Salbutamol (Albuterol)

• It is a racemic mixture → contains two isomers:

  • R-isomer (active) → produces bronchodilation.

  • S-isomer (inactive) → does not help, and may even contribute to side effects (like jitteriness, tachycardia).

• Widely used, available as syrup, inhaler, nebulizer.

• Onset: 5–15 minutes (fast relief).

• Duration: 4–6 hours.

• Side effects: Tremors, jitteriness, fast heartbeat, restlessness (due to S-isomer presence).

💊 Levosalbutamol (Levalbuterol)

• Contains only the R-isomer (active part) of Salbutamol.

• Designed to provide the same bronchodilation at lower doses, with fewer side effects.

• Usually available as nebulizer solution, inhaler, (rarely syrup in India).

• Onset: similar (5–10 minutes).

• Duration: 4–6 hours.

• Side effects: Much less tremor, jitteriness, tachycardia compared to racemic Salbutamol.

✅ Which is Better for Toddlers?

• Both are effective for wheeze/asthma/bronchitis.

• Salbutamol = tried, tested, cheaper, widely available.

• Levosalbutamol = equally effective, with fewer side effects, but costlier.

• In sensitive toddlers (who develop rapid heartbeat, jitteriness, or poor sleep on Salbutamol), doctors often switch to Levosalbutamol.

⚠️ Important

• Both should be given in weight-based doses, preferably via nebulizer with mask/spacer for toddlers.

• Choice depends on child’s tolerance and doctor’s judgement.

• For most children, Salbutamol works well and safely.

• For children prone to side effects, Levosalbutamol may be safer.

🔑 Quick Comparison

👉 Summary:

• Both are safe in toddlers.

• Salbutamol is first-line (cheaper, proven).

• Levosalbutamol is chosen when side effects from Salbutamol are troublesome, especially jitteriness or tachycardia.