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Clinical pharmacology of Levalbuterol (Xopenex):rxlist:"Activation of beta2-adrenergic receptors on airway smooth muscle leads to the activation of adenylcyclase and to an increase in the intracellular concentration of cyclic-3', 5'-adenosine monophosphate (cyclic AMP). This increase in cyclic AMP leads to the activation of protein kinase A, which inhibits the phosphorylation of myosin and lowers intracellular ionic calcium concentrations, resulting in relaxation. Levalbuterol relaxes the smooth muscles of all airways, from the trachea to the terminal bronchioles. Levalbuterol acts as a functional antagonist to relax the airway irrespective of the spasmogen involved, thus protecting against all bronchoconstrictor challenges. Increased cyclic AMP concentrations are also associated with the inhibition of release of mediators from mast cells in the airway. While it is recognized that beta2-adrenergic receptors are the predominant receptors on bronchial smooth muscle, data indicate that there is a population of beta2-receptors in the human heart that comprise between 10% and 50% of cardiac beta-adrenergic receptors. The precise function of these receptors has not been established (see WARNINGS). However, all beta-adrenergic agonist drugs can produce a significant cardiovascular effect in some patients, as measured by pulse rate, blood pressure, symptoms, and/or electrocardiographic changes."
http://www.rxlist.com/cgi/generic2/leval_cp.htm

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Things to consider before using Levalbuterol (Xopenex):medlineplus:"In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For levalbuterol, the following should be considered: Allergies--Tell your doctor if you have ever had any unusual or allergic reaction to levalbuterol, albuterol, or other inhaled asthma medicines. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. Pregnancy--Levalbuterol has not been studied in pregnant women. However, studies in animals have shown that albuterol, a very similar medicine, may cause birth defects or other problems. Levalbuterol has the potential to interfere with contractions during labor. Before taking this medicine, make sure your doctor knows if you are pregnant or may become pregnant. Breast-feeding--It is not known whether levalbuterol passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor. Children--This medicine has been tested in children 12 years of age and older. In effective doses, this medicine has not been shown to cause different side effects or problems than it does in other age groups. Older adults--Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same as they do in young adults. Although there is limited information comparing the use of levalbuterol in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults. Your doctor may want to begin with a lesser dose and increase the dosage as tolerated"
Office of Communications and Public Liaison National Library of Medicine
8600 Rockville Pike Bethesda, Maryland 20894
Phone: (301) 496-6308 Fax: (301) 496-4450 email: publicinfo@nlm.nih.gov
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203784.html

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Levalbuterol (Xopenex) special warnings:Food and drug administration:"Xopenex can produce a narrowing of the airways called paradoxical bronchospasm in some patients, which may be life threatening. Your health care provider may need to prescribe other medications in addition to Xopenex to help control your asthma. Do not stop taking other asthma medications unless advised by your health care provider. Xopenex can cause significant heart-related side effects, such as an increase in pulse, blood pressure, and/or related symptoms. If you have a heart condition, your doctor will determine if Xopenex is right for you. Use as directed by your doctor or health care provider. Deaths have been reported with similar inhaled medications in asthma patients who use too much. Hypersensitivity reaction, (severe allergic reaction) may occur immediately after taking Xopenex. Experiencing itching, areas of skin swelling (angioedema), skin rash, or narrowing of the airways, may be signs of a hypersensitivity reaction"
http://www.fda.gov/cder/consumerinfo/druginfo/xopenex.htm

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Who should not use Levalbuterol (Xopenex) inhalation?:ahealthyme:"Before using this medication, tell your doctor if you have heart disease, an irregular heartbeat, or high blood pressure, epilepsy or another seizure disorder, diabetes, or an overactive thyroid (hyperthyroidism). You may not be able to use levalbuterol inhalation or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Levalbuterol inhalation is in the FDA pregnancy category C. This means that it is not known whether levalbuterol inhalation will harm an unborn baby. Do not use this medication without first talking to your doctor if you are pregnant. It is not known whether levalbuterol passes into breast milk. Do not use levalbuterol inhalation without first talking to your doctor if you are breast-feeding a baby. Levalbuterol inhalation is not approved for use by children younger than 12 years of age"
http://www.ahealthyme.com/

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Levalbuterol (Xopenex) dosage information: nursespdr:"Inhalation Solution: Nebulization Bronchospasms. Adults and adolescents over 12 years of age, initial: 0.63 mg t.i.d. (q 6-8 hr) by nebulization. Those with severe asthma or who do not respond to the 0.63 mg dose may benefit from a dose of 1.25 mg t.i.d"
http://www.nursespdr.com

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Possible side effects of Levalbuterol (Xopenex):personalmd:"Nausea, dry mouth or cough may occur. If these effects persist or worsen, notify your doctor promptly. Report promptly tremor, lightheadedness or mental/mood changes. Unlikely but report promptly, leg cramps, unusually fast pulse, irregular pulse, headache or trouble sleeping. Very unlikely but report promptly fainting, chest pain or seizures. In the unlikely event you have an allergic reaction to this medication, seek immediate medical attention. Symptoms of an allergic reaction include rash, itching, swelling, dizziness or trouble breathing. To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water or use a saliva substitute. If you notice other effects not listed above, contact your doctor or pharmacist"
http://www.personalmd.com/drgdb/8304.htm

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Possible food and drug interactions with Levalbuterol (Xopenex):gettingwell:"Xopenex should be used cautiously, if at all, with other bronchodilators such as Proventil, Ventolin, or Primatene Mist. If Xopenex is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Xopenex with the following: Antidepressant drugs classified as MAO inhibitors (Marplan, Nardil, and Parnate) or tricyclics (Elavil and Tofranil) Beta blockers (heart and blood pressure drugs) such as Inderal, Lopressor, and Tenormin Digoxin (Lanoxin) Diuretics (water pills) that lower your potassium levels such as Lasix and HydroDIURIL"
http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/xop1531.shtml

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Precautions to take while using Levalbuterol (Xopenex):usadrug.com:"Tell healthcare provider if you have heart disease. Tell healthcare provider if you are allergic to any medicine. Make sure to tell about the allergy and how it affected you. This includes telling about rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, throat; or any other symptoms involved. Tell healthcare provider if you are pregnant or plan on getting pregnant. Tell healthcare provider if you are breast-feeding"
http://www.usadrug.com/IMCAccess/ConsDrugs/Levalbuterolcd.shtml

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General product information from the makers of Levalbuterol (Xopenex):Sepracor Inc. office of scientific affairs:"Xopenex may produce a significant cardiovascular effect in some patients, measured by increased pulse rate, increased blood pressure and/or electrocardiograph changes. Xopenex should not be taken by patients who have a hypersensitivity to levalbuterol HCl or racemic albuterol. Adverse events, not necessarily drug-related, occurring in greater than 2% of patients treated with 0.63 mg Xopenex included flu syndrome, pain, tachycardia or increased heart rate, nervousness, viral infection, rhinitis, sinusitis, and nasal congestion. Clinical laboratory abnormalities such as slight increases in plasma glucose and slight decreases in plasma potassium have also occurred in greater than 2% of patients treated with 0.63 mg Xopenex. b-agonists have been associated with paradoxical bronchospasm, which may be life threatening; see Xopenex prescribing information regarding potential drug interactions with b-blockers, diuretics, digoxin, monoamine oxidase inhibitors, or trycyclic antidepressants. Dueto the cardiovascular side effects of b-agonists, caution is generally recommended for patients with cardiovascular disorders (e.g., arrythmias, hypertension, coronary insufficiency), diabetes, hyperthyroidism, or convulsive disorders"
http://www.xopenex.com/product.html

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