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
- acute bronchospasm
- asthma
- bronchospasm prophylaxis
- chronic bronchitis
- chronic obstructive pulmonary disease (COPD)
- emphysema
- exercise-induced bronchospasm prophylaxis
- hyperkalemia
For the treatment of acute bronchospasm and bronchospasm prophylaxis associated with asthma
Side Effects
- abdominal pain
- acne vulgaris
- anaphylactoid reactions
- angioedema
- anxiety
- arrhythmia exacerbation
- asthenia
- atrial fibrillation
- bronchospasm
- candidiasis
- chest pain (unspecified)
- chills
- conjunctivitis
- constipation
- cough
- diarrhea
- dizziness
- dysmenorrhea
- dyspepsia
- dysphonia
- epistaxis
- fever
- gastroesophageal reflux
- headache
- hematuria
- hyperesthesia
- hyperglycemia
- hypertension
- hypokalemia
- hypotension
- infection
- insomnia
- lymphadenopathy
- metabolic acidosis
- migraine
- muscle cramps
- myalgia
- nausea
- ocular pruritus
- paresthesias
- pharyngitis
- rash
- sinus tachycardia
- sinusitis
- syncope
- tremor
- urticaria
- vertigo
- vomiting
- wheezing
- 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
- Amphetamine; Dextroamphetamine
- Amphetamine; Dextroamphetamine Salts
- Anagrelide
- Apomorphine
- Aripiprazole
- Arsenic Trioxide
- Artemether; Lumefantrine
- Articaine; Epinephrine
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Atenolol
- Atenolol; Chlorthalidone
- Atomoxetine
- Azithromycin
- Bedaquiline
- Bendroflumethiazide; Nadolol
- Benzphetamine
- Beta-adrenergic blockers
- Betaxolol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- 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
- Carbinoxamine; Pseudoephedrine
- Carbonic anhydrase inhibitors
- Carteolol
- Carvedilol
- Ceritinib
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloroquine
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Ciprofloxacin
- Cisapride
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clozapine
- Cocaine
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Crizotinib
- Dasatinib
- Degarelix
- Desipramine
- Desloratadine; Pseudoephedrine
- Deutetrabenazine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Dichlorphenamide
- Diethylpropion
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Disopyramide
- Dobutamine
- Dofetilide
- Dolasetron
- Dolutegravir; Rilpivirine
- Donepezil
- Donepezil; Memantine
- Dopamine
- Dorzolamide; Timolol
- Doxepin
- Dronedarone
- Droperidol
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Eliglustat
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Encorafenib
- Enflurane
- Entrectinib
- Ephedrine
- Epinephrine
- Eribulin
- Erythromycin
- Erythromycin; Sulfisoxazole
- Escitalopram
- Esmolol
- Ethacrynic Acid
- Ezogabine
- Fexofenadine; Pseudoephedrine
- Fingolimod
- Flecainide
- Fluconazole
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluphenazine
- Fluvoxamine
- Foscarnet
- Furosemide
- Gemifloxacin
- Gemtuzumab Ozogamicin
- Gilteritinib
- Glasdegib
- Goserelin
- Granisetron
- Green Tea
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Halofantrine
- Haloperidol
- Halothane
- Histrelin
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydroxychloroquine
- Hydroxyzine
- Ibuprofen; Pseudoephedrine
- Ibutilide
- Iloperidone
- Imipramine
- Inotuzumab Ozogamicin
- Isocarboxazid
- Isoflurane
- Isoproterenol
- Itraconazole
- Ivosidenib
- Ketoconazole
- Labetalol
- Lapatinib
- Lefamulin
- Lenvatinib
- Leuprolide
- Leuprolide; Norethindrone
- Levobetaxolol
- Levobunolol
- Levofloxacin
- Levomethadyl
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linezolid
- Liothyronine
- Lisdexamfetamine
- Lithium
- Lofexidine
- Lomefloxacin
- Loop diuretics
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Macimorelin
- Maprotiline
- Mefloquine
- Meperidine; Promethazine
- Mesoridazine
- Methacholine
- Methadone
- Methamphetamine
- Methazolamide
- Metoprolol
- Metronidazole
- Midodrine
- Midostaurin
- Mifepristone
- Mirtazapine
- Monoamine oxidase inhibitors
- Moxifloxacin
- Nadolol
- Naproxen; Pseudoephedrine
- Nebivolol
- Nebivolol; Valsartan
- Nilotinib
- Norepinephrine
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Olanzapine
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Paliperidone
- Panobinostat
- Pasireotide
- Pazopanib
- Pemoline
- Penbutolol
- Pentamidine
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenelzine
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Pimavanserin
- Pimozide
- Pindolol
- Pitolisant
- Posaconazole
- Prilocaine; Epinephrine
- Primaquine
- Procainamide
- Procarbazine
- Prochlorperazine
- Promethazine
- Propafenone
- Propranolol
- Protriptyline
- Pseudoephedrine
- Quetiapine
- Quinidine
- Quinine
- Racepinephrine
- Ranolazine
- Rasagiline
- Ribociclib
- Ribociclib; Letrozole
- Rilpivirine
- Risperidone
- Romidepsin
- Saquinavir
- Selegiline
- Selpercatinib
- Sertraline
- Sevoflurane
- Siponimod
- Solifenacin
- Sorafenib
- Sotalol
- Sunitinib
- Tacrolimus
- Tamoxifen
- Telavancin
- Telithromycin
- Tetrabenazine
- Theophylline, Aminophylline
- Thiazide diuretics
- Thioridazine
- Thyroid hormones
- Timolol
- Tolterodine
- Toremifene
- Torsemide
- Tranylcypromine
- Trazodone
- Triclabendazole
- Tricyclic antidepressants
- Trifluoperazine
- Trimipramine
- Triptorelin
- Vandetanib
- Vardenafil
- Vemurafenib
- Venlafaxine
- Voriconazole
- Vorinostat
- Ziprasidone
