levalbuterol hydrochloride

levalbuterol hydrochloride

Xopenex HFA

Pharmacologic class: Adrenergic beta2 agonist

Therapeutic class: Bronchodilator

Pregnancy risk category C


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.


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.


• Hypersensitivity to drug or racemic albuterol


Use cautiously in:

• renal, hepatic, or cardiac impairment; hyperthyroidism; diabetes mellitus; hypertension; prostatic hypertrophy; angle-closure glaucoma; seizures

• pregnant patients.


• 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.

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


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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved
References in periodicals archive ?
The company added the US Food & Drug Administration (USFDA) approved Levalbuterol Inhalation Solution is the therapeutic equivalent generic version of XOPENEX (levalbuterol hydrochloride) inhalation solution.
For the most recent 12 months ending in June 2014, the XOPENEX (levalbuterol hydrochloride) inhalation solution brand and generic combined had US sales of approximately USD269.7 Million MAT, according to IMS Health.