Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (20)
- amisulpride
amisulpride and levalbuterol both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- 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 (258)
- 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.
- deutetrabenazine
deutetrabenazine and levalbuterol both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- 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. - dolasetron
dolasetron and levalbuterol both increase QTc interval. Use Caution/Monitor.
- donepezil
donepezil and levalbuterol both increase QTc interval. 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.
doxepin and levalbuterol both increase QTc interval. 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.
- efavirenz
efavirenz and levalbuterol both increase QTc interval. Use Caution/Monitor.
- encorafenib
encorafenib and levalbuterol both increase QTc interval. Use Caution/Monitor.
- entrectinib
entrectinib and levalbuterol both increase QTc interval. Use Caution/Monitor.
- 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. - eribulin
eribulin and levalbuterol both increase QTc interval. 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.
- fingolimod
fingolimod and levalbuterol both increase QTc interval. 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.
- gemifloxacin
gemifloxacin and levalbuterol both increase QTc interval. Use Caution/Monitor.
- gentamicin
levalbuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.
- gilteritinib
gilteritinib and levalbuterol both increase QTc interval. 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.
- serdexmethylphenidate/dexmethylphenidate
levalbuterol and serdexmethylphenidate/dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. 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.
- valbenazine
valbenazine and levalbuterol both increase QTc interval. 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.
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
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
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.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
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| 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 - | 0.31 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/0.5 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 - | 0.63 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/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 - | 0.31 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 - | 1.25 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/0.5 mL nebulizer soln |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
levalbuterol HCl inhalation
LEVALBUTEROL PRE-MIXED SOLUTION - INHALATION
(LEV-al-BUE-ter-ol)
COMMON BRAND NAME(S): Xopenex
USES: Levalbuterol is used to treat wheezing and shortness of breath that commonly occur with lung problems (such as asthma, chronic obstructive pulmonary disease). It is a quick-relief drug. Controlling these symptoms can decrease time lost from work or school. 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.
HOW TO USE: Read the Patient Information Leaflet available from your pharmacist before you start using this medication and each time you get a refill. This product is used with a special machine called a nebulizer that changes the solution to a fine mist that you breathe in. Consult your doctor, pharmacist, or respiratory therapist on how to inhale this medication properly with this equipment. If a child is using this equipment, a parent or other responsible adult should supervise the child.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.This product does not require any mixing before use unless your doctor instructs you otherwise. This medication is inhaled into the lungs using a nebulizer 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 medications in the nebulizer. To prevent infections, clean the nebulizer and mouthpiece/face mask according to the manufacturer's directions.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: Headache, nervousness, shaking (tremor), dizziness, trouble sleeping, dry mouth, nausea, stomach upset, diarrhea, or runny nose may occur. If any of these effects last or get worse, 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, anxiety, swollen glands.Get medical help right away if you have any very serious side effects, including: irregular heartbeat, chest pain, 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 using levalbuterol, tell your doctor or pharmacist if you are allergic to it; or to similar bronchodilators (such as albuterol, metaproterenol, salmeterol); or to sympathomimetic drugs (such as epinephrine, pseudoephedrine); 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: heart disease (such as irregular heartbeat, angina, heart attack), high blood pressure, seizures, diabetes.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.Avoid allergens, irritants, smoking and other factors that make asthma worse.Lab and/or medical tests (such as blood pressure, heart rate, EKG) may be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.Learn to use a peak flow meter, use it daily, and promptly report worsening asthma (such as readings in the yellow/red range or increased use of quick-relief inhalers).
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 vials within 2 weeks. Once vials are removed from the foil pouch, use right away, or protect from light and use within 1 week. 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 December 2022. Copyright(c) 2023 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.
Formulary
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.
