From the Guidelines
Levalbuterol (Xopenex) is used for the treatment of asthma exacerbations and as a bronchodilator.
Key Points
- Levalbuterol is the R-enantiomer of albuterol and has a similar effectiveness and side effect profile, but is more expensive 1.
- The standard dose for levalbuterol is 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed 1.
- Levalbuterol can be administered via nebulizer or metered-dose inhaler (MDI), with the MDI dose being equivalent to albuterol 1.
- Levalbuterol is equivalent to 1.25 mg of racemic albuterol for efficacy and side effects, with 0.63 mg of levalbuterol being equivalent to 1.25 mg of racemic albuterol 1.
- The use of levalbuterol has not been shown to have a significant advantage over albuterol in terms of efficacy or safety 1.
Administration and Dosage
- Nebulizer solution: 0.075 mg/kg (minimum dose 1.25 mg) every 20 minutes for 3 doses, then 0.075-0.15 mg/kg up to 5 mg every 1-4 hours as needed 1.
- MDI: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1.
Important Considerations
- Levalbuterol should only be used as needed for acute asthma symptoms, and not as a preventative measure 1.
- The use of levalbuterol in severe asthma exacerbations has not been extensively studied, and its effectiveness in this setting is unclear 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Xopenex (levalbuterol HCl) Inhalation Solution is indicated for the treatment or prevention of bronchospasm in adults, adolescents, and children 6 years of age and older with reversible obstructive airway disease.
- Levalbuterol (Xopenex) is used for the treatment or prevention of bronchospasm in patients with reversible obstructive airway disease.
- The approved age range for use is 6 years of age and older, including adults and adolescents 2.
From the Research
Uses of Levalbuterol (Xopenex)
- Levalbuterol, also known as Xopenex, is used to treat patients with asthma and chronic obstructive lung disease (COPD) 3, 4, 5, 6, 7
- It is a single-isomer formulation of the beta2-adrenergic agonist albuterol, which provides greater bronchodilation than racemic albuterol 3, 5
- Levalbuterol is used as a quick-relief bronchodilator medication to control intermittent symptoms of cough, wheeze, and bronchoconstriction, as well as acute exacerbations 3
- It is also used in the maintenance and treatment of associated symptoms of COPD, including shortness of breath 3
Comparison with Racemic Albuterol
- Levalbuterol has been shown to provide comparable bronchodilation to racemic albuterol at lower doses, with the potential for reduced beta-mediated adverse effects in adults and children 3, 5
- Some studies have suggested that levalbuterol may be more effective than racemic albuterol in patients with moderate to severe asthma, especially with racemic albuterol overuse 4
- However, other studies have found that clinical outcomes are similar between levalbuterol and albuterol, with some differences in treatment costs and hospital length of stay 6, 7
Clinical Outcomes and Treatment Costs
- Studies have compared the clinical outcomes and treatment costs of levalbuterol versus albuterol in hospitalized adults with COPD or asthma, with mixed results 6, 7
- One study found that levalbuterol was associated with a length-of-stay savings of 0.91 days, a total cost savings of $556, and a decrease in the likelihood of hospital readmission of 67% 6
- Another study found that mean total treatment costs per patient were significantly greater with the use of levalbuterol, and hospital length of stay was significantly greater in the levalbuterol group 7