• Basic Info
• Top Questions
• Clinical Info
• Interactions

Uses

Bronchospasm in Asthma

Symptomatic management or prevention of bronchospasm in patients with reversible, obstructive airway disease (e.g., asthma).

Dosage and Administration

General

• Adjust dosage carefully according to individual requirements and response.
• During acute asthma exacerbations, most patients obtain optimum benefit, at least initially, when nebulized levalbuterol is used regularly rather than on demand.

Administration

Oral Inhalation

Administer by oral inhalation via a metered-dose inhaler or nebulization.

Oral Inhalation Aerosol

Administer inhalation aerosol only with the actuator provided by the manufacturer.

Shake the inhaler well before use.

Test-spray inhalation aerosol 4 times (away from the face) before first use and whenever the inhaler has not been used for >3 days.

Avoid spraying the aerosol into the eyes.

Exhale slowly and completely and place the mouthpiece of the inhaler well into the mouth with the lips closed around it. While inhaling slowly and deeply through the mouth,actuate the aerosol inhaler, withdraw the mouthpiece, hold the breath for 10 seconds if possible, and exhale.

Allow 1 minute to elapse between subsequent inhalations from the aerosol inhaler.

Clean the metered-dose inhaler by removing the metal canister and red mouthpiece (actuator) cap and running warm water through the plastic mouthpiece for 30 seconds at least once a week. Shake off excess water and allow the mouthpiece to air-dry thoroughly, such as overnight. Insert the metal canister into the mouthpiece and replace the mouthpiece cap. Do not attempt to clean the metal canister or allow the canister to become wet. If the inhaler is to be used before it is completely dry, shake off excess water, replace the canister, shake the inhaler well, and test the inhaler by spraying twice (away from the face) before administering the dose. After such use, the mouthpiece should be rewashed and allowed to air dry. Proper cleaning of the mouthpiece will prevent medication build-up and blockage. If actuator becomes blocked, remove medication build-up by washing the actuator.

Discard canister after the labeled number of actuations have been used.

Oral Inhalation Solution

For administration of levalbuterol hydrochloride solution for nebulization in single-use units via a nebulizer, open one single-use vial and squeeze the entire contents into the nebulizer reservoir.

Attach the reservoir to the mouthpiece or face mask and to the compressor according to the manufacturer’s instructions.

Place the mouthpiece of the nebulizer in the mouth or put on the nebulizer face mask and turn on the compressor. Breathe as calmly, deeply, and evenly as possible until the nebulizer stops producing mist (flow rate of nebulizer should be adjusted to provide the full dose over about 5–15 minutes).

Clean the nebulizer after use according to the manufacturer’s instructions.

Continue nebulization therapy as necessary to control recurrent bronchospasm. Optimum benefit is obtained when nebulization is used regularly.

Dosage

Available as levalbuterol hydrochloride and levalbuterol tartrate; dosages are expressed in terms of levalbuterol.

Pediatric Patients

Bronchospasm in Asthma

Oral Inhalation Aerosol

Children ≥4 years of age: Initially, 90 mcg every 4–6 hours. Some patients may find 45 mcg every 4 hours to be sufficient.

Oral Inhalation Solution

Children 6–11 years of age: Initially, 0.31 mg 3 times daily via nebulization. Children 6–11 years of age with more severe asthma or those not responding adequately to the 0.31-mg dose may benefit from a dosage of up to 0.63 mg 3 times daily. Some experts on asthma management recommend a dosage of 0.025 mg/kg (minimum 0.63 mg, maximum 1.25 mg) every 4-8 hours in children ≤12 years of age.

Adolescents ≥12 years of age: Initially, 0.63 mg 3 times daily (every 6–8 hours) via nebulization. Adolescents ≥12 years of age with more severe asthma or those not responding adequately to the 0.63-mg dose may benefit from a dosage of 1.25 mg 3 times daily.

Some experts on asthma management recommend a dosage of 0.63-2.5 mg/kg every 4-8 hours in adolescents >12 years of age.

Adults

Bronchospasm in Asthma

Oral Inhalation Aerosol

Initially, 90 mcg every 4–6 hours. Some patients may find 45 mcg every 4 hours to be sufficient.

Oral Inhalation Solution

Initially, 0.63 mg of levalbuterol 3 times daily (every 6–8 hours) via nebulization. Patients with more severe asthma or those not responding adequately to the 0.63-mg dose may benefit from a dosage of 1.25 mg 3 times daily.

Some experts on asthma management recommend a dosage of 0.63-2.5 mg/kg every 4-8 hours in adults.

Prescribing Limits

Pediatric Patients

Bronchospasm in Asthma

Oral Inhalation Aerosol

Children ≥4 years of age: Maximum 90 mcg every 4–6 hours.

Oral Inhalation Solution

Children 6-11 years of age: Maximum 0.63 mg 3 times daily.

Adolescents ≥12 years of age: Maximum 1.25 mg 3 times daily.

Adults

Bronchospasm in Asthma

Oral Inhalation Aerosol

Maximum 90 mcg every 4–6 hours.

Oral Inhalation Solution

Maximum 1.25 mg 3 times daily.

Special Populations

Dosage in Renal Impairment

Inhalation aerosol: Use caution when administering high dosages.

Geriatric Patients

Inhalation aerosol: Use caution and select initial dosage at the lower end of dosing range because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.

Inhalation solution: Increase dosage as tolerated with careful monitoring.