Names and pronunciation
(lev-al-byoo′ter-ole) Xopenex, Xopenex HFA
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Drug reference
(lev-al-byoo′ter-ole) Xopenex, Xopenex HFA
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Func. class.: Bronchodilator, adrener- gic β2-agonist
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ACTION: Causes bronchodilation by action on β2 (pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscle; produces bronchodilation, CNS, cardiac stimulation as well as increased diuresis and gastric acid secretion
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USES: Treatment or prevention of bronchospasm (reversible obstructive airway disease), asthma
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CONTRAINDICATIONS: Hyper- sensitivity to sympathomimetics, this product, albuterol Precautions: Pregnancy, breastfeeding, hyperthyroidism, diabetes mellitus, hypertension, prostatic hypertrophy, angle- closure glaucoma, seizures, renal dis- ease, QT prolongation, tachydysrhyth- mias, severe cardiac disease, hypokale- mia, children
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SIDE EFFECTS CNS: Tremors, anxiety, insomnia, headache, dizziness CV: Tachycardia EENT: Dry nose, irritation of nose and throat, rhinitis GI: Diarrhea, dyspepsia INTEG: Rash META: Hypokalemia, hyperglycemia MS: Muscle cramps RESP: Cough, dyspnea, bronchospasm MISC: Flu-like symptoms
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INTERACTIONS Increase: hypokalemia—loop/thiazide diuretics Increase: action of aerosol bronchodilators Increase: levalbuterol action—tricyclics, MAOIs, other adrenergics; avoid use within 2 wk of MAOIs Decrease: levalbuterol action—other β-blockers; severe bronchospasm may occur Decrease: digoxin effect—digoxin Drug/Herb Increase: stimulation—black/green tea, coffee, cola nut, guarana, yerba maté
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TREATMENT OF OVERDOSE: Administer a β1-adrenergic blocker
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DOSAGE AND ROUTES Prevention of Bronchospasm in reversible obstructive airway disease • Adult/child ≥12 yr: INH 0.63 mg tid q6-8hr by nebulization, may increase 1.25 mg q8hr • Adult/adolescent/child >4 yr: (HFA, metered dose) 90 mcg (2INH) q4-6hr • Child 6-11 yr: INH 0.31 mg tid by nebulization, max 0.63 mg tid
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Available forms: Sol, inh pediatric 0.31 mg/3 mL; 0.63 mg/3 mL; 1.25 mg/3 mL; 1.25 mg/0.5 mL; 45 mcg per actuation (HFA)
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Administer: • Every 6-8 hr; wait ≥1 min between in- halation of aerosols Inhalation route • Keep unopened until ready for use; af- ter opening, use within 2 wk; protect from light, heat • Shake well before use; use a spacer device; prime with 4 test sprays in new canister or when not used for >3 days Nebulizer route • Dilute concentrated (1.25 mg/0.5 mL) with normal sterile saline before use
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Assess: • Respiratory function: vital capacity, pulse oximetry, forced expiratory vol- ume, ABGs, lung sounds, heart rate and rhythm (baseline); character of sputum: color, consistency, amount • Cardiac status: palpitations, increase/ decrease in B/P, dysrhythmias • For evidence of allergic reactions, paradoxic bronchospasm, anaphylaxis, angioedema; if these occur, hold dose, notify prescriber at once; bronchospasm may occur with new canister or vial • Pregnancy/breastfeeding: avoid use in pregnancy, do not breastfeed, reaction is unknown
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Evaluate: • Therapeutic response: absence of dys- pnea, wheezing after 1 hr; improved air- way exchange, ABGs/VBGs
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to use OTC medications because excess stimulation may occur • To avoid getting aerosol in eyes be- cause blurring may result • To avoid smoking, smoke-filled rooms, persons with respiratory infections • That paradoxic bronchospasm may oc cur; to stop product immediately, contact prescriber • To limit caffeine products such as chocolate, coffee, tea, colas, and herbs such as cola nut, guarana, yerba maté • Inhaler: to shake well before using and to breathe normally while using and mist goes into reservoir; to spray 4 times be- fore first use or if not used for 3 days; to wash at least weekly • To use this product first if using other inhalers; to wait 5 min or more between products; to rinse mouth with water after each dose to prevent dry mouth • Diabetes: that diabetes may be exacer- bated; that medications for diabetes may need to be adjusted
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PHARMACOKINETICS Metabolized in the liver and tissues; crosses placenta, breast milk, blood- brain barrier; half-life 3.3-4 hr INH sol: Onset 10-17 min, peak 11⁄2 hr, duration 5-6 hr; INH aerosol: onset 4.5- 10.2 min, peak 76-78 min, duration ≤6 hr
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• Adult/child ≥12 yr: INH 0.63 mg tid q6-8hr by nebulization, may increase 1.25 mg q8hr
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• Adult/adolescent/child >4 yr: (HFA, metered dose) 90 mcg (2INH) q4-6hr
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