Class: Selective β2-Agonist; Bronchodilator
Dosage Forms. Metered Dose Inhaler: 0.045 mg/actuation
Common FDA Label Indication, Dosing, and Titration.
1. Asthma, acute exacerbation: Children 4 y and older, 4-8 inhalations q20min for 3 doses, then q1-4h prn; Adults, 4-8 inhalations po q20min up to 4 h, then q1-4h prn
2. Asthma, bronchospasm: Adults and Children 4 y and older, 2 inhalations q4-6h prn
Off-Label Uses. None
MOA. Activation of β2-adrenergic receptors on airway smooth muscle leads to the activation of adenylate cyclase and to an increase in the intracellular concentration of cyclic-3′,5′-adenosine monophosphate (cyclic AMP). The increase in cyclic AMP is associated with the activation of protein kinase A, which in turn inhibits the phosphorylation of myosin and lowers intracellular ionic calcium concentrations, resulting in muscle relaxation. Levalbuterol relaxes the smooth muscles of all airways, from the trachea to the terminal bronchioles.
Drug Characteristics: Levalbuterol
Medication Safety Issues: Levalbuterol
Drug Interactions: Levalbuterol
Adverse Reactions: Levalbuterol
Efficacy Monitoring Parameters. Resolution of asthma symptoms and improvement in pulmonary function tests.
Toxicity Monitoring Parameters. BP, heart rate.
Key Patient Counseling Points. Instruct patient on proper inhaler technique. Wash the mouthpiece and air dry thoroughly at least once a week (may cease to deliver medication if mouthpiece becomes blocked). Store the inhaler at room temperature, away from heat and direct light. Do not freeze. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold. Contact prescriber if the need to use more levalbuterol to control symptoms than usual as this may indicate asthma deterioration.
Clinical Pearls. The National Heart, Lung and Blood Institute asthma guidelines recommend short-acting beta-agonists (SABA) as the drug of choice for treating acute asthma symptoms and exacerbations. SABA are not recommended for regularly scheduled, daily, long-term use.