Nebulized Albuterol

Aka: Nebulized Albuterol, Albuterol Nebulizer, Levalbuterol Nebulizer, Nebulized Xopenex

1. Dosing: Albuterol
   1. Weight <10 kg or age under 12 months
      1. Albuterol 1.25 mg (0.25 cc) in 2 cc NS q1-4 hours
   2. Weight 10-35 kg or age 12 months to 10 years
      1. Albuterol 2.5 mg (0.5 cc) in 2 cc NS q1-4 hours
   3. Weight >35 kg or age over 10 years
      1. Albuterol 5.0 mg (1.0 cc) in 2 cc NS q1-4 hours
2. Co-administered Medications (May add to Nebulizer)
   1. Ipratropium (Atrovent) 250 mcg (1.25 ml) q6-8 hours
   2. Cromolyn Sodium (Intal) (10 mg/ml) 2cc q6 hours
   3. Flunisolide (Nasalide) (.25%=250 ug/ml) 1-2 ml q6 hours
3. Dosing: Levalbuterol (Xopenex) for Age over 12 years
   1. Dose: 0.63 to 1.25 mg nebulized q6-8 hours
4. Adverse Effects
   1. Hypokalemia
   2. Tachycardia
5. Efficacy
   1. Albuterol MDI and spacer/mask as effective as nebulizer
      1. Studied Wheezing children aged two years and younger
      2. Delgado (2003) Arch Pediatr Adolesc Med 157:76-80 [PubMed]
   2. Antiinflammatory added to nebulizer in RSV
      1. Study showed significant improvement
         1. Much fewer hospitalizations with Nasalide or Intal
      2. Reference
         1. Reijonen T (1996) Arch Pediatr Adolesc 150:512-7 [PubMed]
   3. Levalbuterol (Xopenex): Active R-Isomer of Albuterol
      1. Initially reported to have less Tachycardia than with Albuterol
         1. Appears to have no advantage over Albuterol
      2. References
         1. Bio (2011) J Pediatr Pharmacol Ther 16(3): 191-8 +PMID:22479161 [PubMed]
         2. Lam (2003) Am J Health Syst Pharm 60(19):1971-5 +PMID:14531242 [PubMed]
         3. (1999) Med Lett Drugs Ther 41(1054):51-3 [PubMed]