Levalbuterol
XOPENEX
What it isR-enantiomer and beta-2 agonist; rescue treatment of acute bronchospasm.
Why this oneRemoving albuterol's S-enantiomer has not produced a consistent clinical advantage over racemic albuterol.
What limits itTremor, tachycardia, and hypokalemia remain possible; higher cost usually makes albuterol the practical default.
FDA-approved for
- bronchospasm (1999)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Bronchospasm (asthma) | Adults & adolescents ≥12 yr | 0.63 mg TID (q6–8h) | 0.63 mg TID | 1.25 mg TID |
| Bronchospasm (asthma) | Children 6–11 yr | 0.31 mg TID | 0.31 mg TID | 0.63 mg TID |
Renal Use with caution; risk of toxicity may be greater in renal impairment — monitor renal function.
Hepatic Undefined
Instructions
- For oral inhalation only via standard jet nebulizer with mouthpiece/face mask.
- Do not exceed recommended dose.
- Do not mix with other drugs in the nebulizer (compatibility not established).
Contraindications
- Hypersensitivity to levalbuterol or racemic albuterol (urticaria, angioedema, anaphylaxis, bronchospasm reported)
Cautions
- Paradoxical bronchospasm — discontinue immediately
- Deterioration of asthma / needing more doses signals destabilization
- Not a substitute for corticosteroids
- Cardiovascular effects (↑HR, BP, QTc); caution in CV disease
- Do not exceed dose — fatalities with excessive use
- Hypokalemia; changes in blood glucose
Adverse reactions
- Palpitations, chest pain, tachycardia
- Headache, dizziness, tremor, nervousness
Pregnancy No adequate controlled studies; no teratogenicity for levalbuterol in rabbits (racemic albuterol teratogenic in animals at high doses).
Lactation No data on presence in human milk.
NO BOXED WARNINGS
Principal riskNo proven advantage over albuterol at higher cost
Cost, est. cash$30–$500/month
Generic entry2008
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityTremor, tachycardia or anticholinergic effects; excessive beta-agonist exposure can cause hypokalemia and arrhythmia.
Mechanism of action: Levalbuterol ballicule
