Levalbuterol hydrochloride

Class
Bronchodilators
Subclass
Short-acting beta-agonists
Substance name
Levalbuterol hydrochloride, levosalbutamol
Brand names
Xopenex®
Dosage and administration
Adults patients
Prevention and treatment of bronchospasm in patients with reversible obstructive airway disease
Start at: 0.63 mg INH TID q8h
Maintenance: 0.63-1.25 mg INH TID
Indications for use
Labeled indications
Adults
Prevention and treatment of bronchospasm in patients with reversible obstructive airway disease
Safety risks
Contraindications
Hypersensitivity to levalbuterol or its components, or racemic albuterol
Warnings and precautions
Asthma exacerbation
Maintain a high level of suspicion, as asthma may deteriorate acutely over a period of hours or chronically over several days or longer. Consider initiating combination therapy for adequate control of asthma.
Cardiac arrest
Maintain a high level of suspicion, as fatalities, including cardiac arrest, have been associated with the excessive use of inhaled sympathomimetic drugs in patients with asthma.
Cardiovascular adverse events
Use extreme caution in patients taking MAOIs or TCAs or within 2 weeks of discontinuation.
Use caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension.
Use caution in patients taking other sympathomimetic agents.
Decreased drug efficacy
Use caution in patients taking β-blockers.
Decreased serum potassium
Maintain a high level of suspicion, as β-agonists may cause significant hypokalemia. Use caution in patients taking non‑potassium-sparing diuretics. Consider monitoring potassium levels.
Drug hypersensitivity reaction
Maintain a high level of suspicion, as immediate hypersensitivity reactions, including urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema, may occur after the administration of levalbuterol or racemic albuterol.
Paradoxical bronchospasm
Maintain a high level of suspicion, as life-threatening paradoxical bronchospasm may occur after administration. Discontinue immediately if paradoxical bronchospasm occurs.
Sympathomimetic adverse effects
Use caution in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus, and in patients who are unusually responsive to sympathomimetic amines.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
Use with caution. Monitor renal function in elderly patients.
Renal replacement therapy
Any modality
No guidance available.
Hepatic impairment
Any severity
No guidance available.
Pregnancy and breastfeeding
Pregnancy
All trimesters
Use only if benefits outweigh potential risks. The use of β-2 agonists during pregnancy is not associated with an increased risk of fetal abnormalities. The 2024 GINA guidelines recommend treating acute exacerbations of asthma during pregnancy aggressively with a short-acting β-agonist, oxygen, and early administration of systemic corticosteroids.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
Viral infections
Common 1-10%
Gastroenteritis, ECG abnormalities, migraine, leg cramps, anxiety, accidental injury, chills, chest pain, hypertension, hypotension, syncope, diarrhea, dry mouth, throat dryness, nausea, lymphadenopathy, myalgia, hyperesthesia, insomnia, paresthesia, itchy eyes, cough, dyspepsia, dizziness, flu-like symptoms, nervousness, pain, rhinitis, sinusitis, tachycardia, tremor, turbinate edema
Unknown frequency
Anaphylaxis, asthma, gastroesophageal reflux disease, angioedema, cardiac arrhythmias, dysphonia, metabolic acidosis, skin rash, urticaria, vertigo, headache
Interactions
Drug(s)
Check Interactions
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