Does levobuterol (Levalbuterol) cause tachycardia?

From the Guidelines

Levobuterol, also known as levalbuterol, can cause tachycardia as a potential adverse effect. This medication is a beta-2 adrenergic agonist bronchodilator used to treat asthma by relaxing airway muscles. According to the expert panel report 3 (epr-3): guidelines for the diagnosis and management of asthma-summary report 2007 1, inhaled short-acting beta-2 agonists (SABAs), such as levalbuterol, can cause tachycardia, skeletal muscle tremor, hypokalemia, increased lactic acid, headache, and hyperglycemia. Some key points to consider when using levobuterol include:

• The medication is not approved for children under 4 years of age
• The recommended dose for children between 5-11 years of age is 45 mcg/puff
• The medication can be used every 4-6 hours before exercise
• Patients should be monitored for signs of tachycardia, particularly when first starting treatment or when using higher doses. It is essential for patients to follow the prescribed dosage and to contact their healthcare provider if they experience any persistent or severe side effects, such as rapid heartbeat, palpitations, chest pain, or dizziness, as dosage adjustment or medication change may be necessary 1.

From the FDA Drug Label

Common adverse effects include palpitations, chest pain, rapid heart rate, headache, dizziness, and tremor or nervousness. The expected symptoms with overdosage are those of excessive beta-adrenergic receptor stimulation and/or occurrence or exaggeration of any of the symptoms listed under ADVERSE REACTIONS, e.g., seizures, angina, hypertension or hypotension, tachycardia with rates up to 200 beats/min., arrhythmias, nervousness, headache, tremor, dry mouth, palpitation, nausea, dizziness, fatigue, malaise, and sleeplessness. Yes, levobuteerol can cause tachycardia, as it is listed as a common adverse effect and a potential symptom of overdosage 2 2.

From the Research

Tachycardia and Levobuteerol

• Tachycardia is a potential side effect of beta-2 receptor agonists, such as levobuteerol and albuterol 3.
• Studies have shown that levobuteerol, the "pure" R-isomer, may decrease cardiac side effects compared to racemic albuterol, which contains both the S-isomer and the R-isomer 3.
• However, there is limited data on the safety of levobuteerol in patients with baseline tachyarrhythmias, and further research is needed to determine the most efficacious and safe β-2 receptor agonists in this patient population 3.

Comparison of Heart Rate Changes

• A study comparing heart rate changes associated with levalbuterol and racemic albuterol in pediatric cardiology patients found that both drugs were associated with increased heart rate, with a mean increase of 6.8 beats/min for racemic albuterol and 6.2 beats/min for levalbuterol 4.
• The study found that the increase in heart rate was equivalent for both drugs in patients with congenital heart disease, but equivalence was not established in other analyzed subgroups due to insufficient sample sizes 4.

Clinical Studies

• Clinical studies have shown that levalbuterol and racemic albuterol can produce effects that favor asthma remediation, including corticosteroid amplification and reduction of inflammatory mediators 5.
• However, the studies suggest that there is no overwhelming superiority of levalbuterol over racemic albuterol, although levalbuterol's effects may be greatest in moderate to severe asthma patients, especially with racemic albuterol overuse 5.
• A case report of paradoxical bronchoconstriction in a patient treated with levalbuterol highlights the potential for adverse effects with this drug 6.