Levalbuterol

Indications

Levalbuterol is used for: Bronchospasm, Asthma Exacerbation

Adult Dose

Adult Bronchospasm Nebulizer solution: 0.63-1.25 mg 3 times daily q6-8hr Aerosol: 90 mcg (2 actuations of metered-dose inhaler) q4-6hr Asthma Exacerbation Nebulizer solution: 1.25-2.5 mg q20min for 3 doses, then 1.25-5 mg q1-4hr PRN Aerosol: 180-360 mcg (4-8 actuations of metered-dose inhaler) q20min for ?4 hr, then q1-4hr PRN

Child Dose

Child Bronchospasm Nebulizer solution <5 years: 0.31-1.25 mg q4-6hr PRN 5-12 years: 0.31 mg q8hr; not to exceed 0.63 mg q8hr PRN >12 years: 0.63-1.25 mg q8hr PRN Aerosol <4 years: Safety and efficacy not established >4 years: 90 mcg (2 actuations of metered-dose inhaler) q4-6hr PRN Asthma Exacerbation Nebulizer solution <12 years: 0.075 mg/kg (?1.25 mg) q20min for 3 doses, then 0.075-0.15 mg/kg (?5 mg) q1-4hr PRN >12 years: 1.25-2.5 mg q20min for 3 doses, then 1.25-5 mg q1-4hr PRN Aerosol <4 years: Safety and efficacy not established >4 years: 180-360 mcg (4-8 actuations of metered-dose inhaler) q20min for 3 doses, then q1-4hr PRN

Renal Dose

Administration

Contra Indications

Hypersensitivity to levalbuterol or racemic albuterol

Precautions

Cardiovascular disorder (eg, arrhythmias, hypertension, coronary insufficiency) Risk of paradoxical bronchospasm Has higher affinity for beta1- and beta2-adrenergic receptors than racemic albuterol has Risk of hypersensitivity reactions Use with caution in diabetes mellitus (beta2 agonists may increase glucose) Risk of hypokalemia (usually transient) Lactation There are no available data on presence of levalbuterol in human milk, effects on breastfed child, or effects on milk production Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from therapy or from underlying maternal condition

Pregnancy-Lactation

Interactions

Adverse Effects

Side effects of Levalbuterol : >10% Headache (8-12%) Viral infection (7-12%) Rhinitis (3-11%) 1-10% Pharyngitis (3-10%) Tremor (7%) Sinusitis (1-4%) Flu (1-4%) Dyspepsia (1-3%) Leg cramps (<3%) Generalized pain (2.8%) Nasal edema (2.8%) Nervousness (2.8%) Tachycardia (2.8%) Postmarketing Reports Dysphonia Gastroesophageal reflux disease, nausea Angioedema, anaphylaxis, rash, urticaria Chest pain, tachycardia, arrhythmias (including atrial fibrillation, supraventricular tachycardia, extrasystoles) Asthma, increased cough, dyspnea, dysphonia Metabolic acidosis Nervousness, tremor

Mechanism of Action

Beta2-receptor agonist with some beta1 activity; relaxes bronchial smooth muscle