Asthma (Pediatric) Drug Summary

Last updated: 18 August 2026
Reviewed by

Anticholinergics (Inhaled)*

Drug Available Strength Dosage Remarks
Short-Acting Adverse Reactions
  • Respiratory effects (URTI, bronchitis, sinusitis); CV effects (chest pain, palpitation); CNS effects (headache, dizziness); GI effects (dry mouth, bad taste, dyspepsia, nausea); Hypersensitivity effects (urticaria, angioedema, rash, bronchospasm)
Special Instructions
  • Tiotropium bromide: To be taken at the same time of day
  • Avoid contact of eyes with inhalation solution
  • Use with caution in patients with narrow-angle glaucoma, bladder neck obstruction, myasthenia gravis
  • Check patient’s inhaler technique for optimum delivery of drug
  • Not used as first-line treatment
    • Should be added to beta2-agonist therapy
Ipratropium
bromide		 20 mcg/puff MDI 2 puffs 6 hourly
Max dose: 12 puffs/day
250 mcg/2 mL,
500 mcg/2 mL
inhalation solution unit dose 		1 unit dose
(100-500 mcg) via nebulizer
6-8 hourly as required
0.025% inhalation solution <6 years  old: 0.4-1 mL
(100-250 mcg) via nebulizer
6-8 hourly as required
6-12 years old: 1 mL (250 mcg) via nebulizer 6-8 hourly as required
Long-Acting
Tiotropium
bromide		 1.25 mcg/puff ≥6 years old: 2 puffs 24 hourly
2.5 mcg/puff ≥6 years old: 2 puffs 24 hourly
*Bronchodilator combinations are available. Please see the latest MIMS for specific formulations and prescribing information.

Beta2-Adrenoreceptor Agonists (Bronchodilators) (Inhaled)*

Drug Available Strength Dosage1 Remarks
Short-Acting
Fenoterol 100 and 200 mcg/puff MDI Approved in some countries for children
>6 years old: 1-2 puffs 8 hourly as required
Max dose: 8 puffs/day 		Adverse Reactions
  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
1.25 mg/2 mL solution for inhalation 10-20 drops via nebulizer up to 6 hourly as required
<6 years old: 5-20 drops 8 hourly
6-12 years old: 5-10 drops 6 hourly
≥12 years old: 10 drops 6 hourly
Procaterol 10 mcg/puff MDI Approved in some countries for children:
1 puff 6-12 hourly as required
Max dose: 4 puffs/day
100 mcg/0.3 mL solution for inhalation 10-30 mcg (0.1-0.3 mL) via nebulizer
Salbutamol
(Albuterol) 		100 mcg/dose (autohaler/evohaler) Immediate relief/prior to exertion:
100 mcg as single dose
For chronic or preventive treatment:
100 mcg 6-8 hourly
May increase to 200 mcg 6-8 hourly if necessary
Max dose: 1.2 mg/day
100 and 200 mcg/dose easyhaler
100 mcg/dose MDI
100 and 200 mcg/dose DPI
200 mcg/dose accuhaler DPI
200 mcg/dose diskhaler DPI
200 mcg/cap DPI
1 mg, 2 mg/mL,
2.5 mg/2.5 mL, 5 mg/2.5 mL inhalation solution unit dose 		2.5-5 mg via nebulizer 6-8 hourly as required
5 mg/mL (0.5% solution) inhalation soln 10-15 kg: 0.25 mL (1.25 mg)
>15 kg: 0.5 mL (2.5 mg)
>12 years old: 0.5-1 mL (2.5-5 mg)
Dilute required amount of solution with normal saline to final volume of 2-3 mL via nebulizer over 10 minutes as required
Terbutaline 250 mcg/puff MDI 1-2 puffs 6-8 hourly as required
Max dose: 8 puffs/day
500 mcg/dose DPI, turbuhaler DPI 7-12 years old: 0.5-1 dose inhaled 6 hourly as required
For severe exacerbations: 2 doses
Max dose: 4 doses/day
2.5 mg/mL, 2.5 mg/2 mL,
5 mg/2 mL inhalation solution 		<25 kg: 2.5 mg via nebulizer up to 6 hourly as required
>25 kg: 5 mg via nebulizer up to 6 hourly as required
Long-Acting2
Salmeterol 25 mcg/puff MDI ≥4 years old: 2 puffs 12 hourly
≥12 years old: 2 puffs 12 hourly, up to 4 puffs in severe cases 		Adverse Reactions
  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
50 mcg/dose accuhaler DPI,
diskhaler DPI 		≥4 years old: 1 dose inhaled 12 hourly
 *Inhaled bronchodilator combinations are available. Please see the latest MIMS for specific formulations and prescribing information.
1Please note: Doses for acute exacerbations can be higher than the recommended maintenance doses listed here.
2Should be used as an adjunct to inhaled corticosteroids in the management of asthma. Please see the latest MIMS for specific formulations of different combination products.

Beta2-Adrenoreceptor Agonists (Bronchodilators) (Oral)*

Drug Dosage Remarks
Short-Acting
Fenoterol Approved for use in some countries for children:
<1 year old: 1.25 mg PO 8-12 hourly
1-6 years old: 1.25-2.5 mg PO 8 hourly
6-14 years old: 2.5 mg PO 8 hourly 		Adverse Reactions
  • CNS effects (headache, sleep disturbances, agitation, hyperactivity and restlessness); CV effects (palpitations, cardiac arrhythmias especially in susceptible patients); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
  • Orciprenaline is less selective for beta2 receptors and therefore side effects may be more common
Special Instructions
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma

 
 
Orciprenaline
(Metaproterenol) 		≤5 years old: 1.3-2.6 mg/kg/day PO divided 6-8 hourly
Max dose: 10 mg/dose
6-9 years old or <27 kg: 10 mg PO 6-8 hourly
>9 years old or ≥27 kg: 20 mg PO 6-8 hourly
Procaterol <6 years old: 1.25 mcg/kg/dose PO 8-12 hourly
>6 years old: 25 mcg PO 12-24 hourly
Salbutamol1
(Albuterol) 		2-6 years old: 1-2 mg PO 6-8 hourly
Max dose: 12 mg/day
6-12 years old: 2 mg PO 6-8 hourly
Max dose: 24 mg/day
>12 years old: 2-4 mg PO 6-8 hourly
Max dose: 32 mg/day
Terbutaline <12 years old: 0.05 mg/kg/dose PO 8 hourly
Max dose: 5 mg/day
≥12 years old: 2.5-5 mg PO 8 hourly
Max dose: 15 mg/day
Long-Acting
Bambuterol Approved for use in some countries for children 2-12 years old: 5-10 mg PO 24 hourly
Max dose for children 2-5 years old: 10 mg/day
(Doses >10 mg/day PO are not recommended in Asian children 2-12 years old)
Salbutamol
(Albuterol) 		Extended-release:
6-12 years old: 4 mg PO 12 hourly
Max dose: 24 mg/day
>12 years old: 4-8 mg PO 12 hourly
Max dose: 32 mg/day
*Oral bronchodilator combinations are available. Please see the latest MIMS for specific formulations and prescribing information.
1Combination with other cough preparation is available. Please see the latest MIMS for specific formulations and prescribing information.

Beta2-Adrenoreceptor Agonists (Bronchodilators) (Parenteral)

Drug Dosage Remarks
Beta2-Agonists
Salbutamol
(Albuterol) 		250 mcg slow IV injection, may repeat as required
50 mcg IM/SC, may repeat 4 hourly as required
IV infusion: 3-20 mcg/min IV infusion 		Adverse Reactions
  • Fine skeletal muscle tremor, palpitations, cardiac arrhythmias especially in susceptible patients, headache, sleep disturbances, agitation, hyperactivity and restlessness
  • Potentially severe hypokalemia may result especially in acute severe asthma
  • Epinephrine: Dyspnea, hyperglycemia, restlessness, palpitations, tachycardia, tremors, sweating, hypersalivation, weakness, dizziness, headache, coldness of extremities, hypertension, flushing, hypotension
Special Instructions
  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
Terbutaline 2-15 years old: 10 mcg/kg/dose SC/IM/slow IV up to 6 hourly as required
Max dose: 300 mcg/dose
IV infusion: 25 mcg/kg/day IV as a continuous infusion
Non-specific Sympathomimetic
Epinephrine
(Adrenaline) 		10 mcg/kg up to 300-500 mcg SC/IM every 20 minutes x 3 doses

Corticosteroids (Inhaled)*

Drug Available Strength Dosage Remarks
Beclomethasone
dipropionate		 50, 100, 250 mcg/puff MDI ≥5 years old: 100 mcg/day
6-11 years old: 100-400 mcg/day
≥12 years old: 200-1,000 mcg/day 		Adverse Reactions
  • Local effects (oropharyngeal candidiasis, cough from upper airway irritation, dysphonia); paradoxical bronchospasm (rare)
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising, adrenal suppression, increased bone loss and osteoporotic fractures
    • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics
Special Instructions
  • Local effects may be minimized by using a spacer, gargling and spitting out with water, or gargling with 1:50 dilution of Amphotericin B
100, 200 mcg/cap DPI; 100, 200 mcg/dose diskhaler DPI; 200 mcg/dose easyhaler DPI
Budesonide 100, 200 mcg/puff MDI
 6-11 years old: 100-400 mcg/day
≥12 years old: 200-800 mcg/day
Nebules
1-5 years old:
500 mcg/day
6-11 years old:
250-1,000 mcg/day
100, 200, 400 mcg/dose turbuhaler DPI; 200 mcg/dose swinghaler; 200 mcg/dose easyhaler; 100, 200, 400 mcg/cap DPI
250 mcg/2 mL, 250 mcg/mL, 500 mcg/2 mL, 500 mcg/mL, 1 mg/2 mL solution for inhalation unit dose
Ciclesonide 80, 160 mcg/actuation MDI 6-11 years old: 80-160 mcg/day
≥12 years old: 80-320 mcg/day
Fluticasone 50, 125, 250 mcg/puff MDI ≥4 years old: 50 mcg/day
6-11 years old: 50-200 mcg/day
≥12 years old: 100-500 mcg/day
50, 100, 250 mcg/dose accuhaler DPI; 50, 250 mcg dose diskhaler DPI; 50, 125, 250 mcg/dose evohaler
0.5 mg/2 mL, 2 mg/2 mL soln for inhalation unit dose
Mometasone 50, 100, 200 mcg/dose for inhalation unit dose ≥5 years old: 100 mcg/day
6-11 years old: 100-200 mcg/day
≥12 years old: 200-400 mcg/day 
*Corticosteroids combined with bronchodilators are available. Please see the latest MIMS for specific formulations and prescribing information.

Corticosteroids (Systemic)

Drug Dosage Remarks
Dexamethasone Asthma exacerbations in emergency department:
0.6 mg/kg/dose IM/IV as single dose or 24 hourly x 2 days 		Adverse Reactions
  • CNS effects (excessive mental stimulation, insomnia and psychic disturbances); CV effect (tachycardia); GI effects (gastritis, increased appetite); Other effects (weight gain, muscle weakness)
  • If administered long-term: Adrenocortical insufficiency, osteoporosis, muscle wasting, pain or weakness, increased susceptibility to infection, impaired wound healing, electrolyte imbalances, weight gain, DM, skin thinning leading to striae and easy bruising, cataracts, glaucoma
Special Instructions
  • Should be taken with food
  • Patients on long-term corticosteroids should receive preventive treatment for osteoporosis
Hydrocortisone Asthma exacerbations in emergency department:
2-4 mg/kg/dose slow IM/IV infusion
6 hourly x 24 hours
Adjust dose according to response and reduce over 4-5 days to oral dose when tolerated or 0.56-8 mg/kg/day (20-240 mg/m2/day) IM/IV divided 6-8 hourly
Methylprednisolone, Prednisolone,
Prednisone 		≤11 years od: 1-2 mg/kg/day IV/IM/PO divided 12-24 hourly
≥12 years old: 40-80 mg/day IV/IM/PO divided 12-24 hourly

Cough & Cold Preparations

Drug Dosage Remarks
Acetylcysteine 2-6 years old: 100 mg PO 6-12 hourly
>6 years old: 200 mg PO 8-12 hourly 		Adverse Reactions
  • GI effects (nausea/vomiting, dyspepsia); Other effects (bronchospasm, hypersensitivity)
Special Instruction
  • Should be taken with meals
  • Avoid use in children <2 years old
  • Use with caution in patients with history of peptic ulcer
Ambroxol 2-5 years old: 7.5-15 mg PO 8 hourly
6-12 years old: 15-30 mg PO 8-12 hourly
≥12 years old: 60-120 mg/day PO divided 8-12 hourly 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); Other effects (headache, polyuria, fatigue)
Special Instruction
  • Should not be taken in an empty stomach
  • Use with caution in patients with gastric ulcer
Bromhexine 2-5 years old: 2 mg PO 8 hourly or
4 mg PO 12 hourly
6-11 years old: 4-8 mg PO 8 hourly
≥12 years old: 8-16 mg PO 8 hourly 		Adverse Reactions
  • GI effect (GI irritation); Metabolic effect (transient increase of serum transaminases)
Special Instruction
  • Use with caution in patients with gastric ulcer
Carbocisteine
(Carbocysteine) 		Syrup
<2 years old: 30 mg PO 6 hourly
2-5 years old: 100 mg PO 12 hourly
6-12 years old: 250 mg PO 8 hourly
Tablet
6-12 years old: 375 mg PO 8 hourly 		Adverse Reactions
  • GI effects (GI disturbances, nausea/vomiting); Hypersensitivity effects (bronchospasm, rashes); Other effect (hypotension)
Special Instruction
  • Use with caution in patients with gastric or duodenal ulcer
Dried ivy leaf extract Syrup
2-5 years old: 2.5 mL PO 12 hourly
6-12 years old: 5 mL PO 12 hourly
>12 years old: 5 mL PO 8 hourly
Effervescent Tablet
4-12 years old: 32.5 mg PO 8 hourly
>12 years old: 65 mg PO 12 hourly 		Adverse Reactions
  • Rarely, laxative effect due to sorbitol content
Special Instructions
  • Use with caution in patients with fructose/sorbitol intolerance
Guaifenesin 2-5 years old: 50-100 mg PO 4 hourly
6-11 years old: 100-200 mg PO 4 hourly
≥12 years old: 200-400 mg PO 4 hourly
Max dose: 600 mg/day 		Adverse Reactions
  • GI effects (GI discomfort, nausea/vomiting); CNS effects (drowsiness, headache)
Special Instruction
  • Use with caution in children <2 years old and in patients with persistent or chronic cough
Lagundi (Vitex negundo) 15 mg/kg PO 8 hourly Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); Dermatologic effect (rash)
Special Instruction
  • Use with caution in patients with hypersensitivity to Lagundi

Leukotriene Modifiers

Drug Dosage Remarks
5-Lipoxygenase Inhibitor
Zileuton ≥12 years old: 600 mg PO 6 hourly
Extended-release: 1.2 g PO 12 hourly 		Adverse Reactions
  • CNS effect (headache); GI effects (GI upset, raised LFTs); Other effects (rashes, leukopenia has occurred in a few patients)
Special Instructions
  • Should not be used for acute asthma attacks
  • Avoid in patients with hepatic impairment/disease
  • Monitor liver enzymes before and periodically during therapy
Leukotriene Receptor Antagonists
Montelukast 6 months-5 years old: 4 mg PO 24 hourly before bedtime
6-14 years old: 5 mg PO 24 hourly before bedtime
≥15 years old: 10 mg PO 24 hourly before bedtime 		Adverse Reactions
  • Generally well-tolerated: Headache, GI upset
  • Less commonly: Generalized pain, arthralgia, myalgia, fever, dizziness; hypersensitivity reactions
  • Zafirlukast: Raised liver enzymes, rarely symptomatic hepatitis, hyperbilirubinemia
  • Very rarely: Agranulocytosis, bleeding, bruising and edema, systemic eosinophilia consistent with Churg-Strauss disease
Special Instructions
  • Should not be used for acute asthma attacks
  • Zafirlukast: Avoid in patients with hepatic impairment or cirrhosis
Pranlukast 3.5 mg/kg PO 12 hourly
Max dose: 10 mg/kg/day
Zafirlukast 5-11 years old: 10 mg PO 12 hourly
≥12 years old: 20 mg PO 12 hourly

Mast Cell Stabilizer/Antihistamine

Drug Dosage Remarks
Ketotifen 6 months-3 years old: 0.5 mg PO 12 hourly
>2 years old: 1 mg PO 12 hourly 		Adverse Reactions
  • CNS effects (drowsiness, dizziness, CNS stimulation); GI effects (dry mouth, increased appetite, weight gain)
Special Instructions
  • Should not be used for acute asthma attacks

Monoclonal Antibodies

Drug Dosage Remarks
Anti-Immunoglobulin E (Anti-IgE) Antibody
Depemokimab ≥12 years old: 100 mg SC injection every 6 months Adverse Reactions
  • Respiratory effects (URTI, allergic rhinitis, influenza, pharyngitis); Hypersensitivity effect (anaphylactoid reaction); Local effects (erythema, swelling, pruritus); Musculoskeletal effect (arthralgia), Other effects (antibody formation, withdrawal)
Special Instructions
  • Contraindicated in patients with a history of hypersensitivity to any of its components
  • Systemic or inhaled corticosteroids should not be abruptly discontinued upon initiation of therapy
  • Use with caution in patients with acute bronchospasm, helminth infections & status asthmaticus
  • Discontinue and initiate appropriate therapy if hypersensitivity reaction occurs
Omalizumab 6-11 years old: 75-375 mg in 1-3 SC injection every 2 or 4 weeks
≥12 years old: 150-375 mg in 1-4 SC injection every 2 or 4 weeks
Dose depends on pre-treatment IgE level and body weight 		Adverse Reactions
  • CNS effect (headache); Respiratory effects (respiratory infections, sinusitis, pharyngitis); Other effects (local site reaction, viral infection, anaphylaxis, malignancies)
Special Instructions
  • Max of 150 mg should be delivered per injection site
  • Should not be used for the treatment of acute bronchospasm or status asthmaticus
  • Contraindicated in patients with severe hypersensitivity to the drug and in children <6 years old
  • Corticosteroids should be tapered gradually
  • Use with caution in patients at risk of parasitic infections
Interleukin Inhibitors
Benralizumab ≥12 years old: 30 mg SC every 4 weeks x 3 doses, then every 8 weeks Adverse Reactions
  • CNS effect (headache); Respiratory effects (cough, pharyngitis); Dermatologic effects (urticaria, rash, injection site reaction, erythema, pruritus, papule)
Special Instructions
  • Not for acute asthma treatment
  • Use with caution in patients with helminth infection, children <12 years old, abrupt steroid withdrawal
  • Monitor for hypersensitivity reaction
Dupilumab 6-11 years old, 15-<30 kg:
100 mg SC every other week or
300 mg SC every 4 weeks or
600 mg (300 mg x 2 doses) SC followed by 300 mg SC every 4 weeks
6-11 years old, 30-<60 kg:
200 mg SC every other week or
400 mg (200 mg x 2 doses) SC followed by 200 mg SC every other week
6-11 years old, ≥60 kg:
600 mg (300 mg x 2 doses) SC followed by 300 mg SC every other week
≥12 years old:
Initial dose: 400 mg (200 mg x 2 doses) SC followed by 200 mg SC every other week or 600 mg (300 mg x 2 doses) SC followed by 300 mg SC given every other week 		Adverse Reactions
  • Injection site reaction, eosinophilia, oropharyngeal pain
Special Instructions
  • Not for acute asthma treatment
  • Use with caution in patients with helminth infection, children <12 years old, abrupt steroid withdrawal
  • Monitor for hypersensitivity reaction
  • Administer each of the two doses into different injection sites
Mepolizumab 6-11 years old: 40 mg SC 24 hourly every 4 weeks
≥12 years old: 100 mg SC 24 hourly every 4 weeks		 Adverse Reactions
  • Dermatologic effects (pruritus, eczema, injection site reaction including erythema, swelling, itching, burning); Musculoskeletal effects (muscle spasm, back pain); Respiratory effects (nasal congestion, dyspnea, allergic rhinitis, bronchospasm); Other effects (UTI, headache, toothache, infection)
Special Instructions
  • Not for acute asthma treatment
  • Use with caution in patients with uncontrolled worsening asthma, helminth infection, abrupt steroid withdrawal
Thymic Stromal Lymphopoietin Blocker
Tezepelumab ≥12 years old: 210 mg SC every 4 weeks Adverse Reactions
  • Hypersensitivity effects (eg rash, allergic conjunctivitis); Injection site reactions; Other effects (arthralgia, back pains, pharyngitis)
  • May develop neutralizing antibodies; although anti-antibodies were generally low and transient
Special Instructions
  • Avoid giving live virus vaccines in patients receiving treatment
  • Should not be used for the treatment of acute asthma symptoms, acute exacerbations, acute bronchospasm, or status asthmaticus
  • Use with caution in patients at risk of helminth infections

Other Drugs Acting on the Respiratory System

Drug Dosage Remarks
Bacterial lysate
(Lyophilized H influenzae,
D pneumoniae, K pneumoniae,
K ozaenae, S aureus, S pyogenes,
S viridans, N catarrhalis) 		Acute treatment:
50 mg PO 24 hourly
Long-term treatment:
50 mg PO 24 hourly x 10 days 		Adverse Reactions
  • GI effects (nausea, diarrhea, upper abdominal pain, gastric upset); Other effects (skin itching, cutaneous reactions, urological problems)
Special Instructions
  • Contraindicated in patients with autoimmune disease, cardiopulmonary insufficiency, conditions with compromised immunity, active TB, rheumatic disease

Xanthines (Oral)

Drug Dosage Remarks
Aminophylline Dosage should be individualized Adverse Reactions
  • GI effects (irritation, nausea/vomiting, abdominal pain, diarrhea, gastroesophageal reflux); CNS effects (CNS stimulation, headache, anxiety, restlessness, dizziness, tremor); Other effect (palpitations)
  • Serum concentration >15-20 mcg/mL (85-110 µmol/L) is associated with increased risk of adverse effects including lethal adverse reactions
Special Instructions
  • Use with caution in patients with peptic ulcer, hyperthyroidism, hypertension, cardiac arrhythmias or other CV disease, epilepsy, heart failure, hepatic dysfunction, acute febrile illness, in neonates
  • Serum concentration monitoring is necessary to ensure that concentration are within therapeutic range
    • Serum concentration needs to be measured if a patient is changed from one extended-release product to another
  • Optimal therapeutic concentration: 5-15 mcg/mL (28-85 µmol/L)
  • Many drug interactions occur with Theophylline including smoking
    • Increases Theophylline clearance
Choline theophyllinate 100-200 mg PO 6-8 hourly or
10-20 mg/kg/day PO 6 hourly or
<5 years old: 24-36 mg/kg/day PO divided 8 hourly
5-9 years old: 200-400 mg/day PO divided 6 hourly
10-14 years old: 400-800 mg/day divided 6 hourly
Doxofylline <12 years old: 6-9 mg/kg/dose PO 12 hourly
>12 years old: 400 mg PO 8-24 hourly
Heptaminol acefyllinate Oral drops
<7 years old: 2-3 drops/kg/day PO divided 8 hourly
7-15 years old: 75-100 drops/day PO divided 8 hourly
>15 years old: 25-50 drops PO 8 hourly
Tablet
>15 years old: 500 mg-1 g PO 8 hourly
Theophylline1 Dosage should be individualized based on serum Theophylline levels
Acute bronchospasm
Loading dose in patients not taking methylxanthine: 5 mg/kg PO
Maintenance dose:
6 months-<1 year old: 12-18 mg/kg/day PO
1-<9 years old: 24 mg/kg/day PO
9-<12 years old (including adolescent smokers): 20 mg/kg/day PO
12-<16 years old (non-smokers):
18 mg/kg/day PO
≥16 years old (non-smokers):
13 mg/kg/day PO
1Different formulations for Theophylline are available. Please see the latest MIMS for specific formulations and prescribing information.

Xanthines (Parenteral)

Drug Dosage Remarks
Aminophylline Loading dose: 5 mg/kg IV infusion over 20-30 minutes
Maintenance dose:
6 months-9 years old: 1 mg/kg/hr IV
10-16 years old: 0.8 mg/kg/hr IV 		Adverse Reactions
  • GI effects (irritation, nausea/vomiting, abdominal pain, diarrhea, gastroesophageal reflux); CNS effects (CNS stimulation, headache, anxiety, restlessness, dizziness, tremor); Other effect (palpitations)
  • Serum concentration >15-20 mcg/mL (85-110 µmol/L) is associated with increased risk of adverse effects including lethal adverse reactions
Special Instructions
  • Administer IV injection very slowly to prevent dangerous CNS and CV side effects
  • Use with caution in patients with peptic ulcer, porphyria, hyperthyroidism, hypertension, cardiac arrhythmias or other CV disease, epilepsy, heart failure, hepatic dysfunction, acute febrile illness, in neonates
  • Serum concentration monitoring is necessary to ensure concentration is within therapeutic range
  • Optimal therapeutic concentration: 5-15 mcg/mL (28-85 µmol/L)

Antiasthmatic Preparations - Combination Products

Drug Dosage Remarks
Beclometasone/Salbutamol >6 years old:
50 mcg/100 mcg: 1-2 inhalations 6-12 hourly
Max dose: 8 inhalations/day 		Adverse Reactions

Beclometasone
  • Local effects (oropharyngeal candidiasis, cough from upper airway irritation, dysphonia); paradoxical bronchospasm (rare)
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising, adrenal suppression, increased bone loss and osteoporotic fractures
    • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics

Salbutamol

  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions

Beclometasone

  • Local effects may be minimized by using a spacer, gargling and spitting out with water, or gargling with 1:50 dilution of Amphotericin B
  • Use not to exceed 10 days

Salbutamol

  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
  • Use not to exceed 10 days
Budesonide/Formoterol ≥4 years old:
80 mcg/4.5 mcg: 1-2 inhalations 12-24 hourly
12-17 years old:
80 mcg/4.5 mcg: 1-2 inhalations 12-24 hourly
160 mcg/4.5 mcg: 1-2 inhalations 12 hourly
200 mcg/6 mcg: 1-2 inhalations 12 hourly
320 mcg/9 mcg: 1 inhalation 12-24 hourly
400 mcg/12 mcg: 1-2 inhalations 12 hourly 		Adverse Reactions

Budesonide

  • Local effects (oropharyngeal candidiasis, cough from upper airway irritation, dysphonia); paradoxical bronchospasm (rare)
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising, adrenal suppression, increased bone loss and osteoporotic fractures
    • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics

Formoterol

  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions

Budesonide

  • Local effects may be minimized by using a spacer, gargling and spitting out with water, or gargling with 1:50 dilution of Amphotericin B

Formoterol

  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
Fluticasone/Formoterol ≥5 years old:
50 mcg/5 mcg: 2 inhalations 12 hourly
≥12 years old:
125 mcg/5 mcg: 2 inhalations 12 hourly 		Adverse Reactions

Fluticasone

  • Local effects (oropharyngeal candidiasis, cough from upper airway irritation, dysphonia); paradoxical bronchospasm (rare)
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising, adrenal suppression, increased bone loss and osteoporotic fractures
    • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics

Formoterol

  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions

Fluticasone

  • Local effects may be minimized by using a spacer, gargling and spitting out with water, or gargling with 1:50 dilution of Amphotericin B

Formoterol

  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
Fluticasone/Salmeterol ≥4 years old:
50 mcg/25 mcg: 2 inhalations 12 hourly
125 mcg/25 mcg: 2 inhalations 12 hourly
250 mcg/25 mcg: 2 inhalations 12 hourly
≥12 years old:
100 mcg/50 mcg: 1 inhalation 12 hourly
250 mcg/50 mcg: 1 inhalation 12 hourly
500 mcg/50 mcg: 1 inhalation 12 hourly 		Adverse Reactions

Fluticasone

  • Local effects (oropharyngeal candidiasis, cough from upper airway irritation, dysphonia); paradoxical bronchospasm (rare)
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising, adrenal suppression, increased bone loss and osteoporotic fractures
    • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics

Salmeterol

  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions

Fluticasone

  • Local effects may be minimized by using a spacer, gargling and spitting out with water, or gargling with 1:50 dilution of Amphotericin B

Salmeterol

  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
Fluticasone/Vilanterol ≥12 years old:
100 mcg/25 mcg: 1 inhalation 24 hourly
200 mcg/25 mcg: 1 inhalation 24 hourly 		Adverse Reactions
  • Resp effects (nasopharyngitis, pneumonia, cough, pharyngitis, URTI, oropharyngeal pain, sinusitis, rhinitis); GI effect (abdominal pain); Other effects (headache, pyrexia, back pain, muscle spasms)
Special Instructions
  • Avoid in patients with severe milk protein allergy
  • Discontinue use if paradoxical bronchospasm occurs
  • Use with caution in patients with CV disorders, visual disturbances, hypokalemia, pulmonary TB
Indacaterol/Mometasone ≥12 years old:
150 mcg/80 mcg: 1 inhalation 24 hourly
150 mcg/160 mcg: 1 inhalation 24 hourly
150 mcg/320 mcg: 1 inhalation 24 hourly
Max dose:
150 mcg/320 mcg 24 hourly 		Adverse Reactions
  • Respiratory effects (nasopharyngitis, asthma exacerbation, URTI, oropharyngeal pain, dysphonia); Other effects (headache, musculoskeletal pain)
Special Instructions
  • Administer doses at the same time each day
  • Discontinue use if paradoxical bronchospasm occurs
  • Use with caution in patients with CV disorders, visual disturbances, hypokalemia, pulmonary TB, untreated infections
Ipratropium bromide/Fenoterol Acute asthma attack
>6 years old:
20 mcg/50 mcg: 2 inhalations initially
If there is no improvement after 5 minutes, 2 more inhalations may be given 5 minutes after first inhalation
Intermittent and long-term treatment
>6 years old:
20 mcg/50 mcg: 1-2 inhalations each attack
Max dose: 8 inhalations/day
Acute bronchospasm
<6 years old:
250 mcg/500 mcg/mL: 0.1 mL/kg body wt by nebulization 24 hourly
6-12 years old:
250 mcg/500 mcg/mL: 0.5-2 mL by nebulization 24 hourly
≥12 years old:
250 mcg/500 mcg/mL: 1-2.5 mL by nebulization 24 hourly
0.5 mg/1.25 mg/4 mL: 1 nebulization 24 hourly 		Adverse Reactions

Ipratropium bromide

  • Respiratory effects (URTI, bronchitis, sinusitis); CV effects (chest pain, palpitation); CNS effects (headache, dizziness); GI effects (dry mouth, bad taste, dyspepsia, nausea); Hypersensitivity effects (urticaria, angioedema, rash, bronchospasm)

Fenoterol

  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions

Ipratropium bromide

  • Avoid contact of eyes with inhalation solution
  • Use with caution in patients with narrow-angle glaucoma, bladder neck obstruction, myasthenia gravis
  • Check patient’s inhaler technique for optimum delivery of drug
  • Not used as first-line treatment
    • Should be added to beta2-agonist therapy

Fenoterol

  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
Ipratropium bromide/Salbutamol <5 years old:
20 mcg/120 mcg: 1 inhalation 8 hourly
6-≥12 years old:
20 mcg/120 mcg: 1-2 inhalations 8 hourly
Acute asthma attack
2-12 years old:
500 mcg/2.5 mg/2.5 mL unit dose vial: 3 drops/kg/dose nebulization 6-8 hourly
>12 years old:
500 mcg/2.5 mg/2.5 mL unit dose vial: 2.5-5 mL nebulization
Maintenance dose: 2.5 mL nebulization 6-8 hourly 		Adverse Reactions

Ipratropium bromide

  • Respiratory effects (URTI, bronchitis, sinusitis); CV effects (chest pain, palpitation); CNS effects (headache, dizziness); GI effects (dry mouth, bad taste, dyspepsia, nausea); Hypersensitivity effects (urticaria, angioedema, rash, bronchospasm)

Salbutamol

  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions

Ipratropium bromide

  • Avoid contact of eyes with inhalation solution
  • Use with caution in patients with narrow-angle glaucoma, bladder neck obstruction, myasthenia gravis
  • Check patient’s inhaler technique for optimum delivery of drug
  • Not used as first-line treatment
    • Should be added to beta2-agonist therapy

Salbutamol

  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug
Mometasone/Formoterol 5-<12 years old:
50 mcg/5 mcg: 2 inhalations 12 hourly 		Adverse Reactions

Mometasone

  • Local effects (oropharyngeal candidiasis, cough from upper airway irritation, dysphonia); paradoxical bronchospasm (rare)
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising, adrenal suppression, increased bone loss and osteoporotic fractures
    • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system, the use of spacers and the drug’s pharmacokinetics

Formoterol

  • CV effects (tachycardia, palpitations, cardiac arrhythmias especially in susceptible patients); CNS effects (headache, hyperactivity); Respiratory effects (mouth and throat irritation, paradoxical bronchospasm); Other effect (fine skeletal muscle tremor)
  • Potentially severe hypokalemia may result especially in acute severe asthma
Special Instructions

Mometasone

  • Local effects may be minimized by using a spacer, gargling and spitting out with water, or gargling with 1:50 dilution of Amphotericin B

Formoterol

  • Use with caution in patients with hyperthyroidism, DM, myocardial insufficiency or arrhythmias
  • Monitor K levels in acute severe asthma
  • Check patient’s inhaler technique for optimum delivery of drug

Disclaimer

All dosage recommendations are for children with normal renal and hepatic function unless otherwise stated.
Not all products are available or approved for above use in all countries.
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.