bronchodilator saba

Levalbuterol

Xopenex

Route: inhaled (SVN) · inhaled (MDI)
Onset: 5–10 minutes
Duration: 5–8 hours

Mechanism of action

Pure R-enantiomer of racemic albuterol. Binds beta-2 receptors with greater affinity than the S-isomer. S-isomer (in racemic albuterol) may contribute to some adverse effects. Bronchodilation via cAMP-mediated smooth muscle relaxation.

Dosing

Adult: SVN: 0.63–1.25 mg q6–8h; acute: 1.25 mg q20 min × 3. MDI (Xopenex HFA): 2 puffs (45 mcg/puff) q4–6h
Pediatric: 6–11 years: 0.31 mg SVN q6–8h; ≥12 years: adult dosing

Indications

Acute bronchospasm (asthma, COPD)
Alternative to albuterol in patients with significant tachycardia

Contraindications

Hypersensitivity to levalbuterol or albuterol

Side effects

Less tachycardia than racemic albuterol (clinical benefit debated)
Tremor
Nervousness
Headache
Hypokalemia

Monitoring parameters

Heart rate
SpO2
Serum potassium
Pulmonary function response

Drug interactions

Beta-blockers (antagonism)
MAOIs (cardiovascular potentiation)
Loop diuretics (additive hypokalemia)

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