Xopenex (Levalbuterol) Dosing Guidelines
The recommended dosing for Xopenex (levalbuterol) inhalation solution is 0.63 mg administered three times a day, every 6 to 8 hours by nebulization for adults and adolescents 12 years and older. 1
Age-Based Dosing Recommendations
- For children 6-11 years old: 0.31 mg administered three times a day by nebulization, not exceeding 0.63 mg three times a day 1
- For adults and adolescents ≥12 years old: 0.63 mg administered three times a day, every 6 to 8 hours by nebulization 1
- For adults with more severe asthma or inadequate response to 0.63 mg: May benefit from a higher dose of 1.25 mg three times a day 1
Administration Guidelines
- Xopenex should be administered via nebulization using appropriate equipment (safety and efficacy established with PARI LC Jet™ and PARI LC Plus™ nebulizers) 1
- The medication should not be mixed with other drugs in the nebulizer as compatibility has not been established 1
- Regular use (four or more times daily) does not affect potency but may reduce duration of action 2
Clinical Considerations
- Short-acting beta2 agonists like levalbuterol have an onset of action of five minutes or less, peak within 30-60 minutes, and have a duration of action of four to six hours 2
- Increasing use of Xopenex more than two days per week for symptom relief (not for prevention of exercise-induced bronchospasm) may indicate worsening asthma requiring reassessment of therapy 1
- Patients receiving the highest dose (1.25 mg) should be monitored closely for adverse systemic effects 1
Comparison to Racemic Albuterol
- Levalbuterol is the R-enantiomer of albuterol with effectiveness and side effect profiles similar to racemic albuterol 2
- Standard dosing for both levalbuterol and albuterol inhalers is two puffs every two to six hours as needed 2
- In hospitalized patients, levalbuterol administered every 6-8 hours required fewer total nebulizations compared to racemic albuterol given every 1-4 hours, with similar clinical outcomes 3
Monitoring and Side Effects
- Common dose-dependent side effects include tremor, anxiety, heart pounding, and tachycardia 2
- Beta-mediated changes in heart rate, potassium, and glucose are dose-dependent 4
- If a previously effective dosage regimen fails to provide expected relief, seek medical advice immediately as this may indicate worsening asthma 1
Special Considerations
- For patients with COPD, single-dose studies show similar effectiveness between levalbuterol and conventional nebulized bronchodilators 5
- In pediatric patients, levalbuterol causes significantly greater increase in FEV1 than placebo, with effects comparable to or better than racemic albuterol 4
Remember that if symptoms persist or worsen despite appropriate dosing, this indicates poor asthma control and may require reassessment of the overall treatment plan.