From the Guidelines
Managing tachycardia in patients using Xopenex (levalbuterol) requires careful monitoring and appropriate interventions, with a focus on adjusting the dose or discontinuing the medication if necessary, as recommended by the most recent guidelines 1. When assessing tachycardia in patients using Xopenex, it's essential to determine the severity of the condition and its relation to the medication. Xopenex is a beta-2 agonist bronchodilator that can cause heart rate increases as a side effect.
- For mild tachycardia (heart rate <120 bpm) without symptoms, continue monitoring while ensuring proper inhaler technique and dosing (typically 0.63 mg via nebulizer every 6-8 hours, or 1-2 puffs of the inhaler every 4-6 hours).
- For moderate tachycardia (heart rate 120-150 bpm), consider reducing the Xopenex dose by 50% if clinically appropriate, as suggested by general principles of managing medication side effects.
- For severe tachycardia (>150 bpm) or any tachycardia with symptoms like chest pain or dizziness, temporarily discontinue Xopenex and seek immediate medical attention, following the guidelines for managing acute tachycardia 1. Ensure adequate hydration and consider checking electrolytes, particularly potassium levels, as hypokalemia can worsen tachycardia. In patients with underlying cardiac conditions, more cautious dosing and closer monitoring are warranted. The tachycardia occurs because beta-2 receptors are present in cardiac tissue, and although Xopenex is more selective for pulmonary beta-2 receptors than older medications like albuterol, cardiac effects can still occur, especially at higher doses. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, intravenous beta blockers, diltiazem, or verapamil may be useful for acute treatment in hemodynamically stable patients, but this should be considered in the context of the patient's overall condition and the potential for Xopenex to contribute to tachycardia.
From the FDA Drug Label
Tachycardia 0 2.7 2.8 2.7 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 1.25 mg and racemic albuterol 2. 5 mg groups Changes in heart rate and plasma glucose were slightly less in the Xopenex 0. 63 mg group compared with the other active treatment groups Table 4: 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 Treatment Mean Changes (day 1) Heart Rate (bpm) Glucose (mg/dL) Potassium (mEq/L) Xopenex 0.63 mg, n=72 2.4 4.6 –0.2 Xopenex 1.25 mg, n=73 6.9 10.3 –0.3
To manage tachycardia in patients using Xopenex (levalbuterol), consider the following:
- Monitor heart rate: Closely monitor the patient's heart rate, especially after administration of Xopenex.
- Dose adjustment: Consider adjusting the dose of Xopenex, as the incidence of tachycardia was slightly less in the Xopenex 0.63 mg group compared to the other active treatment groups 2.
- Clinical significance: The clinical significance of the small differences in heart rate changes between the Xopenex groups is unknown, and therefore, caution should be exercised when managing tachycardia in these patients. Key points to consider:
- Tachycardia was reported in 2.7% of patients receiving Xopenex 1.25 mg and 2.8% of patients receiving Xopenex 0.63 mg.
- Heart rate changes were clinically comparable between Xopenex 1.25 mg and racemic albuterol 2.5 mg groups.
- Dose-dependent effects: The effects of Xopenex on heart rate may be dose-dependent, with the 0.63 mg group showing slightly less increase in heart rate compared to the other active treatment groups 2.
From the Research
Managing Tachycardia in Patients Using Xopenex (Levalbuterol)
- Tachycardia is a potential side effect of levalbuterol, a medication used to treat asthma and chronic obstructive pulmonary disease (COPD) 3.
- Levalbuterol is a beta2-adrenergic agonist that can cause increased heart rate and palpitations 3.
- Studies have shown that levalbuterol can be administered at lower doses than racemic albuterol to provide comparable bronchodilation, with the potential for reduced beta-mediated adverse effects, including tachycardia 3.
Comparison of Levalbuterol and Racemic Albuterol
- A study comparing levalbuterol and racemic albuterol in hospitalized patients with acute asthma or COPD found that levalbuterol required significantly fewer median total nebulizations and scheduled nebulizations compared to racemic albuterol 4.
- However, the study also found that beta-mediated adverse effects, including tachycardia, were significantly greater with levalbuterol versus racemic albuterol 4.
Cardioselective Beta-Blockers and Tachycardia
- Cardioselective beta-blockers have been shown to be effective in reducing the risk of tachycardia and other cardiac arrhythmias in patients with reversible airway disease 5.
- A study found that cardioselective beta-blockers given in mild to moderate reversible airway disease or COPD did not produce adverse respiratory effects in the short term 5.
Clinical Outcomes and Treatment Cost Comparison
- A study comparing clinical outcomes and costs of levalbuterol versus albuterol therapy for exacerbations of asthma or COPD found that the mean change from baseline in heart rate did not differ significantly between groups 6.
- However, the study also found that mean total treatment costs per patient were significantly greater with the use of levalbuterol compared to albuterol 6.