LEVALBUTEROL HYDROCHLORIDE

LEVALBUTEROL HYDROCHLORIDE
(lev-al-bu'ter-ole)
Xopenex, Xopenex HFA
Classifications: beta-adrenergic agonist; bronchodilator;
Therapeutic: bronchodilator
; beta-adrenergic agonist
Prototype: Albuterol
Pregnancy Category: C

Availability

0.63 mg/3 mL, 1.25 mg/3 mL inhalation solution

Action

An isomer of albuterol with beta2-adrenergic agonist properties, drug acts on the beta2 receptors of the smooth muscles of the bronchial tree, thus resulting in bronchodilation.

Therapeutic Effect

Effective bronchodilator that decreases airway resistance, facilitates mucous drainage, and increases vital capacity.

Uses

Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease.

Contraindications

Hypersensitivity to levalbuterol or albuterol; angioedema; pregnancy (category C); children <6 y; lactation.

Cautious Use

Cardiovascular disorders especially coronary insufficiency, cardiac arrhythmias, hypertension, QT elongation, convulsive disorders; diabetes mellitus, diabetic ketoacidosis; older adults; seizures, status asthmaticus, tachycardia; hypersensitivity to sympathetic amines; hyperthyroidism, thyrotoxicosis.

Route & Dosage

Bronchospasm
Adult: Inhalation 0.63 mg by nebulization t.i.d. every 6–8 h, may increase to 1.25 mg t.i.d. if needed
Child (6–11 y): Inhalation 0.31 mg by nebulization t.i.d. every 6–8 h (max: 0.63 mg t.i.d.)

Administration

Inhalation
  • Use vials within 2 wk of opening pouch. Protect vial from light and use within one wk after removal from pouch. Use only if solution in vial is colorless.

INCOMPATIBILITIES Solution/additive: Compatibility when mixed with other drugs in a nebulizer has not been established.

  • Store at 15°–25° C (59°–77° F) in protective foil pouch.

Adverse Effects (≥1%)

Body as a Whole: Allergic reactions, flu syndrome, pain. CNS: Migraine, dizziness, nervousness, tremor, anxiety. CV: Tachycardia. GI: Dyspepsia. Respiratory: Increased cough, viral infection, rhinitis, sinusitis, turbinate edema, paradoxical bronchospasm. Endocrine: Increase in serum glucose.

Interactions

Drug: beta-adrenergic blockers may antagonize levalbuterol effects; maoi, tricyclic antidepressants may potentiate levalbuterol effects on vascular system; ECG changes or hypokalemia may be exacerbated by loop or thiazide diuretics.

Pharmacokinetics

Onset: 5–15 min. Duration: 3–6 h. Half-Life: 3.3 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of CNS or cardiovascular stimulation (e.g., BP, HR, respiratory status).
  • Lab tests: Periodic serum potassium levels especially with coadministered loop or thiazide diuretics.
  • Monitor diabetics for loss of glycemic control.

Patient & Family Education

  • Seek medical advice immediately if a previously effective dose becomes ineffective.
  • Report immediately to physician: chest pains or palpitations, swelling of the eyelids, tongue, lips, or face; increased wheezing or difficulty breathing.
  • Do not use drug more frequently than prescribed.
  • Exercise caution with hazardous activities; dizziness and vertigo are possible side effects.
  • Check with physician before taking OTC cold medication.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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