levalbuterol hydrochloride

levalbuterol hydrochloride

Xopenex

Pharmacologic class: Adrenergic beta₂ agonist

Therapeutic class: Bronchodilator

Pregnancy risk category C

Action

Binds to beta₂-adrenergic receptors on bronchial cell membrane, stimulating the intracellular enzyme adenylate cyclase to convert adenosine triphosphate to cyclic-3′,5′-adenosine monophosphate. This action relaxes smooth muscles, dilates bronchioles, and increases diuresis.

Availability

Solution for inhalation: 0.31 mg/3 ml, 0.63 mg/3 ml, 1.25 mg/3 ml

⊘Indications and dosages

➣ Prevention and treatment of bronchospasm

Adults and children ages 12 and older: 0.63 to 1.25 mg by oral inhalation via nebulizer q 6 to 8 hours

Children ages 6 to 11: 0.31 to 0.63 mg by oral inhalation via nebulizer t.i.d.

Contraindications

• Hypersensitivity to drug or racemic albuterol

Precautions

Use cautiously in:
• renal, hepatic, or cardiac impairment; hyperthyroidism; diabetes mellitus; hypertension; prostatic hypertrophy; angle-closure glaucoma; seizures
• pregnant patients.

Administration

• Use only with nebulizer system designed for this drug.
• Keep unopened vials in foil pouch. Once pouch is opened, use within 2 weeks.
• If vial is removed from pouch, protect from light and use within 1 week.

Route	Onset	Peak	Duration
Inhalation	10-17 min	1.5 hr	5-6 hr

Adverse reactions

CNS: anxiety, dizziness, hypertonia, insomnia, migraine, headache, nervousness, paresthesia, syncope, tremor

CV: chest pain, hypertension, hypotension, tachycardia

EENT: rhinitis, sinusitis, dry throat

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia, dry mouth

Metabolic: hypokalemia

Musculoskeletal: muscle cramps, myalgia

Respiratory: cough, dyspnea, asthma exacerbation, paradoxical bronchospasm

Other: sour taste, flulike symptoms, lymphadenopathy, chills

Interactions

Drug-drug. Aerosol bronchodilators: increased action of both drugs

Antidepressants: increased risk of adverse cardiovascular effects

Beta-adrenergic blockers: inhibition of levalbuterol effect

Digoxin: decreased digoxin blood level

Loop and thiazide diuretics: increased risk of hypokalemia

Drug-food. Caffeine-containing foods and beverages: increased stimulation

Drug-herbs. Cola nut, ephedra (ma huang), guarana, yerba maté: increased stimulation

Patient monitoring

• Monitor vital signs and ECG closely.
• Assess cardiovascular and neurologic status. Institute safety measures as needed to prevent injury.
☞ Monitor for paradoxical bronchospasm. If it occurs, stop drug therapy and notify prescriber immediately.
• Check electrolyte levels for hypokalemia.
• Assess patient's response to drug. Contact prescriber if patient needs more frequent doses for same effect.

Patient teaching

• Teach patient how to prepare drug, administer it with nebulizer, and maintain and clean nebulizer.
• Advise patient to continue treatment for about 5 to 15 minutes or until mist no longer forms in nebulizer reservoir.
☞ Tell patient to immediately report increased difficulty breathing or tightness in chest.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, and herbs mentioned above.