Levalbuterol Use in Outpatient Settings for Asthma and COPD

Dosing and Administration

The American Academy of Allergy, Asthma, and Immunology recommends levalbuterol nebulizer solution (0.63 mg/3 mL, 1.25 mg/3 mL) at a dose of 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg every 1-4 hours as needed for children, and 0.25-2.5 mg every 20 minutes for 3 doses, then 1.25-5 mg every 1-4 hours as needed for adults 1, 2
The American Academy of Allergy, Asthma, and Immunology suggests levalbuterol MDI (45 mcg/puff) with a similar dosing pattern to albuterol MDI, 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1, 3
Levalbuterol is administered in half the milligram dose of albuterol for comparable efficacy and safety, as recommended by the American Academy of Allergy, Asthma, and Immunology 1, 2

The American Thoracic Society recommends that levalbuterol should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, hypertension, and cardiac arrhythmias 4
The American Academy of Allergy, Asthma, and Immunology advises that levalbuterol should be used with caution in patients with convulsive disorders 4, hyperthyroidism 3, and diabetes mellitus 2

The American Academy of Allergy, Asthma, and Immunology suggests that for mild-to-moderate asthma exacerbations in outpatient settings, levalbuterol MDI with a valved holding chamber is as effective as nebulized therapy with appropriate administration technique 2, 5
The American Thoracic Society recommends that for COPD management, levalbuterol can be used as a quick-relief bronchodilator for maintenance and treatment of associated symptoms 4