levalbuterol (Rx)

Brand and Other Names:Xopenex, Xopenex HFA
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

nebulizer solution

  • 0.31mg/3mL
  • 0.63mg/3mL
  • 1.25mg/3mL
  • 1.25mg/0.5mL

aerosol

  • 45mcg/actuation

Bronchospasm

Nebulizer solution: 0.63 mg 3 times daily at intervals of 6-8 hr; may increase dose to 1.25 mg 3 times daily with close monitoring for adverse effects

Aerosol: 90 mcg (2 actuations of metered-dose inhaler) q4-6hr; 1 actuation q4hr may be sufficient; not to exceed 2 actuations q4hr

Dosage Modifications

Hepatic impairment: Not evaluated

Renal impairment: Caution when administering high doses of inhalation solution

Dosage Forms & Strengths

nebulizer solution

  • 0.31mg/3mL
  • 0.63mg/3mL
  • 1.25mg/3mL
  • 1.25mg/0.5mL

aerosol

  • 45mcg/actuation

Bronchospasm

Indicated for treatment or prevention of bronchospasm in adults, adolescents, and children ≥6 years (nebulized solution) or >4 years (HFA aerosol) with reversible obstructive airway disease

Nebulizer solution

  • <6 years: Not indicated; clinical trials with levalbuterol inhalation in this age group failed to meet the primary efficacy endpoint
  • ≥6 to <12 years: 0.31 mg q8hr; not to exceed 0.63 mg q8hr PRN
  • >12 years: 0.63 mg 3 times daily at intervals of 6-8 hr; may increase dose to 1.25 mg 3 times daily with close monitoring for adverse effects

Aerosol

  • <4 years: Safety and efficacy not established
  • ≥4 years: 90 mcg (2 actuations of metered-dose inhaler) q4-6hr PRN; in some patients, 1 inhalation (45 mg of levalbuterol free base) q4hr may be sufficient

Dosage Modifications

Hepatic impairment: Not evaluated

Renal impairment: Caution when administering high doses of inhalation solution

Nebulizer solution: 0.63 mg initially in patients >65 years

Next:

Interactions

Interaction Checker

and levalbuterol

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              Serious - Use Alternative (19)

              • amitriptyline

                amitriptyline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • amoxapine

                amoxapine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • chloroquine

                chloroquine and levalbuterol both increase QTc interval. Avoid or Use Alternate Drug.

              • clomipramine

                clomipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • desipramine

                desipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • doxepin

                doxepin, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • fexinidazole

                fexinidazole and levalbuterol both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.

              • imipramine

                imipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • isocarboxazid

                isocarboxazid increases effects of levalbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              • lefamulin

                lefamulin and levalbuterol both increase QTc interval. Avoid or Use Alternate Drug.

              • linezolid

                linezolid increases effects of levalbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              • lofepramine

                lofepramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • maprotiline

                maprotiline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • nortriptyline

                nortriptyline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • phenelzine

                phenelzine increases effects of levalbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              • protriptyline

                protriptyline, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • tranylcypromine

                tranylcypromine increases effects of levalbuterol by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

              • trazodone

                trazodone, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              • trimipramine

                trimipramine, levalbuterol. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

              Monitor Closely (246)

              • acebutolol

                acebutolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                acebutolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • aceclofenac

                aceclofenac increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • acemetacin

                acemetacin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • albuterol

                albuterol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                albuterol and levalbuterol both decrease sedation. Use Caution/Monitor.

                albuterol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • alfentanil

                alfentanil increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • alfuzosin

                alfuzosin and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • alprazolam

                alprazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • amiloride

                amiloride increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • amitriptyline

                amitriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • amobarbital

                amobarbital increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • amoxapine

                amoxapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • apomorphine

                apomorphine and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • arformoterol

                arformoterol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                arformoterol and levalbuterol both decrease sedation. Use Caution/Monitor.

                arformoterol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • aripiprazole

                aripiprazole increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                aripiprazole and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • armodafinil

                levalbuterol and armodafinil both decrease sedation. Use Caution/Monitor.

              • artemether

                artemether and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • artemether/lumefantrine

                artemether/lumefantrine and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • aspirin

                aspirin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • aspirin rectal

                aspirin rectal increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atenolol

                atenolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                atenolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • atomoxetine

                levalbuterol, atomoxetine. Other (see comment). Use Caution/Monitor. Comment: Exercise caution if beta-agonists and atomoxetine are coadministered. Interaction may be less likely with inhaled beta-agonists versus those given systemically. .

                atomoxetine and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • azelastine

                azelastine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bedaquiline

                bedaquiline and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • belladonna and opium

                belladonna and opium increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bendroflumethiazide

                levalbuterol and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

              • benperidol

                benperidol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • benzphetamine

                levalbuterol and benzphetamine both decrease sedation. Use Caution/Monitor.

                levalbuterol and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • betaxolol

                betaxolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                betaxolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • bisoprolol

                bisoprolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                bisoprolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • brompheniramine

                brompheniramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bumetanide

                levalbuterol and bumetanide both decrease serum potassium. Use Caution/Monitor.

              • buprenorphine buccal

                buprenorphine buccal increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • butabarbital

                butabarbital increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • butalbital

                butalbital increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • butorphanol

                butorphanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • caffeine

                levalbuterol and caffeine both decrease sedation. Use Caution/Monitor.

              • carbenoxolone

                levalbuterol and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

              • carbinoxamine

                carbinoxamine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carvedilol

                carvedilol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                carvedilol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • celecoxib

                celecoxib increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • celiprolol

                celiprolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                celiprolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • ceritinib

                ceritinib and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • chloral hydrate

                chloral hydrate increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlordiazepoxide

                chlordiazepoxide increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorothiazide

                levalbuterol and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

              • chlorpheniramine

                chlorpheniramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorpromazine

                chlorpromazine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorthalidone

                levalbuterol and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • cinnarizine

                cinnarizine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • citalopram

                citalopram and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • clarithromycin

                clarithromycin and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • clemastine

                clemastine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • clomipramine

                clomipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • clonazepam

                clonazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • clorazepate

                clorazepate increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • clozapine

                clozapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                clozapine and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • codeine

                codeine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • crizotinib

                crizotinib and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • cyclizine

                cyclizine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cyclopenthiazide

                levalbuterol and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

              • cyproheptadine

                cyproheptadine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dasatinib

                dasatinib and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • deflazacort

                levalbuterol and deflazacort both decrease serum potassium. Use Caution/Monitor.

              • degarelix

                degarelix and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • desflurane

                desflurane increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • desipramine

                desipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexchlorpheniramine

                dexchlorpheniramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexfenfluramine

                levalbuterol and dexfenfluramine both decrease sedation. Use Caution/Monitor.

                levalbuterol and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • dexmedetomidine

                dexmedetomidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dexmethylphenidate

                levalbuterol and dexmethylphenidate both decrease sedation. Use Caution/Monitor.

                levalbuterol and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • dextroamphetamine

                levalbuterol and dextroamphetamine both decrease sedation. Use Caution/Monitor.

                levalbuterol and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • dextromoramide

                dextromoramide increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • diamorphine

                diamorphine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dichlorphenamide

                dichlorphenamide and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                dichlorphenamide, levalbuterol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

              • diclofenac

                diclofenac increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • diethylpropion

                levalbuterol and diethylpropion both decrease sedation. Use Caution/Monitor.

                levalbuterol and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • difenoxin hcl

                difenoxin hcl increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • diflunisal

                diflunisal increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • digoxin

                digoxin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dimenhydrinate

                dimenhydrinate increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • diphenhydramine

                diphenhydramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • diphenoxylate hcl

                diphenoxylate hcl increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dipipanone

                dipipanone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dobutamine

                dobutamine and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                dobutamine and levalbuterol both decrease sedation. Use Caution/Monitor.

                dobutamine and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • dopamine

                levalbuterol and dopamine both decrease sedation. Use Caution/Monitor.

                levalbuterol and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • dopexamine

                dopexamine and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                dopexamine and levalbuterol both decrease sedation. Use Caution/Monitor.

                dopexamine and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

                dopexamine, levalbuterol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • doxepin

                doxepin increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • droperidol

                droperidol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • drospirenone

                drospirenone increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • ephedrine

                ephedrine and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                ephedrine and levalbuterol both decrease sedation. Use Caution/Monitor.

                ephedrine and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • epinephrine

                epinephrine and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                epinephrine and levalbuterol both decrease sedation. Use Caution/Monitor.

                epinephrine and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • epinephrine racemic

                levalbuterol and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.

                levalbuterol and epinephrine racemic both decrease sedation. Use Caution/Monitor.

                levalbuterol and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • esmolol

                esmolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                esmolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • estazolam

                estazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ethacrynic acid

                levalbuterol and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

              • ethanol

                ethanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • etodolac

                etodolac increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fenfluramine

                levalbuterol and fenfluramine both decrease sedation. Use Caution/Monitor.

                levalbuterol and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • fenoprofen

                fenoprofen increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • fluoxetine

                fluoxetine and levalbuterol both increase QTc interval. Modify Therapy/Monitor Closely. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system

              • fluphenazine

                fluphenazine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • flurazepam

                flurazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • flurbiprofen

                flurbiprofen increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • formoterol

                formoterol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                formoterol and levalbuterol both decrease sedation. Use Caution/Monitor.

                formoterol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • fostemsavir

                levalbuterol and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

              • furosemide

                levalbuterol and furosemide both decrease serum potassium. Use Caution/Monitor.

              • gentamicin

                levalbuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • green tea

                green tea increases effects of levalbuterol by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

              • haloperidol

                haloperidol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hydrochlorothiazide

                levalbuterol and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

              • hydromorphone

                hydromorphone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • hydroxyzine

                hydroxyzine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ibuprofen

                ibuprofen increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ibuprofen IV

                ibuprofen IV increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • iloperidone

                iloperidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • imipramine

                imipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • indapamide

                levalbuterol and indapamide both decrease serum potassium. Use Caution/Monitor.

              • indomethacin

                indomethacin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • isoproterenol

                isoproterenol and levalbuterol both decrease serum potassium. Use Caution/Monitor.

                isoproterenol and levalbuterol both decrease sedation. Use Caution/Monitor.

                isoproterenol and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • ketoprofen

                ketoprofen increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ketorolac

                ketorolac increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ketorolac intranasal

                ketorolac intranasal increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • ketotifen, ophthalmic

                ketotifen, ophthalmic increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • labetalol

                labetalol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                labetalol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • levorphanol

                levorphanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lisdexamfetamine

                levalbuterol and lisdexamfetamine both decrease sedation. Use Caution/Monitor.

                levalbuterol and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • lofepramine

                lofepramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lofexidine

                lofexidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • loprazolam

                loprazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lorazepam

                lorazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lormetazepam

                lormetazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • lornoxicam

                lornoxicam increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • loxapine

                loxapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • loxapine inhaled

                loxapine inhaled increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • maprotiline

                maprotiline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • marijuana

                marijuana increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meclofenamate

                meclofenamate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mefenamic acid

                mefenamic acid increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • melatonin

                melatonin increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meloxicam

                meloxicam increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meperidine

                meperidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meprobamate

                meprobamate increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metaproterenol

                levalbuterol and metaproterenol both decrease serum potassium. Use Caution/Monitor.

                levalbuterol and metaproterenol both decrease sedation. Use Caution/Monitor.

                levalbuterol and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • methadone

                methadone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • methamphetamine

                levalbuterol and methamphetamine both decrease sedation. Use Caution/Monitor.

                levalbuterol and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • methyclothiazide

                levalbuterol and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

              • methylenedioxymethamphetamine

                levalbuterol and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.

                levalbuterol and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • methylphenidate

                levalbuterol and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • metolazone

                levalbuterol and metolazone both decrease serum potassium. Use Caution/Monitor.

              • metoprolol

                metoprolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                metoprolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • midazolam

                midazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • midodrine

                levalbuterol and midodrine both decrease sedation. Use Caution/Monitor.

                levalbuterol and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • mirtazapine

                mirtazapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • modafinil

                levalbuterol and modafinil both decrease sedation. Use Caution/Monitor.

              • morphine

                morphine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • motherwort

                motherwort increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • moxonidine

                moxonidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nabilone

                nabilone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nabumetone

                nabumetone increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nadolol

                nadolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                nadolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • nalbuphine

                nalbuphine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • naproxen

                naproxen increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nebivolol

                nebivolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                nebivolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • norepinephrine

                levalbuterol and norepinephrine both decrease serum potassium. Use Caution/Monitor.

                levalbuterol and norepinephrine both decrease sedation. Use Caution/Monitor.

                levalbuterol and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • nortriptyline

                nortriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • olanzapine

                olanzapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • olodaterol inhaled

                levalbuterol and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

              • opium tincture

                opium tincture increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • osilodrostat

                osilodrostat and levalbuterol both increase QTc interval. Use Caution/Monitor.

              • oxaprozin

                oxaprozin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxazepam

                oxazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxycodone

                oxycodone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxymorphone

                oxymorphone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • paliperidone

                paliperidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • papaveretum

                papaveretum increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • parecoxib

                parecoxib increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • penbutolol

                penbutolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                penbutolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • pentazocine

                pentazocine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pentobarbital

                pentobarbital increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • perphenazine

                perphenazine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phendimetrazine

                levalbuterol and phendimetrazine both decrease sedation. Use Caution/Monitor.

                levalbuterol and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • phenobarbital

                phenobarbital increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • phenoxybenzamine

                phenoxybenzamine, levalbuterol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

              • phentermine

                levalbuterol and phentermine both decrease sedation. Use Caution/Monitor.

                levalbuterol and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • phenylephrine

                levalbuterol and phenylephrine both decrease sedation. Use Caution/Monitor.

                levalbuterol and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • phenylephrine PO

                levalbuterol and phenylephrine PO both decrease sedation. Use Caution/Monitor.

                levalbuterol and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • pholcodine

                pholcodine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pimozide

                pimozide increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pindolol

                pindolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                pindolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • pirbuterol

                levalbuterol and pirbuterol both decrease serum potassium. Use Caution/Monitor.

                levalbuterol and pirbuterol both decrease sedation. Use Caution/Monitor.

                levalbuterol and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • piroxicam

                piroxicam increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • potassium acid phosphate

                potassium acid phosphate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • potassium chloride

                potassium chloride increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • potassium citrate

                potassium citrate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • primidone

                primidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • procarbazine

                procarbazine increases effects of levalbuterol by pharmacodynamic synergism. Use Caution/Monitor.

              • prochlorperazine

                prochlorperazine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • promethazine

                promethazine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • propranolol

                propranolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • propylhexedrine

                levalbuterol and propylhexedrine both decrease sedation. Use Caution/Monitor.

                levalbuterol and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • protriptyline

                protriptyline increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pseudoephedrine

                levalbuterol and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • quazepam

                quazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • quetiapine

                quetiapine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • risperidone

                risperidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sacubitril/valsartan

                sacubitril/valsartan increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • salicylates (non-asa)

                salicylates (non-asa) increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • salmeterol

                levalbuterol and salmeterol both decrease serum potassium. Use Caution/Monitor.

                levalbuterol and salmeterol both decrease sedation. Use Caution/Monitor.

                levalbuterol and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • salsalate

                salsalate increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • saquinavir

                levalbuterol, saquinavir. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Increased risk of hypokalemia, QT prolongation, and cardiac arrhythmias.

              • scullcap

                scullcap increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • secobarbital

                secobarbital increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • shepherd's purse

                shepherd's purse increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

                levalbuterol and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • solriamfetol

                levalbuterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • sotalol

                sotalol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                sotalol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • spironolactone

                spironolactone increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • succinylcholine

                succinylcholine increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sufentanil

                sufentanil increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sulfasalazine

                sulfasalazine increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sulindac

                sulindac increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tapentadol

                tapentadol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • temazepam

                temazepam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • terbutaline

                levalbuterol and terbutaline both decrease serum potassium. Use Caution/Monitor.

                levalbuterol and terbutaline both decrease sedation. Use Caution/Monitor.

                levalbuterol and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • thioridazine

                thioridazine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • thiothixene

                thiothixene increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • timolol

                timolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                timolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • tolfenamic acid

                tolfenamic acid increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tolmetin

                tolmetin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tolvaptan

                tolvaptan increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • topiramate

                topiramate increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • torsemide

                levalbuterol and torsemide both decrease serum potassium. Use Caution/Monitor.

              • tramadol

                tramadol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • trazodone

                trazodone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • triamterene

                triamterene increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • triazolam

                triazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • triclofos

                triclofos increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • trifluoperazine

                trifluoperazine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • trimipramine

                trimipramine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • triprolidine

                triprolidine increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • xylometazoline

                levalbuterol and xylometazoline both decrease sedation. Use Caution/Monitor.

                levalbuterol and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • yohimbine

                levalbuterol and yohimbine both decrease sedation. Use Caution/Monitor.

                levalbuterol and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • ziconotide

                ziconotide increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ziprasidone

                ziprasidone increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              Minor (15)

              • bendroflumethiazide

                levalbuterol, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • bumetanide

                levalbuterol, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • chlorothiazide

                levalbuterol, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • chlorthalidone

                levalbuterol, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • cyclopenthiazide

                levalbuterol, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • ethacrynic acid

                levalbuterol, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • eucalyptus

                eucalyptus increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

              • furosemide

                levalbuterol, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • hydrochlorothiazide

                levalbuterol, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • indapamide

                levalbuterol, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • methyclothiazide

                levalbuterol, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • metolazone

                levalbuterol, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

              • noni juice

                noni juice increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

              • sage

                sage increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

              • torsemide

                levalbuterol, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

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              Adverse Effects

              >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

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              Warnings

              Contraindications

              Hypersensitivity to levalbuterol or racemic albuterol

              Cautions

              Risk of paradoxical bronchospasm; this should be distinguished from inadequate response; discontinue and treat with alternate therapy if it occurs

              Has higher affinity for beta1- and beta2-adrenergic receptors than racemic albuterol has

              Risk of hypersensitivity reactions

              Use caution in hyperthyroidism; may increase thyroid activity

              Use with caution in diabetes mellitus (beta2 agonists may increase glucose)

              Risk of hypokalemia (usually transient); use with caution in hypokalemia

              Use with caution in patients with history of seizure disorders; therapy may increase CNS activity/excitation

              Exceeding the recommended dose may result in serious adverse effects, including fatalities

              Cardiovascular effects

              • Use with caution in cardiovascular disorder (eg, arrhythmias, hypertension, coronary insufficiency)
              • May cause elevation in blood pressure and heart rate; may cause CNS stimulation or excitation
              • May increase risk of arrhythmia and electrocardiogram changes, including ST segment depression, prolongation of the QTc interval, or flattening of the T wave

              Drug interaction overview

              • Short-acting bronchodilators
                • Avoid use
                • If additional adrenergic drugs are to be administered by any route, use with caution to avoid deleterious additive cardiovascular effects
              • Beta-blockers
                • Beta-adrenergic receptor blocking agents not only block the pulmonary effect of beta-adrenergic agonists, but may produce severe bronchospasm in asthmatic patients.
                • Therefore, patients with asthma should not normally be treated with beta-blockers.
                • Under certain circumstances, cardioselective beta-blockers should be considered and may be used with caution
              • Diuretics
                • ECG changes or hypokalemia that may result from the administration of non-potassium-sparing diuretics can be acutely worsened by beta-agonists, especially when the recommended dose of the beta-agonist is exceeded
              • Digoxin
                • Mean decreases of 16% and 22% in serum digoxin levels were demonstrated after single-dose IV and oral administration of racemic albuterol, respectively, to normal volunteers who had received digoxin for 10 days
              • Monoamine oxidase inhibitors or tricyclic antidepressants
                • Use extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents, because the action of levalbuterol on the vascular system may be potentiated
                • Consider alternative therapy in patients taking MAO inhibitors or tricyclic antidepressants
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              Pregnancy & Lactation

              Pregnancy

              There are no adequate and well-controlled studies in pregnant women; there are clinical considerations with use in pregnant women

              Pregnancy exposure registry

              • Monitors pregnancy outcomes in women exposed to asthma medication during pregnancy
              • To enroll in MotherToBaby Pregnancy Studies’ Asthma & Pregnancy Study or for more information about the registry, call 1-877-311-8972 or visit www.mothertobaby.org/ongoing-study/asthma

              Clinical considerations

              • In women with poorly or moderately controlled asthma, there is increased risk of preeclampsia in mother and prematurity, low birth weight, and small for gestational age in neonate
              • Closely monitor and adjust medication as necessary to maintain optimal control

              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 Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

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

              Absorption

              Peak plasma concentration

              • Single levalbuterol 1.25 mg solution: 1.1 ng/mL ([R]-albuterol)
              • Cumulative levalbuterol 5 mg solution: 4.5 ng/mL ([R]-albuterol)
              • Levalbuterol inhaler 90 mcg: 199 pg/mL

              Peak plasma time

              • Single levalbuterol 1.25 mg solution: 0.2 hr ([R]-albuterol)
              • Cumulative levalbuterol 5 mg solution: 0.2 hr ([R]-albuterol)

              AUC

              • Single levalbuterol 1.25 mg: 3.3 ng⋅hr/mL ([R]-albuterol)
              • Cumulative levalbuterol 5 mg: 17.4 ng⋅hr/mL ([R]-albuterol)
              • Levalbuterol inhaler 90 mcg: 695 ng⋅hr/mL

              Metabolism

              Published literature suggests that the primary enzyme responsible for the metabolism of albuterol enantiomers in humans is SULT1A3 (sulfotransferase)

              Elimination

              Primary route of elimination of albuterol enantiomers is through renal excretion (80% to 100%) of either the parent compound or the primary metabolite

              Excretion: Feces (< 20%)

              Following IV administration of racemic albuterol, between 25% and 46% of the (R)-albuterol fraction of the dose was excreted as unchanged (R)-albuterol in the urine

              Half-time

              • Single levalbuterol 1.25 mg: 3.3 hr ([R]-albuterol)
              • Cumulative levalbuterol 5 mg: 4 hr
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              Administration

              Oral Inhalation Preparation

              Aerosol inhaler

              • Priming
                • Prime inhaler before using for the first time and when inhaler has not been used for more than 3 days by releasing 4 test sprays into the air, away from the face
              • Cleaning
                • Wash the actuator with warm water and air-dry thoroughly at least once a week; may cease to deliver levalbuterol tartrate if not properly cleaned and dried thoroughly
                • Keep plastic actuator clean to prevent medication build-up and blockage
                • If actuator becomes blocked with levalbuterol tartrate, wash actuator to remove the blockage
                • The canister is fitted with a dose indicator, which indicates how many inhalations remain
                • When nearing the end of the usable inhalations, the color behind the number in the dose indicator window changes to red
                • Discard inhaler when dose indicator displays zero, corresponding to the use of 200 actuations

              Oral Inhalation Administration

              Oral inhalation only

              Aerosol inhaler

              • Shake well before use
              • Avoid spraying in the eyes
              • Check inside the mouthpiece of the actuator for objects
              • Shake the inhaler well for 5 seconds before use
              • Breathe out through mouth and push out as much air from lungs as possible
              • While breathing in deeply and slowly, press down on the center of the targeting rings until a spray of medicine has been released
              • Close your mouth and hold your breath for 10 seconds if possible; then breathe out gently
              • Wait about 1 min before next dose

              Nebulizer solution

              • Administer by nebulization using with a standard jet nebulizer (with a face mask or mouthpiece) connected to an air compressor
              • Drug compatibility (physical and chemical), efficacy, and safety of nebulizer solution when mixed with other drugs in a nebulizer have not been established
              • Safety and efficacy of nebulizer solution have been established in clinical trials when administered using the PARI LC Jet and PARI LC Plus nebulizers, and the PARI Master® Dura-Neb® 2000 and Dura-Neb® 3000 compressors

              Storage

              Aerosol inhaler

              • Store canister at 20-25ºC (68-77ºF)
              • Protect from freezing temperatures and direct sunlight
              • Do not use or store inhaler near heat or open flame; do not throw into a fire or an incinerator
              • Temperatures >120ºF may cause the canister to burst

              Nebulizer solution

              • Store in the protective foil pouch at 20-25ºC (68-77ºF)
              • Protect from light and excessive heat
              • Once foil pouch is opened, contents of the vial should be used immediately; discard any vial if the solution is not colorless
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Xopenex Concentrate inhalation
              -
              1.25 mg/0.5 mL nebulizer soln
              Xopenex Concentrate inhalation
              -
              1.25 mg/0.5 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/0.5 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/0.5 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              1.25 mg/0.5 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.31 mg/3 mL nebulizer soln
              levalbuterol HCl inhalation
              -
              0.63 mg/3 mL nebulizer soln
              Xopenex inhalation
              -
              0.31 mg/3 mL nebulizer soln
              Xopenex inhalation
              -
              1.25 mg/3 mL nebulizer soln
              Xopenex inhalation
              -
              0.63 mg/3 mL nebulizer soln
              Xopenex inhalation
              -
              1.25 mg/3 mL nebulizer soln
              Xopenex inhalation
              -
              0.31 mg/3 mL nebulizer soln
              Xopenex inhalation
              -
              0.63 mg/3 mL nebulizer soln

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              levalbuterol HCl inhalation

              LEVALBUTEROL CONCENTRATED SOLUTION - INHALATION

              (LEV-al-BUE-ter-ol)

              COMMON BRAND NAME(S): Xopenex

              USES: Levalbuterol is used to prevent and treat wheezing and shortness of breath caused by breathing problems (such as asthma, chronic obstructive pulmonary disease). It is a quick-relief drug. Levalbuterol belongs to a class of drugs known as bronchodilators. It works by relaxing the muscles around the airways so that they open up and you can breathe more easily. Controlling symptoms of breathing problems can decrease time lost from work or school.

              HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start using this medication and each time you get a refill. This medication is used with a special machine called a nebulizer that changes the solution to a fine mist that you inhale. Learn how to prepare the solution and use the nebulizer properly. If a child is using this medication, a parent or other responsible adult may need to help the child use the nebulizer properly. If you have any questions, ask your doctor, pharmacist, or respiratory therapist.This product should be clear and colorless. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid.Using the nebulizer, inhale this medication into your lungs as directed by your doctor, usually 3 times a day. Each treatment usually takes about 5 to 15 minutes. Use this medication only through a nebulizer. Do not swallow or inject the solution. Do not mix with other medicines in the nebulizer. To prevent infections, clean the nebulizer and mouthpiece/face mask according to the manufacturer's directions.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.The dosage is based on your medical condition, age, and response to treatment. Do not increase your dose or use this drug more often than prescribed without your doctor's approval. Using too much of this medication will increase your risk of serious (possibly fatal) side effects.Learn which of your inhalers/medications you should use every day (controller drugs) and which you should use if your breathing suddenly worsens (quick-relief drugs). Ask your doctor ahead of time what you should do if you have new or worsening cough or shortness of breath, wheezing, increased sputum, worsening peak flow meter readings, waking up at night with trouble breathing, if you use your quick-relief inhaler/medication more often (more than 2 days a week), or if your quick-relief inhaler/medication does not seem to be working well. Learn when you can treat sudden breathing problems by yourself and when you must get medical help right away.Tell your doctor if your symptoms do not improve or if they worsen.

              SIDE EFFECTS: Nervousness, dizziness, shaking (tremor), trouble sleeping, headache, nausea, dry mouth, increased coughing, or runny nose may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if you have any serious side effects, including: fast/pounding heartbeat.Get medical help right away if you have any very serious side effects, including: chest pain, irregular heartbeat, rapid breathing, confusion.Rarely, this medication has caused severe (rarely fatal), sudden worsening of breathing problems/asthma (paradoxical bronchospasm). If you experience sudden wheezing, get medical help right away.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking levalbuterol, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as albuterol, metaproterenol, salmeterol); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, heart problems (such as irregular heartbeat, angina, previous heart attack), high blood pressure, kidney disease, seizure.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Levalbuterol is very similar to albuterol. Do not use inhaled medications containing albuterol while using levalbuterol.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: chest pain, fast/pounding/irregular heartbeat, headache, shaking (tremors), nervousness, weakness, severe dizziness, seizures.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as blood pressure, heart rate, EKG) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Avoid allergens/irritants that can worsen breathing problems, such as smoke, pollen, pet dander, dust, or molds.Learn to use a peak flow meter, use it daily, and promptly report worsening breathing problems (such as readings in the yellow/red range, increased use of quick-relief inhalers).Because the flu virus can worsen breathing problems, ask your doctor or pharmacist if you should have a flu shot every year.

              MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store vials in the foil pouch at room temperature away from light and heat. Do not store in the bathroom. After the foil pouch is opened, use the medication right away. Throw away any vials if the solution is discolored. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.