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Levosalbutamol Uses, Dosage, Side Effects & Price | DrugsAtlas

Authoritative Clinical Reference

DRUG NAME: Levosalbutamol

Therapeutic Class: Bronchodilator

Subclass: Short-acting β2-agonist (SABA)

Speciality: Pulmonology

Schedule (India): Schedule H

Route(s): Inhalation (MDI), Nebulisation, Oral

Formulations Available in India:

Formulation	Strength	Pack Details
Metered Dose Inhaler (MDI)	50 mcg/actuation	200 doses/canister
Nebuliser Solution (Respules)	0.31 mg/2.5 mL	Single-dose vials
Nebuliser Solution (Respules)	0.63 mg/2.5 mL	Single-dose vials
Nebuliser Solution (Respules)	1.25 mg/2.5 mL	Single-dose vials
Syrup	1 mg/5 mL	60 mL, 100 mL bottle
Tablet	1 mg	Strip of 10/15
Tablet	2 mg	Strip of 10/15

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

⮞ 1. Acute Bronchospasm (Asthma Exacerbation, COPD Exacerbation, Acute Wheeze)

A) Inhalation via MDI:

Parameter	Recommendation
Starting dose	1 puff (50 mcg) via MDI with spacer
Titration	May repeat 1–2 puffs after 15–20 minutes if inadequate response
Usual maintenance dose	1–2 puffs every 4–6 hours as needed
Maximum dose	2 puffs (100 mcg) per dose; up to 8 puffs/day

Clinical Notes:

Always use spacer device for optimal drug delivery
In acute severe asthma, may use 4–6 puffs initially with spacer, repeated every 20 minutes for first hour

B) Nebulisation:

Parameter	Recommendation
Starting dose	0.63 mg nebulised over 5–15 minutes
Titration	May increase to 1.25 mg based on severity and response
Usual maintenance dose	0.63–1.25 mg every 6–8 hours
Maximum dose	3.75 mg/day in divided doses

Clinical Notes:

Use with oxygen-driven nebuliser in acute exacerbations
Can combine with ipratropium bromide for additive effect in severe cases

⮞ 2. Asthma Maintenance — Reliever (PRN) Therapy

Parameter	Recommendation
Starting dose	1 puff (50 mcg) MDI as needed
Titration	Not applicable for PRN use
Usual maintenance dose	1–2 puffs as needed for symptoms
Maximum dose	Should not exceed 8 puffs/day on regular basis

Clinical Notes:

Must be used alongside inhaled corticosteroids (ICS) for persistent asthma
Frequent SABA use (>2 times/week) indicates poor control — reassess and step-up controller therapy
Single-agent SABA therapy without ICS is not recommended in persistent asthma

⮞ 3. Chronic Bronchospasm — Oral Route (Limited Use)

Oral route is less preferred due to higher systemic adverse effects; use only when inhaled route not feasible.

Parameter	Recommendation
Starting dose	1 mg twice daily (tablet or syrup equivalent)
Titration	May increase based on response and tolerability
Usual maintenance dose	1–2 mg twice to three times daily
Maximum dose	2 mg three times daily (6 mg/day)

Clinical Notes:

Reserve for patients unable to use inhaler or nebuliser
Higher incidence of tremor, palpitations, and hypokalaemia with oral route

Secondary Indications — Adults Only (Off-label, if any)

⮞ Acute Severe Asthma/COPD with Ipratropium Combination Nebulisation — OFF-LABEL (Accepted Practice)

Parameter	Details
Indication	Acute severe bronchospasm unresponsive to SABA alone
Dose	Levosalbutamol 1.25 mg + Ipratropium 500 mcg nebulised together
Frequency	Every 20 minutes for 3 doses in first hour, then every 4–6 hours
Duration	Until acute phase resolved
Supervision	Emergency/ICU setting preferred
Evidence basis	Indian hospital protocols; widely accepted clinical practice

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

⮞ Acute Bronchospasm / Viral-Induced Wheeze / Asthma Exacerbation

A) Nebulisation (Preferred in young children):

Age/Weight	Starting Dose	Usual Maintenance	Maximum Dose
6 months – 2 years (<15 kg)	0.31 mg	0.31–0.63 mg every 6–8 hours	1.25 mg/day
2–6 years (15–20 kg)	0.63 mg	0.63 mg every 6–8 hours	1.89 mg/day
>6 years (>20 kg)	0.63–1.25 mg	0.63–1.25 mg every 6–8 hours	3.75 mg/day

Clinical Notes:

Administer via face mask in children <4 years
In acute severe exacerbation, may nebulise every 20 minutes for first hour under supervision
Consider adding nebulised ipratropium if poor response

B) MDI via Spacer with Mask/Mouthpiece:

Age	Dose	Frequency	Maximum
1–4 years	1 puff (50 mcg) via spacer + mask	Every 4–6 hours PRN	4 puffs/day
≥4 years	1–2 puffs via spacer + mouthpiece	Every 4–6 hours PRN	8 puffs/day

Clinical Notes:

MDI with spacer is as effective as nebulisation and preferred for mild-moderate exacerbations
Ensure proper technique; reassess at each visit

C) Oral Route (Syrup/Tablets — Limited Use):

Age	Starting Dose	Usual Maintenance	Maximum
2–6 years	0.5 mg (2.5 mL syrup) BD	0.5–1 mg BD–TDS	3 mg/day
6–12 years	1 mg BD	1 mg BD–TDS	4 mg/day
>12 years	1 mg BD	1–2 mg BD–TDS	6 mg/day

Clinical Notes:

Oral route only when inhaled route not feasible
Higher systemic side effects expected

Secondary Indications — Paediatric Doses (Off-label, if any)

⮞ Bronchiolitis in Infants — OFF-LABEL

Parameter	Details
Status	NOT ROUTINELY RECOMMENDED per IAP guidelines
If used	0.31 mg nebulised as therapeutic trial under specialist supervision
Evidence	Limited benefit demonstrated; not standard of care
Supervision	Paediatric pulmonologist/intensivist only

Statement: Not recommended below 6 months of age except under specialist supervision in tertiary care settings.

Safety Monitoring (All Paediatric Patients):

Heart rate monitoring during acute nebulisation
Watch for tremor, irritability, vomiting
Assess frequency of reliever use — indicates control status

RENAL ADJUSTMENT

Renal Function	Recommendation
Mild to moderate impairment	No dose adjustment required
Severe impairment (eGFR <30)	Use with caution; limited clearance data — monitor for systemic effects
Haemodialysis	Not significantly dialysed; no supplemental dose needed

HEPATIC ADJUSTMENT

Severity	Recommendation
Mild impairment	No dose adjustment required
Moderate impairment	Use with caution; monitor for systemic adverse effects (tremor, tachycardia)
Severe impairment	Use only under specialist supervision; prefer inhaled over oral route

CONTRAINDICATIONS

Known hypersensitivity to levosalbutamol, salbutamol, or any β2-agonist
Severe uncontrolled tachyarrhythmias (e.g., ventricular tachycardia, uncontrolled atrial fibrillation)
Hypertrophic obstructive cardiomyopathy
Concurrent use with non-selective beta-blockers (relative — may antagonise effect)

CAUTIONS

Cardiovascular disease (coronary artery disease, arrhythmias, hypertension) — may exacerbate tachycardia
Diabetes mellitus — may cause transient hyperglycaemia
Hyperthyroidism — augmented sympathomimetic response
Pre-existing hypokalaemia — risk of worsening; correct before or during therapy
Seizure disorders — may lower seizure threshold at high doses
Concomitant use with other sympathomimetics — additive cardiovascular effects
Overuse/dependence — frequent use indicates poor disease control; reassess therapy

PREGNANCY

Parameter	Details
Safety	Generally considered safe; no documented teratogenicity at therapeutic doses
Preferred route	Inhaled levosalbutamol or salbutamol preferred over oral/systemic route
When to use	For acute bronchospasm or as-needed reliever in pregnant asthmatics
Monitoring	Maternal heart rate, blood pressure; uterine activity (high doses may cause tocolysis); avoid excessive use near term

LACTATION

Parameter	Details
Compatibility	Compatible with breastfeeding
Drug levels in milk	Negligible with inhaled route; low with oral route
Preferred route	Inhaled administration preferred
Infant monitoring	Watch for tremors, irritability, poor feeding if mother on high-dose oral therapy

ELDERLY

Parameter	Recommendation
Starting dose	Use lowest effective dose; prefer inhaled route
Titration	Slower titration if oral route used
Special risks	Higher susceptibility to tachycardia, arrhythmias, tremor, hypokalaemia
Monitoring	Heart rate, blood pressure, serum potassium (especially with concurrent diuretics/corticosteroids)
Comorbidities	Assess for cardiac disease, renal impairment before initiation

MAJOR DRUG INTERACTIONS

Interacting Drug	Effect	Management
Non-selective beta-blockers (propranolol, carvedilol)	Antagonism of bronchodilator effect; may precipitate bronchospasm	Avoid concurrent use; use cardioselective beta-blocker if essential
Monoamine oxidase inhibitors (MAOIs)	Risk of severe hypertensive crisis	Avoid use within 14 days of MAOI therapy
Tricyclic antidepressants	Potentiation of cardiovascular effects	Use with caution; monitor heart rate and BP
Digoxin	SABA may reduce serum digoxin levels via potassium shift	Monitor digoxin levels and serum potassium

MODERATE DRUG INTERACTIONS

Interacting Drug	Effect	Management
Loop diuretics (furosemide), Thiazides	Additive hypokalaemia	Monitor serum potassium; supplement if needed
Systemic corticosteroids	Enhanced hypokalaemia risk	Monitor potassium, especially with high-dose steroids
Theophylline/Aminophylline	Additive cardiac and CNS stimulation	Use with caution; monitor for toxicity signs
Other sympathomimetics (epinephrine, pseudoephedrine)	Additive cardiovascular effects	Avoid or use cautiously
QT-prolonging drugs	Hypokalaemia may increase arrhythmia risk	Monitor ECG and electrolytes

COMMON ADVERSE EFFECTS

Tremor (dose-related, most common)
Palpitations
Tachycardia
Headache
Nervousness/anxiety
Throat irritation or dryness (inhaled route)
Nausea (oral route)
Muscle cramps

SERIOUS ADVERSE EFFECTS

Adverse Effect	Clinical Action
Paradoxical bronchospasm	Discontinue immediately; administer alternative bronchodilator; do not rechallenge
Severe hypokalaemia	Monitor ECG; replace potassium; can precipitate arrhythmias
Cardiac arrhythmias (SVT, VT)	Discontinue; cardiac monitoring; treat arrhythmia as indicated
Hypersensitivity reactions (urticaria, angioedema)	Discontinue; supportive care
Lactic acidosis (rare, with high-dose IV use)	Supportive management

MONITORING REQUIREMENTS

Phase	Parameters
Baseline	Heart rate, blood pressure, serum potassium (if high-dose or oral use anticipated), baseline SpO₂
After initiation	Symptom response; heart rate after first few doses
Long-term	Frequency of SABA use (indicator of control); inhaler technique review at each visit; serum potassium if on concurrent diuretics/steroids; reassess asthma control regularly

BRANDS AVAILABLE IN INDIA

Brand Name	Manufacturer	Formulation
Levolin	Cipla	MDI, Respules, Syrup, Tablets
Salbair-L	Lupin	Respules
Levosiz	Zydus	MDI, Respules
Asthalin-L	IPCA	MDI
L-Salbutamol	Various	Tablets, Syrup

Fixed-Dose Combinations (FDCs):

Brand Name	Composition	Manufacturer
Duolin	Levosalbutamol + Ipratropium	Cipla
Combimist-L	Levosalbutamol + Ipratropium	Zydus

PRICE RANGE (INR)

Formulation	Approximate Price
MDI 50 mcg (200 doses)	₹100–150
Respules 0.63 mg (unit dose)	₹8–12 per vial
Respules 1.25 mg (unit dose)	₹10–15 per vial
Tablets 1 mg (strip of 10)	₹15–25
Syrup 100 mL	₹30–50

Salbutamol (racemic) is included under NLEM; levosalbutamol pricing is not NPPA-controlled
Available in government supply as salbutamol; levosalbutamol primarily in private sector

CLINICAL PEARLS

Levosalbutamol vs Salbutamol: Levosalbutamol is the R-enantiomer (active form) of racemic salbutamol; theoretical advantage of fewer side effects, but clinical superiority remains inconsistent — choice often based on tolerability and cost
MDI + Spacer Preferred: For most age groups, MDI with spacer is as effective as nebulisation and more practical for outpatient use; nebulisation reserved for severe exacerbations or very young children
SABA Overuse Alert: If patient requires SABA >2 times/week (excluding pre-exercise use), indicates poor asthma control — step-up controller therapy
Never Monotherapy in Persistent Asthma: SABA should always be combined with ICS in persistent asthma; SABA-only treatment increases exacerbation and mortality risk
Pregnancy Safe: Inhaled SABA is safe and preferred for managing asthma during pregnancy; uncontrolled asthma poses greater risk to mother and fetus than medication
Hypokalaemia Monitoring: In patients on concurrent diuretics, high-dose steroids, or receiving frequent nebulisations, monitor serum potassium regularly

VERSION

RxIndia v0.1 — 19 Feb 2026

REFERENCES

CDSCO approved product information
Indian Pharmacopoeia / National Formulary of India
NLEM India (reference for salbutamol)
IAP Asthma Guidelines
AIIMS Paediatric Treatment Protocols
API Textbook of Medicine
Goodman & Gilman’s The Pharmacological Basis of Therapeutics

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Levosalbutamol Uses, Dosage, Side Effects & Price | DrugsAtlas

DRUG NAME: Levosalbutamol

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Secondary Indications — Adults Only (Off-label, if any)

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

Secondary Indications — Paediatric Doses (Off-label, if any)

RENAL ADJUSTMENT

HEPATIC ADJUSTMENT

CONTRAINDICATIONS

CAUTIONS

PREGNANCY

LACTATION

ELDERLY

MAJOR DRUG INTERACTIONS

MODERATE DRUG INTERACTIONS

COMMON ADVERSE EFFECTS

SERIOUS ADVERSE EFFECTS

MONITORING REQUIREMENTS

BRANDS AVAILABLE IN INDIA

PRICE RANGE (INR)

CLINICAL PEARLS

TAGS

VERSION

REFERENCES

Clinical Responsibility

Is this information helpful?

RxIndia

Levosalbutamol Uses, Dosage, Side Effects & Price | DrugsAtlas

DRUG NAME: Levosalbutamol

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Secondary Indications — Adults Only (Off-label, if any)

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

Secondary Indications — Paediatric Doses (Off-label, if any)

RENAL ADJUSTMENT

HEPATIC ADJUSTMENT

CONTRAINDICATIONS

CAUTIONS

PREGNANCY

LACTATION

ELDERLY

MAJOR DRUG INTERACTIONS

MODERATE DRUG INTERACTIONS

COMMON ADVERSE EFFECTS

SERIOUS ADVERSE EFFECTS

MONITORING REQUIREMENTS

BRANDS AVAILABLE IN INDIA

PRICE RANGE (INR)

CLINICAL PEARLS

TAGS

VERSION

REFERENCES

Clinical Responsibility

Is this information helpful?