Xopenex side effects with a nebulizer

Xopenex

SIDE EFFECTS

The following serious adverse reactions are described below and elsewhere in the labeling:

  • Paradoxical bronchospasm
  • Cardiovascular effects
  • Immediate hypersensitivity reactions
  • Hypokalemia

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of the drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Adults And Adolescents 12 Years Of Age And Older

Adverse reaction information concerning XOPENEX Inhalation Solution in adults and adolescents is derived from one 4-week, multicenter, randomized, double-blind, active-, and placebo-controlled trial in 362 patients with asthma 12 years of age and older. Adverse reactions reported in ≥2% of patients receiving XOPENEX Inhalation Solution or racemic albuterol and more frequently than in patients receiving placebo are listed in Table 1.

Table 1: Adverse Reactions Reported in a 4-Week, Controlled Clinical Trial in Adults and Adolescents ≥12 Years Old

The incidence of certain systemic beta-adrenergic adverse reactions (e.g., tremor, nervousness) was slightly less in the XOPENEX Inhalation Solution 0.63 mg group compared with the other active treatment groups. The clinical significance of these small differences is unknown.

Changes in heart rate 15 minutes after drug administration and in plasma glucose and potassium 1 hour after drug administration on day 1 and day 29 were clinically comparable in the XOPENEX Inhalation Solution 1.25 mg and racemic albuterol 2.5 mg groups (see Table 2). Changes in heart rate and plasma glucose were slightly less in the XOPENEX Inhalation Solution 0.63 mg group compared with the other active treatment groups (see Table 2). The clinical significance of these small differences is unknown. After 4 weeks, effects on heart rate, plasma glucose, and plasma potassium were generally diminished compared with day 1 in all active treatment groups.

Table 2: Mean Changes from Baseline Heart Rate at 15 Minutes and Glucose and Potassium at 1 Hour after First Dose (Day 1) in Adults and Adolescents ≥12 Years Old

No other clinically relevant laboratory abnormalities related to administration of XOPENEX Inhalation Solution were observed in this study.

In the clinical trials, a slightly greater number of serious adverse events, discontinuations due to adverse events, and clinically significant ECG changes were reported in patients who received XOPENEX 1.25 mg compared with the other active treatment groups.

The following adverse reactions, considered potentially related to XOPENEX, occurred in less than 2% of the 292 subjects who received XOPENEX and more frequently than in patients who received placebo in any clinical trial:

Body as a Whole: chills, pain, chest pain

Cardiovascular System: ECG abnormal, ECG change, hypertension, hypotension, syncope

Digestive System: diarrhea, dry mouth, dry throat, dyspepsia, gastroenteritis, nausea

Hemic and Lymphatic System: lymphadenopathy

Musculoskeletal System: leg cramps, myalgia

Nervous System: anxiety, hyperesthesia of the hand, insomnia, paresthesia, tremor

Special Senses: eye itch

The following reactions, considered potentially related to XOPENEX, occurred in less than 2% of the treated subjects but at a frequency less than in patients who received placebo: asthma exacerbation, cough increased, wheezing, sweating, and vomiting.

Pediatric Patients 6 To 11 Years Of Age

Adverse reaction information concerning XOPENEX Inhalation Solution in pediatric patients is derived from one 3-week, multicenter, randomized, double-blind, active-, and placebo-controlled trial in 316 pediatric patients 6 to 11 years of age. Adverse reactions reported in ≥2% of patients in any treatment group and more frequently than in patients receiving placebo are listed in Table 3.

Table 3: Most Frequently Reported Adverse Reactions (≥2% in Any Treatment Group) and Those Reported More Frequently Than in Placebo during the Double-Blind Period (ITT Population, 6-11 Years Old)

Note: Subjects may have more than one adverse event per body system and preferred term.

Changes in heart rate, plasma glucose, and serum potassium are shown in Table 4. The clinical significance of these small differences is unknown.

Table 4: Mean Changes from Baseline Heart Rate at 30 Minutes and Glucose and Potassium at 1 Hour after First Dose (Day 1) and Last Dose (Day 21) in Children 6-11 Years Old

Post-Marketing Experience

In addition to the adverse reactions reported in clinical trials, the following adverse reactions have been observed in postapproval use of XOPENEX Inhalation Solution. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion due to their seriousness, their frequency of reporting, or their likely beta-mediated mechanism: angioedema, anaphylaxis, arrhythmias (including atrial fibrillation, supraventricular tachycardia, extrasystoles), asthma, chest pain, cough increased, dysphonia, dyspnea, gastrooesophageal reflux disease (GERD), metabolic acidosis, nausea, nervousness, rash, tachycardia, tremor, urticaria.

In addition, XOPENEX Inhalation Solution, like other sympathomimetic agents, can cause adverse reactions such as hypertension, angina, vertigo, central nervous system stimulation, sleeplessness, headache, and drying or irritation of the oropharynx.

Read the entire FDA prescribing information for Xopenex (Levalbuterol)

Xopenex Side Effects

Generic Name: levalbuterol

Medically reviewed by Drugs.com. Last updated on Jan 24, 2019.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

Note: This document contains side effect information about levalbuterol. Some of the dosage forms listed on this page may not apply to the brand name Xopenex.

In Summary

Common side effects of Xopenex include: rhinitis. Other side effects include: nervousness and tremor. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to levalbuterol: inhalation aerosol powder, inhalation solution

Along with its needed effects, levalbuterol (the active ingredient contained in Xopenex) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking levalbuterol:

More common

  • Fast heartbeat

Less common or rare

  • Chest pain or tightness
  • dizziness
  • feeling “faint”
  • lightheadedness
  • troubled breathing

Incidence not known

  • Cough
  • difficult or labored breathing
  • difficulty swallowing
  • extra heartbeats
  • fainting
  • fast, pounding, slow, or irregular heartbeat or pulse
  • hives, welts, itching, or rash
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • noisy breathing
  • redness of the skin
  • tightness in the chest
  • unusual tiredness or weakness

Get emergency help immediately if any of the following symptoms of overdose occur while taking levalbuterol:

Symptoms of overdose

  • Chest pain
  • dizziness
  • dry mouth
  • general feeling of discomfort or illness
  • headache
  • impaired consciousness
  • irregular or fast heartbeat
  • lightheadedness
  • nausea
  • nervousness
  • seizures
  • sleeplessness
  • sweating
  • tremor

Some side effects of levalbuterol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Accidental injury (in children 4 to 11 years of age)
  • anxiety
  • body aches or pain
  • chills
  • congestion
  • cough or hoarseness
  • dryness or soreness of the throat
  • fever
  • general aches and pains
  • headache
  • hoarseness
  • increased cough
  • leg cramps
  • loss of appetite
  • migraines or other headaches
  • muscle tightness
  • nervousness
  • runny or stuffy nose

Less common or rare

  • Abdominal or stomach pain
  • abnormal growth filled with fluid or semisolid material
  • blemishes on the skin
  • blood in the urine
  • bloody nose
  • burning, dry, or itching eyes
  • burning or stinging of the skin
  • cough producing mucus
  • cramps
  • diarrhea
  • difficulty having a bowel movement (stool)
  • discharge from the eye
  • dry mouth or throat
  • ear pain
  • excessive tearing
  • eye itch
  • heavy menstrual bleeding
  • muscle pain
  • night sweats
  • numbness or decreased sensitivity of the hand
  • pain
  • painful cold sores or blisters on the lips, nose, eyes, or genitals
  • pimples
  • redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
  • tingling sensation in the arms or legs
  • vaginal yeast infection
  • weight loss

For Healthcare Professionals

Applies to levalbuterol: inhalation aerosol, inhalation solution

General

This drug has been associated with paradoxical bronchospasm, cardiovascular effects, immediate hypersensitivity reactions, and hypokalemia.

Cardiovascular

ECG abnormal, ECG change, hypotension, and syncope occurred in less than 2%.

Common (1% to 10%): Hypertension, tachycardia

Frequency not reported: ECG abnormal, ECG change, hypotension, syncope

Postmarketing reports: Arrhythmias (including atrial fibrillation, supraventricular tachycardia, extrasystoles)

Musculoskeletal

Myalgia occurred in less than 2%.

Common (1% to 10%): Leg cramps

Frequency not reported: Myalgia

Metabolic

Metabolic acidosis occurred in less than 2%.

Frequency not reported: Changes in plasma glucose and serum potassium; metabolic acidosis

Nervous system

Central nervous system stimulation and hyperesthesia of the hand occurred in less than 2%.

Common (1% to 10%): Dizziness, migraine, tremor, nervousness

Frequency not reported: Central nervous system stimulation, hyperesthesia of the hand

Other

Common (1% to 10%): Pain, flu syndrome, accidental injury, asthenia, fever

Frequency not reported: Ear pain, herpes simplex, chills, cyst

Ear pain, herpes simplex, chills, and cyst occurred in less than 2%.

Gastrointestinal

Diarrhea, dry mouth, dry throat, nausea, gastroenteritis, vomiting, and constipation occurred in less than 2%.

Common (1% to 10%): Dyspepsia

Frequency not reported: Diarrhea, dry mouth, dry throat, nausea, gastroenteritis, vomiting, constipation

Postmarketing reports: Gastroesophageal reflux disease (GERD), nausea

Respiratory

Common (1% to 10%): Asthma, pharyngitis, rhinitis, bronchitis, sinusitis, turbinate edema, cough increased, viral infection

Frequency not reported: Epistaxis, lung disorder, asthma exacerbation, wheezing

Postmarketing reports: Chest pain, dysphonia, dyspnea

Viral infection, epistaxis, lung disorder, asthma exacerbation, and wheezing occurred in less than 2%.

Dermatologic

Frequency not reported: Acne, sweating

Postmarketing reports: Rash, urticaria

Acne and sweating occurred less than 2%.

Hypersensitivity

Common (1% to 10%): Allergic reactions

Postmarketing reports: Angioedema, anaphylaxis

Genitourinary

Frequency not reported: Hematuria, dysmenorrhea, vaginal moniliasis

Hematuria, dysmenorrhea, vaginal moniliasis occurred in less than 2%.

Immunologic

Frequency not reported: Lymphadenopathy

Lymphadenopathy occurred in less than 2%.

Ocular

Eye itch occurred in less than 2%.

Frequency not reported: Eye itch

Psychiatric

Insomnia occurred in less than 2%.

Common (1% to 10%): Anxiety

Frequency not reported: Insomnia

1. Nelson HS, Bensch G, Pleskow WW, DiSantostefano R, DeGraw S, Reasner DS, Rollins TE, Rubin PD “Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma.” J Allergy Clin Immunol 102 (1998): 943-52

2. “Product Information. Xopenex (levalbuterol).” Sepracor, Marlborough, MA.

3. Gawchik SM, Saccar CL, Noonan M, Reasner DS, DeGraw SS “The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients.” J Allerg Clin Immunol 103 (1999): 615-21

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Medical Disclaimer

More about Xopenex (levalbuterol)

  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Drug Interactions
  • Pricing & Coupons
  • En Español
  • 13 Reviews
  • Generic Availability
  • Drug class: adrenergic bronchodilators

Consumer resources

  • Xopenex
  • Xopenex (Advanced Reading)

Professional resources

  • Xopenex (FDA)

Other Formulations

  • Xopenex HFA
  • Xopenex Concentrate

Related treatment guides

  • Asthma
  • Asthma, acute
  • Asthma, Maintenance
  • COPD
  • COPD, Acute
  • COPD, Maintenance

Levalbuterol Oral Inhalation

Levalbuterol comes as a solution (liquid) to inhale by mouth using a nebulizer (machine that turns medication into a mist that can be inhaled), a concentrated solution to be mixed with normal saline and inhaled by mouth using a nebulizer, and as an aerosol to inhale by mouth using an inhaler. The solution for oral inhalation is usually used three times a day, once every 6 to 8 hours. The inhaler is usually used every 4 to 6 hours. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use levalbuterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

If your asthma symptoms become worse, if levalbuterol inhalation becomes less effective, or if you need more doses than usual of the asthma medications you use as needed, your condition may be getting worse. Do not use extra doses of levalbuterol. Call your doctor right away.

Levalbuterol controls symptoms of asthma and other lung diseases but does not cure these conditions. Continue to use levalbuterol even if you feel well. Do not stop using levalbuterol without talking to your doctor.

If you are using the inhaler, your medication will come in canisters. Each canister of levalbuterol aerosol is designed to provide 200 inhalations. After the labeled number of inhalations has been used, later inhalations may not contain the correct amount of medication. Dispose of the canister after you have used the labeled number of inhalations even if it still contains some liquid and continues to release a spray when it is pressed.

You will need to keep track of the number of inhalations you have used. You can divide the number of inhalations in your inhaler by the number of inhalations you use each day to find out how many days your inhaler will last. Do not float the canister in water to see if it still contains medication.

The inhaler that comes with levalbuterol aerosol is designed for use only with a canister of albuterol. Never use it to inhale any other medication, and do not use any other inhaler to inhale levalbuterol.

Be careful not to get levalbuterol inhalation into your eyes.

Do not use your levalbuterol inhaler when you are near a flame or source of heat. The inhaler may explode if it is exposed to very high temperatures.

Before you use levalbuterol for the first time, read the written instructions that come with the inhaler or nebulizer. Ask your doctor, pharmacist, or respiratory therapist to show you how to use it. Practice using the inhaler or nebulizer while he or she watches.

If your child will be using the inhaler, be sure that he or she knows how to use it. Watch your child each time he or she uses the inhaler to be sure that he or she is using it correctly.

To use the aerosol inhaler, follow these steps:

  1. Remove the protective dust cap from the end of the mouthpiece. Check the mouthpiece for dirt or other objects. Be sure that the canister is fully and firmly inserted in the mouthpiece.
  2. Shake the inhaler well.
  3. If you are using the inhaler for the first time or if you have not used the inhaler in more than 3 days, you will need to prime it. To prime the inhaler, press down on the canister four times to release four sprays into the air, away from your face. Be careful not to get albuterol in your eyes.
  4. Breathe out as completely as possible through your mouth.
  5. Hold the canister with the mouthpiece on the bottom, facing you, and the canister pointing upward. Place the open end of the mouthpiece into your mouth. Close your lips tightly around the mouthpiece.
  6. Breathe in slowly and deeply through the mouthpiece.At the same time, press down once on the container with your middle finger to spray the medication into your mouth.
  7. As soon as the medication is released, remove your finger from the canister and remove the mouthpiece from your mouth.
  8. Try to hold your breath for 10 seconds.
  9. If you were told to use two puffs, wait 1 minute and then repeat steps 4 to 8.
  10. Replace the protective cap on the inhaler.

To use the solution or the concentrated solution for oral inhalation, follow these steps:

  1. Open the foil pouch by tearing through the rough edge along the side of the pouch and remove one vial. Leave the rest of the vials inside the foil pouch to protect them from light. Look at the solution in the vial to be sure it is colorless. If it is not colorless, call your doctor or pharmacist and do not use the solution.
  2. Twist off the top of the vial and squeeze all of the liquid into the reservoir of your nebulizer. Do not add any other medications to the nebulizer because it may not be safe to mix them with levalbuterol. Use all nebulized medications separately unless your doctor specifically tells you to mix them.
  3. If you are using the concentrated solution, add the amount of normal saline that your doctor told you to use to the reservoir. Gently swirl the nebulizer to mix the normal saline and the concentrated solution.
  4. Connect the nebulizer reservoir to your mouthpiece or facemask.
  5. Connect the nebulizer to the compressor.
  6. Sit upright and place the mouthpiece in your mouth or put on the facemask.
  7. Turn on the compressor.
  8. Breathe calmly, deeply, and evenly until mist stops forming in the nebulizer. This should take between 5 and 15 minutes.
  9. Clean the nebulizer according to the manufacturer’s instructions.

Clean your inhaler or nebulizer regularly. Follow the manufacturer’s directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler or nebulizer. If you do not clean your inhaler properly, the inhaler may become blocked and may not spray medication. If this happens, follow the manufacturer’s directions for cleaning the inhaler and removing the blockage.

We have good news for the asthma community! A generic for Xopenex HFA, an inhalation aerosol used to treat bronchospasms, is available in pharmacies now!

The generic, levalbuterol, is a rescue inhaler used to immediately open the airways in your lungs for acute symptoms like shortness of breath, wheezing, or coughing. This is good news for your pocketbook!

What is levalbuterol used for?

Levalbuterol is indicted for the treatment or prevention of bronchospasm in patients 4 years of age or older, with reversible obstructive airway disease.

Levalbuterol is good for people who experience side effects from albuterol sulfate, which is a main ingredient in many alternative inhalers. So, if you experience heart palpitations, rapid heart rate, or shakiness from albuterol sulfate inhalers, levalbuterol may be a good option for you!

What strength(s) and dosage form(s) of levalbuterol will be available?

Levalbuterol will be available as an inhaler in the strength of 45mcg.

What are the most common side effects of levalbuterol?

Just like any medication, there are some side effects:

  • Accidental injury
  • Bronchitis
  • Dizziness
  • Pain
  • Sore throat
  • Runny nose
  • Vomiting
  • Palpitations
  • Chest pain
  • Fast heart rate
  • Tremors
  • Nervousness

Are there any similar inhalers to Xopenex HFA (levalbuterol)?

Yes! Xopenex HFA (levalbuterol) is considered a rescue inhaler, or a short-acting inhaler, and is mainly used to quickly treat an attack. There are a few other rescue inhalers, like:

  • ProAir HFA
  • ProAir RespiClick
  • Proventil HFA
  • Ventolin HFA
  • Combivent Respimat

Unfortunately, none of the inhalers mentioned above have generics, which makes them more expensive for consumers. However, ProAir HFA has an anticipated generic release date of December 2016.

What if I want to continue to use the brand, Xopenex HFA?

First off, if you would like to take brand Xopenex HFA, make sure your doctor handwrites ‘brand medically necessary’ on your prescription. This means that the pharmacy is not permitted to substitute and give you the generic product. If you prefer, you can also speak with your pharmacist and request that they fill the brand over the generic.

Unfortunately though, if you stick with the brand, you will be paying more out of pocket. If you are concerned about the cost, you can always call your pharmacist who will let you know the price ahead of time. This can save you both time and money.

Finally, keep in mind that your insurance company may not be willing to cover the cost of the brand medication, since the generic is now available. Call your prescription insurance company beforehand to ensure that it is covered.

  • Generic Name: levalbuterol inhalation (leh val BYOO ter all)
    Brand Names: Xopenex, Xopenex Concentrate, Xopenex HFA

    Medically reviewed by Drugs.com. Last updated on Feb 20, 2019.

    • Overview
    • Side Effects
    • Dosage
    • Professional
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    What is Xopenex?

    Xopenex (levalbuterol) is a short-acting bronchodilator that relaxes muscles in the airways and increases air flow to the lungs.

    Xopenex inhalation is used to treat or prevent bronchospasm in people with reversible obstructive airway disease.

    Xopenex solution is for use in adults and children 6 years of age and older. Xopenex HFA aerosol is for use in adults and children 4 years of age and older.

    Important information

    You should not use Xopenex if you are allergic to levalbuterol or albuterol (Accuneb, ProAir, Proventil, Ventolin).

    Before using Xopenex, tell your doctor if you have heart disease, high blood pressure, congestive heart failure, a heart rhythm disorder, a seizure disorder, diabetes, or overactive thyroid.

    Tell your doctor about all other medicines you use, especially heart or blood pressure medication, diuretics (water pills), antidepressants, or other inhaled bronchodilators.

    Talk with your doctor if any of your asthma medications do not seem to work as well in treating or preventing attacks. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor. An increased need for medication could be an early sign of a serious asthma attack.

    It is very important that you use nebulized Xopenex properly, so that the medicine gets into the lungs. Talk to your doctor about proper nebulizer use.

    Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of levalbuterol can be fatal.

    Before taking this medicine

    You should not use Xopenex if you are allergic to levalbuterol or albuterol (Accuneb, ProAir, Proventil, Ventolin).

    To make sure Xopenex is safe for you, tell your doctor if you have:

    • heart disease, high blood pressure, or congestive heart failure;

    • a seizure disorder;

    • diabetes; or

    • a thyroid disorder.

    It is not known whether Xopenex will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

    It is not known whether levalbuterol passes into breast milk or if it could affect a nursing baby. Tell your doctor if you are breast-feeding.

    A Xopenex inhaler should not be given to a child younger than 4 years old. Xopenex solution in a nebulizer should not be given to a child younger than 6 years old.

    How should I use Xopenex?

    Use Xopenex exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

    Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

    Any child using Xopenex should be supervised by an adult while using this medicine.

    Prime the Xopenex inhaler device before your first use. Pump 4 test sprays into the air, away from your face. Shake the inhaler for at least 5 seconds before each spray. Prime again whenever the inhaler has not been used in longer than 3 days.

    To use the Xopenex inhaler:

    • Shake the canister well just before each spray.

    • Uncap the mouthpiece of the inhaler. Breathe out fully. Put the mouthpiece into your mouth and close your lips. Breathe in slowly while pushing down on the canister. Hold your breath for 10 seconds, then breathe out slowly.

    • If you use more than one inhalation at a time, wait at least 1 minute before using the second inhalation and shake the inhaler again.

    • Keep your inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Shake out the excess water and allow the parts to air dry completely before putting the inhaler back together.

    Store the Xopenex inhaler with the mouthpiece down. Keep the inhaler at room temperature away from heat, sunlight, or freezing temperatures.

    If your inhaler has a dose number indicator on it, throw away the inhaler when the number displays “0” to show that all sprays have been used.

    Keep the inhaler canister away from open flame or high heat, such as in a car on a hot day. The canister may explode if it gets too hot. Do not puncture or burn an empty inhaler canister.

    Xopenex concentrate solution is given with a nebulizer. The concentrate must be mixed with a liquid (diluent) before using it. Ask your pharmacist about which diluent to use and where you can buy it. Be sure you understand how to properly mix the medicine and place it into the nebulizer.

    To use the Xopenex solution with a nebulizer:

    • Open the foil pouch and empty the medicine into the chamber of the nebulizer. Add the correct amount of diluent as directed by your doctor.

    • Attach the mouthpiece or face mask, then attach the drug chamber to the compressor.

    • Sit upright in a comfortable position. Place the mouthpiece into your mouth or put on the face mask, covering your nose and mouth. Turn on the compressor.

    • Breathe in slowly and evenly until no more mist is formed by the nebulizer and the drug chamber is empty.

    • Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

    Do not use the nebulizer solution if it does not appear clear and colorless.

    Store the Xopenex concentrate vials in the protective foil pouch at room temperature, away from moisture, heat, and light. Keep each vial in the foil pouch until you are ready to prepare a dose in the nebulizer.

    Each single-use plastic vial of Xopenex concentrate is for one use only. Throw away after one use, even if there is still some medicine left in it after inhaling your dose.

    Asthma is often treated with a combination of drugs. Use all medications as directed by your doctor. Do not change your doses or medication schedule without your doctor’s advice.

    Using too much Xopenex or using it too often can cause life-threatening side effects. Seek medical attention if you think your asthma medications are not working as well. An increased need for medication could be an early sign of a serious asthma attack.

    What happens if I miss a dose?

    Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

    Use this medicine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

    What happens if I overdose?

    Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of levalbuterol can be fatal.

    What should I avoid while using Xopenex?

    Avoid situations that may make your condition worse such as exercising in cold, dry air; smoking; breathing in dust; and exposure to allergens such as pet fur.

    Xopenex side effects

    Get emergency medical help if you have signs of an allergic reaction to Xopenex: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

    Call your doctor at once if you have:

    • wheezing, choking, or other breathing problems after using this medicine;

    • pounding heartbeats or fluttering in your chest;

    • worsening asthma symptoms; or

    • low potassium–leg cramps, constipation, irregular heartbeats, fluttering in your chest, extreme thirst, increased urination, numbness or tingling, muscle weakness or limp feeling.

    Common Xopenex side effects may include:

    • dizziness, nervousness, tremors;

    • runny nose, sore throat;

    • chest pain or tightness, irregular heartbeats;

    • pain; or

    • vomiting.

    This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

    What other drugs will affect Xopenex?

    Tell your doctor if you have used an MAO inhibitor in the past 14 days. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others.

    Tell your doctor about all your current medicines and any you start or stop using, especially:

    • any other inhaled medicines to treat asthma or COPD (chronic obstructive pulmonary disease);

    • an antidepressant;

    • a diuretic or “water pill”; or

    • medicine to treat a heart condition.

    This list is not complete. Other drugs may interact with levalbuterol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

    Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Xopenex only for the indication prescribed.

    Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

    Copyright 1996-2020 Cerner Multum, Inc. Version: 8.01.

    Medical Disclaimer

    Levalbuterol vs Albuterol: Main Differences and Similarities

    Levalbuterol and albuterol are inhaled medications that are prescribed to treat asthma and chronic obstructive pulmonary disease (COPD). More specifically, both medications treat acute symptoms such as bronchospasms, wheezing, shortness of breath, and coughing. They are known as rescue inhalers that are used when necessary.

    Both levalbuterol and albuterol are grouped in a class of medications called beta-2 agonists. They are essentially cousins due to their chemical similarities. Levalbuterol contains the active form of albuterol, known as R-albuterol, while albuterol contains a 50:50 mixture of R-albuterol and S-albuterol. S-albuterol is known to be an inactive form of albuterol that still contributes to side effects.

    Levalbuterol

    Levalbuterol is the generic name for Xopenex. It was FDA approved in 1999 to treat and prevent bronchospasms in patients 4 years of age and older. As the R-isomer of albuterol, it was developed to provide the same effects of albuterol with less side effects and less medication needed.

    Levalbuterol is available as a generic inhalation solution in strengths of 0.31 mg, 0.63 mg, and 1.25 mg per 3 mL. These solutions are administered via a nebulizer. The brand name Xopenex HFA inhalers deliver 45 micrograms of levalbuterol per puff.

    Albuterol

    Albuterol is the generic name for brand name inhalers such as Ventolin, Proair, and Proventil. It can treat and prevent acute asthma and COPD symptoms in individuals age 4 years and older. Like levalbuterol, albuterol can cause side effects such as tremors or fast heart rate. Albuterol may cause more of these side effects especially in those with heart conditions.

    Currently, there is no generic albuterol inhaler available. Brand name albuterol inhalers deliver 90 micrograms per puff. However, there are generic albuterol nebulizer solutions available. Oral tablets and syrups can also be used for some people.

    Levalbuterol vs Albuterol Side by Side Comparison

    Levalbuterol and albuterol are identical medications for acute symptoms of asthma and COPD. Despite their similarities, there are some differences to look at. Similarities and differences can be found below.

    Levalbuterol Albuterol
    Prescribed For
    • Asthma (acute symptoms)
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Asthma (acute symptoms)
    • Chronic Obstructive Pulmonary Disease (COPD)
    Drug Classification
    • Beta-2 Adrenergic Agonist
    • Beta-2 Adrenergic Agonist
    Manufacturer
    • Generic
    • Generic
    Common Side Effects
    • Bronchitis
    • Dizziness
    • Sore throat
    • Vomiting
    • Runny nose
    • Accidental injury
    • Palpitations
    • Chest pain
    • Tremors
    • Nervousness
    • Fast Heart Rate
    • Dizziness
    • Bronchitis
    • Sore throat
    • Fast Heart Rate
    • Chest pain
    • Palpitations
    • Tremors
    • Nervousness
    • Vomiting
    • Runny nose
    • Accidental injury
    Is there a generic?
    • Yes
    • Levalbuterol is the generic
    • Yes
    • Albuterol is the generic
    Is it covered by insurance?
    • Varies according to your provider
    • Varies according to your provider
    Dosage Forms
    • Inhalation solution
    • Inhalation powder
    • Inhalation solution
    • Inhalation powder
    • Oral tablet
    • Oral tablet, extended release
    • Oral syrup
    Average Cash Price
    • $167.25 per 25 vials (3ml) ((1.25mg/ml)
    • $15 (per 2.5 mg inhalation solution)
    SingleCare Discount Price
    • Levalbuterol Price
    • Albuterol Price
    Drug Interactions
    • Digoxin
    • Beta-blockers (atenolol, carvedilol, etc.)
    • Diuretics (hydrochlorothiazide, furosemide, etc.)
    • MAO inhibitors (selegiline, isocarboxazid, etc.)
    • Tricyclic antidepressants (amitriptyline, doxepin, etc.)
    • Digoxin
    • Beta-blockers (atenolol, carvedilol, etc.)
    • Diuretics (hydrochlorothiazide, furosemide, etc.)
    • MAO inhibitors (selegiline, isocarboxazid, etc.)
    • Tricyclic antidepressants (amitriptyline, doxepin, etc.)
    Can I use while planning pregnancy, pregnant, or breastfeeding?
    • Levalbuterol is in Pregnancy Category C. Consult a physician regarding taking levalbuterol while pregnant or breastfeeding.
    • Albuterol is in Pregnancy Category C. Consult a physician regarding taking albuterol while pregnant or breastfeeding.

    Summary

    If you experience bronchospasms from acute asthma or COPD, you may be using a beta-2 agonist as a rescue inhaler. Levalbuterol and albuterol are two options that can help treat symptoms as needed. Because they both contain the active R-isomer of albuterol, they are both effective options.

    Levalbuterol only contains the active R-isomer of albuterol, which may produce less side effects than the R/S mixture. Albuterol, unlike levalbuterol, comes in other forms such as oral syrups and tablets for different uses. Studies comparing the benefits of levalbuterol versus albuterol are still ongoing.

    It is important to discuss these options with your doctor. One treatment option may be preferred over the other depending on other conditions you may have. Administering the medication properly is another important aspect of these medications and should be explained by your healthcare provider.

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