Immunology 3

Do not use levalbuterol doses equivalent to racemic albuterol on a milligram-per-milligram basis, as this results in overdosing, according to the American Academy of Allergy, Asthma, and Immunology 1, 2