Levalbuterol (Inhalation)

Overview

Levalbuterol is an inhaled medication that is taken as either a solution or as an aerosol powder. Patients inhale the treatment to help prevent or treat bronchospasm that may occur as a result of asthma or other lung diseases.

Levalbuterol is prescribed by doctors in the form of Xopenex, Xopenex HFA or Xopenex Pediatric and should be used only as you have been directed by the doctor.

Levalbuterol is an adrenergic bronchodilator that is breathed in through windpipe to allow the bronchial tubes to relax and be opened up in the lungs. These treatments relieve coughs, wheezing, shortness of breath and help to ease breathing in general.

Condition treated

  • Bronchospasm, caused by asthma
    Bronchospasm, caused by lung disease

Type Of Medicine

  • Adrenergic bronchodilator

Side Effects

In addition to relaxing the bronchial tubes to ease breathing and relieve symptoms of lung disease, Levalbuterol can also cause unwanted side effects to occur in the patient. While not all unwanted side effects may occur, in some cases the patient may need to seek urgent medical care if they do.

You should check with your doctor immediately if you experience any of the following side effects from the use of Levalbuterol:

Occurring more commonly:

    • Fast heartbeat

Occurring less commonly or rarely:

  • Troubled breathing
  • Lightheadedness
  • Faintness
  • Dizziness
  • Chest pain
  • Chest tightness

Frequency of occurrence not known:

  • Unusual tiredness or weakness
  • Tightness in the chest
  • Redness of the skin
  • Noisy breathing
  • Swelling with a hive-like appearance on the:
  •  tongue
  • throat
  • sex organs
  • lips
  • legs
  •  hands
  • feet
  • face
  • eyelids
  • Hives, welts, itching, or rash
  • Increased heart rate or pulse
  • Irregularity of the heartbeat or pulse
  • Fainting
  • Extra heartbeats
  • Difficulty swallowing
  • Difficult or labored breathing
  • Coughing

It is possible to suffer from an overdose of this medication. You should seek emergency help if you experience any of the following symptoms of overdose when using Levalbuterol:

  • Tremor
  • Sweating
  • Sleeplessness
  • Seizures
  • Nervousness
  • Nausea
  • Lightheadedness
  • Irregular or increased heartbeat
  • Impaired consciousness
  • Headaches
  • General feeling of discomfort or illness
  • Dry mouth
  • Dizziness
  • Chest pain

This medication may also cause other unwanted side effects to occur that are not as serious and do not normally require you to seek medical attention. If you experience these side effects and they are ongoing or bothersome then you can seek advice from your healthcare professional but you will not normally require assistance:

Occurring more commonly:

  • Runny or stuffy nose
  • Nervousness
  • Muscle tightness
  • Migraines or other headaches
  • Loss of appetite
  • Leg cramps
  • Increased coughing after use
  • Hoarseness
  • Headache
  • General aches and pains
  • Fever
  • Dryness or soreness of the throat
  • Cough or hoarseness
  • Congestion
  • Chills
  • Body aches or pain
  • Anxiety
  • Accidental injury (in children 4 to 11 years of age)

Occurring less commonly or rarely:

  • Weight loss
  • Vaginal yeast infection
  • Tingling sensation in the arms or legs
  • Sleeplessness
  • Pain, swelling or redness of the eye, eyelid or inner eyelid
  • Pimples
  • Painful cold sores on face or genitals
  • Blisters on lips, nose, eyes or genitals
  • Pain
  • Numbness or decreased sensitivity of the hand
  • Night sweats
  • Muscle pain
  • Heavy menstrual bleeding
  • Eye itch
  • Excessive tearing
  • Ear pain
  • Dry mouth or throat
  • Discharge from the eye
  • Difficulty passing a bowel movement
  • Diarrhea
  • Cramps
  • Cough producing mucus
  • Burning, dry or itching eyes
  • Burning or stinging of the skin
  • Bloody nose
  • Blood in the urine
  • Blemishes on the skin
  • Abnormal growth filled with fluid or other liquid-like material
  • Abdominal or stomach pain

Other side effects from the use of Levalbuterol can also occur that have not been listed here. If you experience any other side effects then you should contact your doctor immediately. If you believe your immediate health is at risk, however, then you should always contact the emergency services.

Dosage

This medication should only ever be taken as directed by your doctor. You should not ever use more of it than prescribed and should not use it more often then you have been ordered to. Doing so can put you at risk of experiencing more serious side effects and may increase the severity of the side effects. You should also not cease use of this medication without first informing your doctor. If you do so then you may increase your chance of developing breathing problems.

The solution should be used with a jet nebulizer that is connected to a compressor. The nebulizer will come with instructions and information about maintenance. You should follow these instructions carefully and should ask your doctor if there is anything you do not understand. Ensure that you know how to use it before you attempt to do so.

To use the solution in the nebulizer you should follow these steps:

  • Open the pouch containing the vial only when you are ready to use it.
  • Break open the vial and pour the solution into the correct reservoir in the nebulizer.
  • Connect the face mask to the nebulizer and use it to breathe the medication in through the nebulizer.
  • Use the nebulizer for a period of up to five minutes until the full dose of treatment has been consumed.
  • Clean the nebulizer as directed in the instructions after each use and store in a sanitary location.
  • Do not take this medication if the solution is cloudy or contains particulates.
  • Do not mix any other medication or substance into the nebulizer and use it only to take this medication as directed.

To use the inhalation aerosol you should follow these steps:

    • Keep a record of the number of inhalations you are using so you know when to replace your inhaler. An inhaler will usually contain around 200 inhalations and you should update your prescription before you run out of this medication.
    • You should test or prime the inhaler before using it for the first time in a while as it may not deliver the correct dose at first. Prime the canister before taking the dose as directed by your doctor. To do this follow these steps:

O Shake the inhaler thoroughly.
O Remove the cap and inspect for any foreign contaminants.
O Prime the inhaler 4 times pointing the medication away from your face and away from others. You will then receive the correct dose on the 5th use.

  • Shake the inhaler well before use.
  • Breathe out as much as you can to expel all of the air from your body before use.
  • Place inhaler into your mouth and seal with your lips. While breathing in slowly depress the top fully to administer a dose into your lungs.
  • Hold your breath for at least 10 seconds to allow full absorption.
  • If you are to take more than one does then wait for 1 minute between each dose before shaking and repeating.
  • Store the inhaler with the cap on to protect the mouthpiece and keep it clean at all times.
  • Clean the mouthpiece at least once weekly.

To clean the aerosol inhaler weekly you should follow these steps:

  • Remove both the mouthpiece cap and the canister from the inhaler.
  • Was the mouthpiece cap thoroughly in warm water for at least 30 seconds.
  • Wash the inhaler with warm water through both the top and the bottom for at least 30 seconds each.
  • Shake the excess water off and allow the inhaler to dry naturally in the air before reassembling.
  • Do not use anything to clean the canister and ensure that it does not become wet.
  • Make sure the canister is firmly and fully inserted back into the inhaler after cleaning. A blockage will occur more readily if this is not the case.

If the inhaler becomes blocked then you should follow this advice:

  • If medication is not coming out then the inhaler may be blocked. You should begin by following the steps above to clean the inhaler. You should then carry out a test spray to see if this has worked and to clear any remaining water that may still be in the inhaler. You can then take the prescribed dose.
  • Following clearance of a blockage, you should then thoroughly clean the inhaler again and leave it to dry overnight to ensure blockages do not occur again.

You should only ever use this medication as prescribed and should not make any changes to the dosing unless you have been directed to by your doctor. Following the instructions of your doctor will ensure that you are able to get the best benefit from use and will help you to maintain control of your lung condition. Ensure that you always follow advice on how long to wait between doses to avoid any risk of overdose. The following information is for guidance only and should not be used to change your dose of medication:

When using the inhalation aerosol:

  • Children over the age of four and adults can use two doses (puffs) of this treatment every four-six hours. Many patients will find one dose to be enough during this period.
  • The use in children below the age of four is not recommended.

When using solution for inhalation through a nebulizer:

  • Children aged 12+ and adults should use 0.63mg three times daily. This may be increased to 1.25mg taken three times daily.
  • Children aged 6-11 should be treated with 0.31mg three times daily. This dose can be increased up to 0.63mg taken three times daily.
  • Children under the age of six would not normally be prescribed this treatment.

If a dose of this medication is missed then you should take it as soon as possible unless you are close to your next dose being due. In this case, you should skip the dose you have missed and return to your usual schedule. Never take a double dose of this medication. If you have any queries about your dose then you should check with your doctor before making any changes.

Interactions

Interactions between Levalbuterol and other medications can occur that may cause unwanted severe reactions in the body. These interactions need to be avoided so you must inform your doctor of all other medications that you are taking before you begin use. The reactions to drug interactions can sometimes be life-threatening and in other cases, they can lead to more severe side effects occurring.

For Levalbuterol it is especially important that you inform your doctor if you are taking any of the following medications. These medications are not normally recommended for use with Levalbuterol. In some cases, treatment with both may be required, but your doctor may need to adjust the dose or frequency of use of one or both medications:

  • Tulobuterol
  • Trimipramine
  • Tianeptine
  • Protriptyline
  • Propizepine
  • Opipramol
  • Nortriptyline
  • Melitracen
  • Lofepramine
  • Iprindole
  • Imipramine
  • Hexoprenaline
  • Fenoterol
  • Epinephrine
  • Doxepin
  • Dothiepin
  • Dibenzepin
  • Desipramine
  • Clomipramine
  • Butriptyline
  • Amoxapine
  • Amitriptylinoxide
  • Amitriptyline
  • Amineptine
  • Albuterol

Other drug interactions can also occur that have not been listed herein. This list has been compiled because of the severity of the interactions and may not be all-inclusive. To ensure that you are able to avoid drug interactions occurring you should be sure to inform your doctor of all medications you are taking whether they are prescribed, sold over-the-counter or otherwise obtained.

Other medical problems from which you suffer can also affect your use of Levalbuterol. In some cases, other medical conditions may be worsened by certain treatments or they may increase the side effects experienced by the patient. You must inform your doctor of your full medical history before you begin to use it, and for Levalbuterol it is especially important that you inform your doctor if you have any of the following conditions

These conditions may be worsened by use:

  • Diabetes
  • Heart Disease
  • Heart rhythm problems
  • Hypertension
  • Hyperthyroidism
  • History of seizures

Patients with kidney disease will also need to use caution when taking this medication. This is because the effects of the medication can be intensified because there will be a slower removal of the medication from the body.

Other medical conditions not listed herein can also affect the use of Levalbuterol. Ensure your doctor is aware of your full medical history before use.

Warnings

Before you begin to use Levalbuterol it is vital that you weigh the benefits of use against the risks of use. You should take the decision to use this medication with your doctor having ensured that all of the following has been properly considered:

Allergies ' You must inform your doctor of any allergies from which you suffer. This includes allergies to foods, dyes, preservatives, animals and other substances. It is also very important that you inform your doctor if you have ever reacted unusually to any medications in the past. Allergies to this medication may prohibit use. Levalbuterol can cause anaphylaxis to occur when you use it. This can be life-threatening and can occur at any time. Seek emergency care if you experience these symptoms of anaphylaxis

  • Rash
  • Hives
  • Itching
  • Troubled breathing
  • Troubled swallowing
  • Swelling

Pediatric ' This medication has been established for safe and effective use in children of certain ages as follows

  • Levalbuterol solution has been approved for use in children aged 6+.
  • Levalbuterol aerosol has been approved for use in children aged 4+.

Safety and efficiency of use outside these age ranges have not been established. Discuss with your doctor before use.

Geriatric ' There are no known limitations to the use of this medication in elderly patients. Elderly patients are, however, more likely to be suffering from kidney disease which may require extra caution to be taken and dose reductions to be made. Use caution when prescribing Levalbuterol to elderly patients.

Pregnancy ' There is a risk to the use of this medication when pregnant. You should inform your doctor if you are pregnant and should inform your doctor if you may become pregnant. Other treatments may be prescribed for the period of pregnancy.

Breastfeeding ' There have been no studies in relation to the use of this treatment when breastfeeding. Discuss this with your doctor and weigh the benefits of use against the potential risks.

When taking this medication for a prolonged period as is common you will need to regularly undergo a checkup with your doctor. This will allow them to see if the medication is working properly and to check for any unwanted side effects that may occur.

You should never take this medication in conjunction with other similar medications intended for the treatment of the same condition. To do so will risk an overdose of active agents occurring and this can be life-threatening.

This medication can cause the occurrence of paradoxical bronchospasm, which will cause a worsening of your breathing problems. This can be life-threatening and will need to be treated straight away. Seek emergency treatment if you are struggling to breathe, coughing heavily or wheezing after use of the treatment.

If you do not notice any improvement in condition within a few weeks you should contact your doctor for advice. If your inhaler appears to be becoming less effective then you should contact your doctor for advice.

If this medication is being used with an anti-inflammatory medication then you should continue using both treatments regardless of improvements in condition unless you are directed to change use by your doctor.

Hypokalemia may occur from the use of this treatment. You should report any of the following symptoms of this condition to your doctor straight away:

  • Convulsions
  • Decrease in urination
  • Loss of appetite
  • Nausea
  • Vomiting
  • Numbness of hands or feet
  • Unusual tiredness
  • Unusual weakness
  • Shortness of breath

You should not take this medication in conjunction with any other medications unless they have been prescribed by your doctor.

Storage

Keep this medication well out of reach of children, even when the medication is for the child's use. Do not keep any outdated or unwanted medication and ensure that it is properly and safely disposed of. Your healthcare professional can advise you on how best to dispose of unwanted medication.

Store the vials of medication for the nebulizer in their foil packaging until you are ready to use them. These can be stored at room temperature but should be kept out of direct light. Once a pouch has been opened the vials within must be used within a period of two weeks from opening.

Summary

Levalbuterol is used in the treatment of asthma and other lung diseases. It is an inhaled medication that is taken either using an aerosol inhaler or using a solution nebulizer.

Levalbuterol works by relaxing the bronchial tubes to allow for easier and more efficient breathing in the patient. The treatment will relieve the symptoms that commonly occur with lung disease.

The aerosol medication is usually taken as one-two doses every four-six hours as required by the patient. The solution is inhaled through a nebulizer and is used three times daily to keep the lungs relaxed. The nebulizer should be used for up to 15 minutes to inhale all of the solution.

Levalbuterol should not be used with other medications unless you have been directed to do so by your doctor. To do so can increase the risk of side effects occurring and increase the risk of suffering an overdose of the treatment.

Patients should be aware of the potential side effects of use before beginning treatment. While not all side effects may occur, in some cases the patient may be required to seek urgent medical attention.

Levalbuterol has been approved for use in children as follows:

  • Levalbuterol aerosol is approved for use in children aged 4+
  • Levalbuterol solution is approved for use in children aged 6+

The use of this medication outside of these age groups is not recommended and other treatments may need to be found. Discuss this with your doctor where it is applicable.