What you need to know about Xopenex (levalbuterol)


Xopenex (levalbuterol) is a short-acting inhaled medication used to relieve the acute symptoms of asthma and chronic obstructive pulmonary disease (COPD) . The medicine relaxes the smooth muscles in the airways of the lungs, usually within a few minutes. It is not used for long-term control of symptoms, but rather for the sudden onset of bronchoconstriction (narrowing of the airways).

Xopenex is available as an aerosol inhaler and as a solution for use in a nebulizer .

Generic Xopenex, marketed under the name levalbuterol, has been available since 2016 .

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Xopenex is a short-acting beta agonist (SABA) used for the first-line treatment of the acute symptoms of reversible obstructive airway disease . This includes fully reversible asthma and partially reversible COPD. Xopenex is not used for irreversible obstructive airway diseases such as bronchiectasis .

Xopenex was approved by the US Food and Drug Administration in 1999 as an alternative to SABA inhaled albuterol (marketed under the ProAir, Ventolin, and other brand names). There are no other SABAs other than Xopenex or Albuterol.

Xopenex versus albuterol

Xopenex contains only the active component of albuterol (called levalbuterol) and not the inactive component (dextroalbuterol), which provides certain benefits, including a lower dose of the drug .

That said, Xopenex has not been shown to be more or less effective than albuterol, nor has Xopenex been shown to have fewer side effects than albuterol, despite acting more directly on the lungs .

Xopenex is offered in inhalation form only, while albuterol is available in inhaler, oral tablet, and oral syrup form. Since generic versions of both are now available, the cost of Xopenex and albuterol is about the same.

Xopenex and albuterol are useful drugs with similar effects. Since some providers think Xopenex has fewer side effects, this might be a smart choice if you have any concerns about albuterol.

Use not indicated on the label

Xopenex is sometimes used off-label to treat exercise-induced bronchospasm (EIB), a narrowing of the airways caused by excessive exercise. Although technically a form of asthma , IBD can occur in both people with asthma and in elite athletes without any diagnostic signs of asthma .

Before drinking

You are a candidate for Xopenex if you have asthma attacks or worsening COPD .

For people with mild intermittent asthma , Xopenex may be all that is needed to control symptoms. In other cases, daily medications (such as long-acting beta-agonists and inhaled steroids ) may be added to the treatment plan to provide long-term control.

Your healthcare provider will assess your needs based on pulmonary function tests (PFTs) and imaging tests , and your overall response to treatment.

Precautions and contraindications.

Xopenex should not be used by people with a known or suspected allergy to levalbuterol, albuterol, or any other ingredient in the drug.

Xopenex is known to affect heart rate and blood pressure, posing risks for people with pre-existing cardiovascular disease. Levalbuterol is also known to act on the sympathetic nervous system and can affect glucose tolerance and thyroid function.

Because of this, Xopenex should be used with caution in people with the following pre-existing medical conditions :

To avoid complications from medications, people with diabetes, thyroid disease, or cardiovascular disease should be monitored regularly. Any increase in the frequency or severity of symptoms may require dose adjustments or changes in treatment.

Be sure to discuss the risks and benefits of using Xopenex with your doctor if you are pregnant or planning to become pregnant. Use appears to be safe for both mother and baby during pregnancy, but it is important that you get personal advice from your healthcare provider.

It is not known if Xopenex is transmitted through breast milk.


There are two forms of Xopenex: Xopenex HFA, a spray form of levalbuterol, and Xopenex solution, a spray form.

Xopenex HFA is approved for use in adults and children over 4 years of age. It is available in 15-gram jars with 200 doses or 8.4-gram jars with 80 doses.

The recommended dose is the same for adults and children :

  • Take 2 inhaled doses (approximately 90 mcg of levalbuterol) every four to six hours. For some, an inhaled dose of Xopenex HFA every four hours may be sufficient. Follow your healthcare provider's instructions.

Xopenex is approved for use in adults and children 6 years of age and older. It is available in three dosage options: 0.31 milligrams (mg), 0.63 mg, and 1.25 mg. There is also a 1.25 mg concentrate that must be mixed with sterile saline.

The recommended dose depends on age:

  • Adults and adolescents 12 years and older : Start with a 0.63 mg dose, given three times a day (every six to eight hours) using a nebulizer. If necessary, the dose can be increased, but it should not exceed 1.25 mg three times a day.
  • Children 6 to 11 years : start with 0.31 mg given three times a day (every six to eight hours) using a nebulizer. If necessary, the dose can be increased, but should not exceed 0.63 mg three times a day.

In general, the lowest possible dose should be used to reduce respiratory restriction. If Xopenex cannot provide relief with the prescribed dose, inform your healthcare professional before adjusting the dose.

Never exceed the maximum recommended daily dose. If Xopenex does not provide relief at this dose, other medications will likely be needed to maintain long-term control of asthma or COPD symptoms.

How to take and store

Due to its convenience and simpler dosing regimen, Xopenex HFA is often the preferred choice for novice users. On the other hand, nebulizers are easier to use with young children and allow precise dosing in people with severe COPD or asthma. Talk to your doctor about the advantages and disadvantages of each.

Both can be stored at room temperature, ideally between 68 and 77 degrees Fahrenheit. Do not store it in direct sunlight and do not use it after the expiration date. Keep out of the reach of children.

Using the Xopenex HFA inhaler

  1. Remove the cap from the mouthpiece.
  2. Shake the canister for five seconds.
  3. If this is the first time the inhaler has been used, you must refill it. To do this, spray it from your face by pressing fully into the top of the bowl. Shake and repeat three more times.
  4. After filling, breathe out fully to empty your lungs.
  5. Holding the can upright, place the nozzle in your mouth and close your lips tightly to seal.
  6. Lower the top of the canister completely in one motion as you inhale.
  7. Remove the mouthpiece and hold your breath for 10 seconds.
  8. Shake and repeat steps 4-7 as necessary.
  9. Close the cover by pushing it until it clicks.

Using Xopenex spray solution

  1. Open the bag and remove a 3 milliliter (ml) vial.
  2. Check the bottle. The liquid should be clear; If it is discolored, do not use it. Make sure the dose is correct. The 0.31 mg dose has a green aluminum cap, the 0.63 mg dose has a yellow aluminum cap, and the 1.25 mg dose has a red aluminum cap .
  3. Open the bottle and pour the solution into the reservoir or nebulizer cup. If you are using a 1.25 mg strength, mix it with sterile saline according to the manufacturer's instructions before pouring it into the machine.
  4. Attach the nebulizer to a mask or mouthpiece.
  5. Put on the mask or mouthpiece securely and turn on the machine.
  6. Relax and inhale the mist until all of the solution is gone (5 to 15 minutes).
  7. Turn off the machine.
  8. Clean all parts of the nebulizer after each use.

Never mix another inhaled medicine with Xopenex Nebulizer Solution unless your healthcare professional tells you to.

Side effects

Xopenex is considered safe for long-term use with few excruciating side effects.

The risk of side effects depends on the dose, which means that it increases with the dose or the frequency of administration .


Common side effects of Xopenex HFA and Xopenex Solution include :

  • Dizziness
  • Headache
  • Runny nose
  • Throat pain
  • Stomach ache
  • Nervousness
  • Shaking
  • Bronchitis
  • Cardiopalmus
  • Nausea and vomiting
  • Chest pain
  • Palpitations

Most of these side effects are mild and go away without treatment in about an hour. Many of these will go away completely when your body adjusts to the medicine.

Severe form

There are several serious side effects associated with Xopenex. Some are life threatening and require immediate medical attention.

One such condition is known as paradoxical bronchospasm, in which an inhaled beta agonist causes an unexpected worsening of symptoms. Although the cause is not well understood, paradoxical bronchospasm often occurs the first time a new container or vial is used. It can be life threatening.

It is also important to be on the lookout for signs of allergy. Although this is rare, some people may develop a rash or hives after using Xopenex. The drug can also cause anaphylaxis , which, if left untreated, can lead to shock and death.

When to call 911

If breathing problems get worse after using Xopenex (or any other inhaled beta agonist), call 911.

Similarly, seek emergency medical attention if allergy symptoms develop rapidly and are accompanied by shortness of breath, wheezing, irregular heartbeat, dizziness, and swelling of the face or throat.

Warnings and interactions

Xopenex can affect potassium levels and, in some cases, lead to hypokalemia, a condition in which low potassium levels lead to muscle weakness, fatigue, cramps and stiffness, and tingling or numbness. It is important to tell your doctor if you experience these symptoms, as hypokalemia can increase your risk of cardiovascular side effects.

Don't take potassium supplements to avoid hypokalemia unless your healthcare provider tells you to. It can affect the way you take other medicines, including ACE inhibitors .

Drug interactions

Xopenex is known to interact with certain medications, increasing or decreasing the concentration of one or both medications, or causing serious side effects.

Drugs of concern include :

  • Beta- blockers such as Coreg (carvedilol) or Tenormin (atenolol)
  • Digoxin
  • Diuretics such as Lasix (furosemide) or Microzide (hydrochlorothiazide)
  • Adrenalin
  • MAOI antidepressants such as Emsam ((selegiline) or Marplan (isocarboxazid)
  • Tricyclic antidepressants such as amitriptyline or doxepin.

In some cases, dose adjustments or dividing doses from one to four hours may be sufficient to compensate for the interaction. In other cases, a change in treatment may be indicated. Others may not require any adjustments.

To avoid drug interactions, tell your doctor about all the medications and supplements you are taking before you start taking Xopenex. This includes pharmaceutical, over-the-counter, nutritional, herbal, and recreational medications.

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