NATIONAL
CALIFORNIA
VENTURA
policies
- VC 705.2 Allergic Reaction and Anaphylaxis
- VC 705.11 Crush Injury/Syndrome
- VC 705.21 Shortness of Breath - Pulmonary Edema
- VC 705.22 Shortness of Breath – Wheezes
- SB 533-07 Anaphylaxis / Allergic Reaction
- SB 533-26 Potential Crush Injury / Crush Syndrome
- SB 533-18 Shortness of Breath
- LA County Ref. No. 1237 Respiratory Distress
- LA County Ref. No. 1242 Crush Injury / Syndrome
category
mechanism
- Relaxes bronchial smooth muscle by action on beta-2 receptors with little effect on heart rate.
- Stimulates the Na+/K+ pump, leading to transport of potassium from the extracellular space into the cell.
indications
- Bronchospasm: Treatment or prevention of bronchospasm in patients with reversible obstructive airway disease (eg, asthma).
- Hyperkalemia: Treatment of hyperkalemia by shifting potassium into the intracellular space.
- Crush Injury: Treatment of potential hyperkalemia due to crush injury from cellular damage causing release of intracellular potassium.
contraindications
- Use with caution in patients with cardiac disease, hypertension, hyperthyroidism, diabetes, glaucoma, and seizure disorder.
dosing
Adult
Nebulized: 2.5 mg
Inhaler: 4 inhalations (180 mcg)
Pediatrics
Nebulized: 1.25 mg
Inhaler: 2 inhalations (90 mcg)
administration
Nebulizer: adjust nebulizer flow to deliver dosage over 5 to 15 minutes; use a mask device if patient unable to hold mouthpiece in mouth for administration. Compatible with Atrovent in nebulizer.
Inhalers: Shake well before use; prime prior to first use, and whenever inhaler has not been used for > 2 weeks or when it has been dropped, by releasing 4 test sprays into the air.
Inhalers: Shake well before use; prime prior to first use, and whenever inhaler has not been used for > 2 weeks or when it has been dropped, by releasing 4 test sprays into the air.
onset
≤5 minutes
duration
3 to 6 hours
notes
- Albuterol vs levalbuterol: Albuterol exists in 2 mirror forms called isomers - like a right and left hand. Albuterol is a racemic (1:1) mixture of these isomers - the active form, (R)-albuterol, or levalbuterol, and (S)-albuterol, classically considered inert. It had been hoped that levalbuterol might cause fewer stimulatory side effects than albuterol, but this difference has not been demonstrated with certainty.
- Adrenergic Medications: Concurrent use with other adrenergic medications will result in increased adrenergic side effects (e.g. methamphetamine, cocaine, MDMA, pseudoephedrine, Ritalin)
- Monoamine Oxidase Inhibitors: Use with MAOIs may lead to hypertensive crisis (isocarboxazid, phenelzine, tranylcypromine, and selegiline)
- Beta-blockers: Beta-blocking agents inhibit the effects of levalbuterol
dosage form
Nebulization Solution: 1.25 mg/3 mL (3 mL)
1.25 mg/0.5 mL (0.5 mL)
Inhalation: 45 mcg/actuation
1.25 mg/0.5 mL (0.5 mL)
Inhalation: 45 mcg/actuation
brand name
Xopenex
adverse reactions
- Respiratory
- Paradoxical bronchospasm with an incidence in the literature ~ 4%
- Cardiovascular
- Mild tachycardia
- Cardiac arrhythmias
- Central Nervous System
- Excitement
- Nervousness
- Tremor
- Anxiety
- Hyperactive behavior
- Insomnia
structure
