Levalbuterol

Levalbuterol Brand Names- Xopenex | Xopenex Pediatric

What is Levalbuterol

Levalbuterol is a moderately selective short-acting beta-2-receptor agonist (SABA); it is the R-enantiomer of racemic albuterol and the therapeutically active enantiomer of the racemic compound.

When given in equimolar doses of R-albuterol (i.e., 2.5 mg of racemic albuterol or 1.25 mg of levalbuterol), levalbuterol produces bronchodilation and clinical activity similar to the parent drug.

Levalbuterol is used for the treatment or prevention of bronchospasm due to reversible obstructive airway disease (e.g., asthma) and for the treatment of chronic obstructive pulmonary disease (COPD).

Inhaled SABAs are considered the preferred pharmacologic treatment to relieve acute bronchospasm according to the Expert Panel of the National Asthma Education and Prevention Program (NAEPP).

In general, if an SABA is required more than 2 days a week or significant symptoms recur, the NAEPP panel recommends initiating treatment for persistent asthma (e.g., inhaled corticosteroids).

Quick-relief medication such as SABAs should be made available to all patients with persistent asthma for acute symptom control.

The American Thoracic Society also strongly recommends administration of an inhaled SABA such as levalbuterol 15 minutes before exercise for prevention of exercise-induced bronchospasm (EIB).

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD, levalbuterol may be used for first-line therapy in patients with mild COPD (Group A) and in combination with other treatments in those with more severe disease (Groups B, C, and D); inhaled SABAs are preferred for the management of acute COPD exacerbations, with or without an inhaled short-acting anticholinergic.

Levalbuterol inhalation nebulizer solution was approved by the FDA in 1999, and is used in adults and pediatric patients.

The levalbuterol HFA inhaler was FDA-approved in 2005 and is used in adults and pediatric patients as young as 4 years of age.

Indications

  1. acute bronchospasm
  2. asthma
  3. bronchospasm prophylaxis
  4. chronic bronchitis
  5. chronic obstructive pulmonary disease (COPD)
  6. emphysema
  7. exercise-induced bronchospasm prophylaxis
  8. hyperkalemia

For the treatment of acute bronchospasm and bronchospasm prophylaxis associated with asthma

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. anaphylactoid reactions
  4. angioedema
  5. anxiety
  6. arrhythmia exacerbation
  7. asthenia
  8. atrial fibrillation
  9. bronchospasm
  10. candidiasis
  11. chest pain (unspecified)
  12. chills
  13. conjunctivitis
  14. constipation
  15. cough
  16. diarrhea
  17. dizziness
  18. dysmenorrhea
  19. dyspepsia
  20. dysphonia
  21. epistaxis
  22. fever
  23. gastroesophageal reflux
  24. headache
  25. hematuria
  26. hyperesthesia
  27. hyperglycemia
  28. hypertension
  29. hypokalemia
  30. hypotension
  31. infection
  32. insomnia
  33. lymphadenopathy
  34. metabolic acidosis
  35. migraine
  36. muscle cramps
  37. myalgia
  38. nausea
  39. ocular pruritus
  40. paresthesias
  41. pharyngitis
  42. rash
  43. sinus tachycardia
  44. sinusitis
  45. syncope
  46. tremor
  47. urticaria
  48. vertigo
  49. vomiting
  50. wheezing
  51. xerostomia

Monitoring Parameters

  • pulmonary function tests (PFTs)

Contraindications

  • albuterol hypersensitivity
  • alcoholism
  • angioedema
  • bradycardia
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • children
  • coronary artery disease
  • deterioration of asthma
  • diabetes mellitus
  • females
  • geriatric
  • heart failure
  • hepatic disease
  • hypertension
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • infants
  • labor
  • levalbuterol hypersensitivity
  • malnutrition
  • MAOI therapy
  • myocardial infarction
  • neonates
  • obstetric delivery
  • paradoxical bronchospasm
  • pheochromocytoma
  • pregnancy
  • QT prolongation
  • renal failure
  • renal impairment
  • seizure disorder
  • seizures
  • tachycardia
  • thyroid disease
  • thyrotoxicosis

Interactions

  • Abarelix
  • Acebutolol
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Pseudoephedrine
  • Acetazolamide
  • Acrivastine; Pseudoephedrine
  • Alfuzosin
  • Amiodarone
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine
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  • Amphetamine; Dextroamphetamine Salts
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  • Articaine; Epinephrine
  • Asenapine
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  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Atenolol
  • Atenolol; Chlorthalidone
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  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Brimonidine; Timolol
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Bumetanide
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Caffeine
  • Caffeine; Ergotamine
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
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  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorpromazine
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  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
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  • Halothane
  • Histrelin
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
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  • Phentermine; Topiramate
  • Phenylephrine
  • Phenylephrine; Promethazine
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