Levalbuterol HCl

A to Z Drug Facts

 Actions Produces bronchodilation by relaxing bronchial smooth muscles via beta₂-adrenergic receptor stimulation.

 Indications Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease.

 Contraindications Hypersensitivity to levalbuterol or racemic albuterol.

 Route/Dosage

ADULTS AND CHILDREN ³ 12 yr: Inhalation solution Usual starting dose is 0.63 mg tid (q 6 to 8 hr) by nebulization. Patients with more severe asthma or patients who do not respond adequately to the 0.63 mg dose may benefit from 1.25 mg tid.

 Interactions

Beta Blockers (eg, Propranolol): Severe bronchospasms may be produced in asthmatic patients taking levalbuterol. Digoxin: Plasma digoxin levels may be decreased. Diuretics (eg, Loop [eg, Furosemide] and Thiazide [Hydrochlorothiazide]): ECG changes and hypokalemia associated with diuretic therapy may be worsened by levalbuterol administration. MAOIs (eg, Phenelzine), Tricyclic Antidepressants (eg, Amitriptyline): The action of levalbuterol on the vascular system may be potentiated.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Tachycardia; migraine; abnormal ECG and ECG changes; hypertension; hypotension; syncope. CNS: Dizziness; nervousness; tremor; anxiety; hypesthesia of the hand; insomnia; paresthesia. EENT: Rhinitis; sinusitis; turbinate edema; dry throat; eye itch. GI: Dyspepsia; diarrhea; dry mouth; gastroenteritis; nausea. RESPIRATORY: Increased cough; viral infection. OTHER: Flu-like symptoms; accidental injury; pain; leg cramps; lymphadenopathy; myalgia.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Safety and efficacy not established in children < 12 yr. Cardiovascular Effects: Clinically important cardiovascular effects, as measured by pulse rate and BP may occur; use with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypotension. CNS Effects: CNS stimulation may occur; use with caution in patients with a history of seizures or hyperthyroidism. Diabetes Mellitus: Use with caution. Bronchospasm: Life-threatening paradoxical bronchospasm may occur. Deterioration of Asthma: A dosage requirement increase may indicate destabilization of asthma, requiring reevaluation of the treatment regimen.

 Administration/Storage

• This medication is available only as an inhalation solution.
• Administer only via nebulizer. Not for injection or oral use.
• Medication requires no dilution before administration and is added directly into the nebulizer reservoir.
• Administer immediately or discard once vial has been opened.
• Administer prescribed dose q 6 to 8 hr as needed.
• Find location where patient can sit comfortably for 10 to 15 min. Have patient take slow, deep breaths and, if possible, hold breath for 10 sec before slowly exhaling. Continue until nebulizer reservoir is empty.
• Discard solution if not colorless.
• Discard any unused solution.
• Do not mix with other nebulized medications unless ordered by health care provider.
• Store unused vials in protective foil pouch between 59° and 77°F. Use vials within 2 wk once the foil pouch has been opened. Protect vials from light and excessive heat.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of coronary artery disease, arrhythmias, hypertension, seizures, hyperthyroidism, diabetes, or unusual sensitivity to sympathomimetic amines.
• Ensure that baseline pulmonary function tests have been completed.
• Note frequency and severity of asthma attacks.
• Monitor pulse, BP, RR, and lung sounds before and after treatment. Notify health care provider of unexpected or unusual findings.
• Monitor patient’s respiratory status during each treatment. If bronchospasm worsens during a treatment, discontinue the treatment and notify health care provider immediately.
• Notify health care provider if patient needs treatments on an increasingly frequent basis.
• Monitor patient for GI, CNS, CV, and general body side effects. Notify health care provider if noted and significant.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Advise patient to review illustrated “Patient’s Instructions for Use.” Ensure that patient can prepare, use, and clean the nebulizer without difficulty.
• Instruct patient to not mix nebulizer medications unless advised by health care provider.
• Instruct patient to use nebulizer solution immediately after opening. If solution is not used immediately advise patient to discard the solution.
• Advise patient to discard any unused nebulizer solution.
• Instruct patient to not exceed prescribed dose. Advise patient to contact their health care provider if the medication no longer seems to control asthma symptoms or if increasing doses of the medicine are needed. These may indicate worsening asthma.
• Advise patient using > 1 inhaled medication to use medication first if needed. Take inhaled corticosteroids or other inhaled controller medications last.
• Advise patient that if asthma symptoms worsen immediately after using this medication to stop and inform health care provider.
• Inform patient that levalbuterol is not a substitute for inhaled or oral corticosteroids and to not stop or reduce the dose of corticosteroid medication.
• Advise women to contact their health care provider if they become pregnant, plan on becoming pregnant, or are breastfeeding.
• Caution patient to not take any prescription or otc medications or dietary supplements unless advised by health care provider.
• Advise patient that follow-up visits will be required to monitor therapy and to keep appointments.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts