Levalbuterol | Side Effects, Dosage, Uses & More

Generic Name:

levalbuterol, Inhalation Solution

All Brands

  • Xopenex
  • Xopenex Pediatric (Discontinued)
A discontinued drug is a drug that has been taken off the market due to safety issues, shortage of raw materials, or low market demand.
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Highlights for levalbuterol

Inhalation Solution
1

Levalbuterol is used to treat or prevent spasms in the airways (bronchi) of your lungs caused by asthma. This drug is a rescue medication that’s used to treat acute asthma attacks.

2

This drug comes in the form of an inhaler and as a regular or concentrated solution for inhalation through a nebulizer.

3

Levalbuterol is available as a brand-name drug called Xopenex HFA (inhaler) and Xopenex (solution for inhalation through a nebulizer). It’s available as a generic drug only for the solution for inhalation through a nebulizer form.

4

More common side effects of taking this drug include increased heart rate and chest pain, blood pressure changes, dizziness, headache, shakiness, or nervousness. If you have these side effects, your doctor may change your drug.

5

You shouldn’t increase your dose or use levalbuterol more often than your doctor prescribes. Very high doses can be fatal (cause death). If you need more levalbuterol than usual, feel like it’s not helping to decrease symptoms, or if your symptoms get worse, let your doctor know right away. Your asthma may be getting worse and you may need other drugs, such as corticosteroids.

IMPORTANT INFORMATION

Taking more than prescribed

You shouldn’t increase your dose or use this drug more often than your doctor prescribes. Very high doses can be fatal (cause death). If you need more of this drug than usual, feel like it’s not helping to decrease symptoms, or if your symptoms get worse, let your doctor know right away. Your asthma may be getting worse and you may need other medicines, such as corticosteroids.

Lung spasms

Even though this drug is used to treat spasms in your lungs, it can also cause the spasms in some people. This is more likely to happen with the first use of a new container. If you have more trouble breathing when you use this drug, tell your doctor. They may switch you to a different asthma drug.

Heart effects

This drug may increase your heart rate and blood pressure. It may also change the results of your electrocardiogram test of the heart. If this occurs, your doctor may monitor you more closely and adjust your treatment if you have significant changes. Talk to your doctor about whether this drug is safe for you if you have a weak heart (coronary insufficiency), rhythm changes in the heart (arrhythmias), or high blood pressure.

Drug features

This drug is a prescription drug. It’s available in these forms: inhaler and regular or concentrated solutions for inhalation through a nebulizer.

This drug is available as a generic drug only for the solution for inhalation through a nebulizer form. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version. Talk to your doctor to see if the generic version will work for you.

This drug may be used as part of a combination therapy. This means you may need to take it with other medications.

Why it's used

This drug is used to treat or prevent spasms in the airways (bronchi) of your lungs caused by asthma.  

This drug is used to treat acute asthma attacks. It doesn’t control asthma long-term. It shouldn’t be used as a substitute for an asthma controller medication, such as a corticosteroid.

How it works

This drug belongs to a class of drugs called beta2-adrenergic agonists (beta-agonists). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

More Details

How it works

This drug belongs to a class of drugs called beta2-adrenergic agonists (beta-agonists). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

This drug works to relax the smooth muscles in the airways (bronchi) of your lungs. This stops spasms and helps you breathe easier.

Bronchospasm is a sudden, prolonged involuntary contraction of the smooth muscles in the bronchi of your lung. It happens in response to irritation, infections, or allergies. Bronchospasms narrow the airway and make it hard to breath. They may cause a dry cough with wheezing (whistling sound when having trouble breathing).

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levalbuterol Side Effects

Inhalation Solution

More Common Side Effects

  • Some of the more common side effects that can occur with use of levalbuterol solutions for nebulization include:

    • palpitations (feeling like your heart skipped or added a beat )
    • chest pain
    • tachycardia (fast heart rate)
    • headache
    • dizziness
    • shakiness (tremor)
    • nervousness
    • heart changes on an electrocardiogram test
    • low blood levels of potassium. Symptoms can include:
      • irregular heartbeat
      • muscle weakness or spasms
      • tingling
    • high blood sugar levels. Symptoms can include:
      • feeling more thirsty than normal
      • feeling more hungry than normal
      • urinating more than normal
  • Some of the more common side effects that can occur with the use of levalbuterol HFA inhalers include: 

    • dizziness
    • chest pain
    • inflammation of the air passages between your nose and your lungs (bronchitis)
    • sore throat (pharyngitis)
    • runny nose
    • vomiting
    • shakiness (tremor)

If these effects are mild, they may go away within a few hours. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Chest pain with a very fast heart rate or pulse

  • More trouble breathing

  • Allergic reaction. Symptoms can include:

    • itching
    • swelling of your face or throat
    • rash
    • trouble breathing because of spasms in the airways of your lungs
Pharmacist's Advice
Healthline Pharmacist Editorial Team

If you need more of this drug than usual, feel like it’s not helping to decrease symptoms, or if your symptoms get worse, let your doctor know right away. Your asthma may be getting worse and you may need other drugs, such as corticosteroids.

This drug doesn’t cause drowsiness. 

After taking this drug, you may have palpitations (feeling like your heart skipped or added a beat), tachycardia (fast heart rate), and high blood sugar levels.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
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levalbuterol May Interact with Other Medications

Inhalation Solution

Levalbuterol can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor or pharmacist about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Medications that might interact with this drug

Other asthma drugs

You shouldn’t take certain other drugs that open the airways to help you breathe when you’re using levalbuterol. They can increase effects of levalbuterol and cause side effects in the heart. Examples of these drugs include: 

  • short-acting sympathomimetic bronchodilators, such as:
    •  albuterol

Depression drugs

Ask your doctor whether this drug is safe for you if you’re taking drugs used to treat depression or have stopped these drugs in the last 2 weeks. These drugs may increase the action of levalbuterol on the heart and blood vessels. Your doctor may give you other asthma drugs if you’re taking depression medications. Examples of these drugs include:

  • monoamine oxidase inhibitors (MAOIs), such as:
    • phenelzine
    • selegiline
    • tranylcypromine
  • tricyclic antidepressants, such as:
    • amitriptyline
    • imipramine
    • nortriptyline

Digoxin

Levalbuterol may decrease your digoxin blood levels. This means that digoxin may not work as well for you. Your doctor may check your blood levels of digoxin if you take both of these drugs.

Epinephrine

Talk to your doctor about whether this drug is safe for you if you’re taking levalbuterol. Taking these drugs together can cause effects on the heart. 

High blood pressure drugs

Certain high blood pressure drugs, beta blockers, can block the action of levalbuterol on your lungs. These drugs may also cause a severe spasm in your lungs. In general, you shouldn’t use beta blockers if you have asthma. Examples of these drugs include:

  • beta blockers, such as:
    • acebutolol
    • atenolol
    • betaxolol
    • bisoprolol
    • esmolol
    • metoprolol
    • nadolol
    • nebivolol
    • penbutolol
    • pindolol
    • propranolol
    • sotalol
    • timolol

Water pills (diuretics)

Levalbuterol, especially at high doses, can decrease your potassium levels and cause changes on your electrocardiogram if you’re also taking a water pill that decreases potassium levels in your body. Your doctor may need to check your potassium blood levels while you’re taking these medicines. Examples of these drugs include:

  • loop diuretics
    • bumetanide
    • ethacynic acid
    • furosemide
    • torsemide
  • thiazide diuretics
    • hydrochlorothiazide
    • chlorothiazide
    • chlorthalidone
    • indapamide
    • metolazone

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

People with heart problems

This drug can cause side effects on the heart, including increased heart rate (tachycardia) and blood pressure. Talk to your doctor about whether this drug is safe for you if you have heart-related disorders, such as coronary insufficiency, heart rhythm disorders (arrhythmias), and high blood pressure.

People with seizures

Talk to your doctor about whether this drug is safe for you if you have a seizure disorder. This drug may cause seizures.

People with hyperthyroidism

Talk to your doctor about whether this drug is safe for you if you have hyperthyroidism. It may make your condition worse.

People with diabetes

This drug may increase your blood sugar levels. Your doctor may change your diabetes medicines.

People with low blood levels of potassium (hypokalemia)

This drug may lower your blood potassium levels temporarily, which can worsen low potassium levels you already have. This can affect your heart. 

Pregnant women

This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk to the fetus.

Women who are breast-feeding

It isn’t known if this drug passes into breast milk or causes side effects in a child who is breast-fed.

Talk to your doctor if you breast-feed your baby. You may need to decide whether to stop breast-feeding or stop taking this medication.

For seniors

Older adults may process drugs more slowly. A normal adult dose may cause levels of the drug to be higher than normal. If you’re a senior, your doctor may start you at the lowest effective dose and adjust your dose slowly.

For children

The safety and effectiveness of the inhalation solution haven’t been established in children younger than 6 years.

The safety and effectiveness of the HFA inhaler haven’t been established in children younger than 4 years.

When to call the doctor

If you need more of this drug than usual, feel like it’s not helping to decrease symptoms, or if your symptoms get worse, let your doctor know right away. Your asthma may be getting worse and you may need other medicines, such as corticosteroids.

Allergies

Tell your doctor if you’ve ever had an allergic reaction to albuterol (Ventolin, Proair) or this drug. They may prescribe a different medicine to treat your acute asthma attacks.

This drug can cause a severe allergic reaction. Symptoms can include:

  • itching
  • swelling of your face or throat (angioedema)
  • skin rash
  • trouble breathing
  • fast development of trouble breathing

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room. 

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take levalbuterol (Dosage)

Inhalation Solution

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Treat or prevent spasm in the airways caused by asthma

Brand: Xopenex HFA

Form: HFA metered-dose inhaler with 80 or 200 actuations
Strength: each actuation delivers 59 mcg of levalbuterol

Brand: Xopenex solution

Form: Inhalation solution
Strength: 3-mL unit-dose vials contain 0.31 mg, 0.63 mg, or 1.25 mg levalbuterol

Brand: Xopenex solution, concentrate

Form: Inhalation solution concentrate
Strength: 0.5-mL unit-dose vial contains 1.25 mg levalbuterol

Generic: levalbuterol

Form: Inhalation solution
Strength: 3-mL unit-dose vials contain 0.31 mg, 0.63 mg, or 1.25 mg levalbuterol
Form: Inhalation solution concentrate
Strength: 0.5-mL unit-dose vial contains 1.25 mg levalbuterol

Inhalation solution

Adult dosage (ages 18–64 years)
  • Inhalation solution for nebulization: The recommended dose is 0.63 mg taken three times per day, 6–8 hours apart. If you have severe asthma and don’t respond to the 0.63-mg dose, you doctor may tell you to take 1.25 mg three times per day every 6–8 hours.
  • Concentrated inhalation solution for nebulization: The recommended dose is 1.25 mg taken three times per day, 6–8 hours apart.
Child dosage (ages 12–17 years)
  • Inhalation solution for nebulization: The recommended dose is 0.63 mg taken three times per day, 6–8 hours apart. If you have severe asthma and don’t respond to the 0.63-mg dose, you doctor may tell you to take 1.25 mg three times per day every 6–8 hours.
  • Concentrated inhalation solution for nebulization: The recommended dose is 1.25 mg taken three times per day, 6–8 hours apart.
Child dosage (ages 6–11 years)

The recommended dose is 0.31 mg (one unit-dose vial) taken three times a day by nebulization. You shouldn’t take more than 0.63 mg three times a day.

Child dosage (ages 0–5 years)

The safety and effectiveness of levalbuterol inhalation solution haven’t been established in children younger than 6 years.

HFA inhaler

Adult dosage (ages 18–64 years)

Use 1–2 puffs every 4–6 hours.

Child dosage (ages 12–17 years)

Use 1–2 puffs every 4–6 hours.

Child dosage (ages 4–6 years)

The usual dose is 1–2 inhalations taken every 4–6 hours.

Child dosage (ages 0–3 years)

The safety and effectiveness of levalbuterol HFA inhaler haven’t been established in children younger than 4 years.

Senior dosage (ages 65 years and older)

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This increases your risk of side effects.

Seniors should start at a dose of 0.63 mg of levalbuterol inhalation solution or the lowest dose of the HFA inhaler. This can help keep levels of this drug from building up too much in your body. If your asthma doesn’t improve, your doctor may increase your dose to the maximum recommended daily dose.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Healthline Pharmacist Editorial Team

This drug comes with risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all

Your asthma attack won’t be treated and you may need to go to the hospital.

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times during an asthma attack. If you don’t take this drug correctly, you may need to go to the hospital to treat your asthma attack.

If you take too much

You could have dangerous levels of this drug in your body. This can cause effects on your heart and may even be fatal (cause death).  Symptoms of an overdose of this drug can include:

  • low blood pressure
  • high blood pressure
  • arrhythmias (irregular heartbeat)
  • increased heart rate or heartbeat
  • seizures
  • fatigue
  • dizziness
  • insomnia (trouble sleeping)
  • headache
  • dry mouth
  • nervousness
  • palpitations (a fast or strong heart rate)

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects on your heart and/or death.

How to tell if the drug is working

If this drug is working, the spasms in the bronchi of your lungs or your asthma attack will go away.

This drug is used for short-term treatment.

Store this drug carefully

The inhalation solution comes in foil packages of several unit-dose vials. Keep unopened vials in the foil pouch. Once the foil pouch is opened, the concentrated solution should be used right away. The regular inhalation solution should be used within 2 weeks after opening the pouch. Once you take the vials out of the pouch, use them within one week.

Store the inhalation solution for nebulization at room temperature between 68°F and 77°F (20°C and 25°C). Keep it away from high temperatures.

Protect the solution from light.

The inhalation solution should be colorless. Throw out the vials if the solution isn’t colorless.

Don’t use the solution after the expiration date stamped on the container.

Don’t store this medication in moist or damp areas, such as bathrooms.

Store the inhaler in its protective foil pouch at room temperature between 68°F and 77°F (20°C and 25°C).Protect the inhaler from freezing temperatures and direct sunlight.

Store the inhaler with the actuator mouthpiece down.

Don’t puncture or put the inhaler in an open flame, fire, or an incinerator. Temperatures greater than 120°F may cause the inhaler to burst.

Don’t use the blue actuator that comes with the HFA inhaler with any other inhaler canisters.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

Inhalation solution for nebulization:

  • Your doctor or home health nurse will show you how to prepare the inhalation solution in your nebulizer. They’ll also show you how to use the nebulizer correctly.

Inhaler:

Your doctor or pharmacist will show you how to use the inhaler.

Your doctor may prescribe a peak flow meter for you to use at home. This device checks how well you’re breathing.

Inhalation solution for nebulization:

  • You’ll need a nebulizer with facemask or mouthpiece to inhale this medicine. You can get this at the pharmacy or at a medical supply store.

Inhaler:

  • If you have trouble using your inhaler, your doctor may prescribe a spacer device. This helps you receive the full medication dose.

Clinical monitoring

Your doctor will do pulmonary function tests to check how your lungs are working. Your doctor may also have you use a peak flow meter at home to check your breathing. They’ll ask you for the peak flow meter results.

During treatment with this drug, your doctor will check the following:

  • Asthma symptoms
  • Potassium blood levels
  • Heart rate
  • Heart rhythm check using an electrocardiogram
  • Blood sugar (glucose) levels

Not every pharmacy stocks this drug and necessary supplies

The concentrated inhalation solutions, nebulizers, and nebulizer supplies may not be in stock. When filling your prescription, be sure to call ahead.

Hidden costs

You may also need the following while you’re taking this drug:

  • peak flow meter to check your breathing at home
  • a nebulizer with a facemask or mouthpiece if you’re taking the inhalation solution for nebulization
  • a spacer divider if you’re using the inhaler and are having trouble using it

Insurance

Many insurance companies require a prior authorization for this drug or nebulizers. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription. You may also need prior authorization for a nebulizer.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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How Much Does levalbuterol Cost?

Inhalation Solution

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on October 16, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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