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Albuterol (NEB)

Question 4:

What is the maximum dose of continuous albuterol?

Asthma ED Team Recommendation: EPR-3 (2007) recommends with the following dosages for intermittent and continuous albuterol:

  • Child dose (≤ 12 years of age)-0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization.

  • Adult dose-2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed, or 10-15 mg/hour continuously.

EPR- 3 (2007) recommends only selective beta2-agonists (albuterol, levalbuterol, pributerol). For optimal delivery, dilute aerosols to minimum of 3 mL at gas flow of 6-8 L/min. Use large volume nebulizers for continuous albuterol administration. Albuterol (as an intermittent or continuous administration) may be mixed with ipratropium nebulizer solution. The Asthma ED Team concurs with these recommendations, including the use of 15 mg/hour as the maximum dose per hour of continuous albuterol The Asthma ED Team values amelioration of symptoms while minimizing adverse effects of the medication. This is a strong recommendation based on EPR-3 (2007).

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.