Generic Name: levalbuterol inhalation (leh val BYOO ter all)
Brand Names: Xopenex, Xopenex Concentrate

What is Xopenex?

Xopenex (levalbuterol) is a bronchodilator that relaxes muscles in the airways and increases air flow to the lungs.

Xopenex inhalation is used to treat or prevent bronchospasm in people with reversible obstructive airway disease.

Xopenex may also be used for purposes not listed in this medication guide.

Important information

You should not use Xopenex if you are allergic to levalbuterol or albuterol (Accuneb, ProAir, Proventil, Ventolin).

Before using Xopenex, tell your doctor if you have heart disease, high blood pressure, congestive heart failure, a heart rhythm disorder, a seizure disorder, diabetes, or overactive thyroid.

Tell your doctor about all other medicines you use, especially heart or blood pressure medication, diuretics (water pills), antidepressants, or other inhaled bronchodilators.

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Talk with your doctor if any of your asthma medications do not seem to work as well in treating or preventing attacks. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor. An increased need for medication could be an early sign of a serious asthma attack.

Xopenex comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

It is very important that you use nebulized Xopenex properly, so that the medicine gets into the lungs. Talk to your doctor about proper nebulizer use.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of levalbuterol can be fatal.

Before using Xopenex

You should not use Xopenex if you are allergic to levalbuterol or albuterol (Accuneb, ProAir, Proventil, Ventolin).

To make sure you can safely use Xopenex, tell your doctor if you have any of these other conditions:

  • heart disease, high blood pressure, or congestive heart failure;

  • a heart rhythm disorder;

  • a seizure disorder;

  • diabetes; or

  • overactive thyroid.

FDA pregnancy category C. It is not known whether Xopenex will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using Xopenex. It is not known whether levalbuterol passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using levalbuterol. A Xopenex inhaler should not be given to a child younger than 4 years old. Xopenex solution in a nebulizer should not be given to a child younger than 6 years old.

See also: Pregnancy and breastfeeding warnings (in more detail)

How should I use Xopenex?

Use Xopenex exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Use only the prescribed dose of this medicine and follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits of using Xopenex.

When using the Xopenex inhaler device for the first time, prime it by spraying 4 test sprays into the air, away from your face. Shake well before priming. Also prime the inhaler if you have not used it for 3 days or longer, or if you have dropped the inhaler.

Xopenex comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

The instructions below are for standard use of the inhaler and nebulizer devices. Your doctor may want you to use your device differently. Use only the inhaler device provided with your medicine or you may not get the correct dose.

To use the inhaler:

  • Shake the canister well just before each spray.
  • Uncap the mouthpiece of the inhaler. Breathe out fully. Put the mouthpiece into your mouth and close your lips. Breathe in slowly while pushing down on the canister. Hold your breath for 10 seconds, then breathe out slowly.

  • If you use more than one inhalation at a time, wait at least 1 minute before using the second inhalation and shake the inhaler again.

  • Keep your Xopenex inhaler clean and dry, and store it with the cap on the mouthpiece. Clean your inhaler once a week by removing the canister and placing the mouthpiece under warm running water for at least 30 seconds. Shake out the excess water and allow the parts to air dry completely before putting the inhaler back together.

To use the solution with a nebulizer:

  • Open the foil pouch and remove one vial of Xopenex solution. Do not use the medication if it does not appear clear and colorless.

  • Gently twist open the vial and squeeze all of the medicine out into the chamber of the nebulizer. The medicine must be used right away after opening the vial. Throw away any medicine in the vial if it is opened and not used right away.

  • Attach the mouthpiece or face mask to the drug chamber. Then, attach the drug chamber to the compressor.

  • Sit upright in a comfortable position. Place the mouthpiece into your mouth or put the face mask on, covering your nose and mouth. Turn on the compressor.

  • Breathe in slowly and evenly until you have inhaled all of the Xopenex solution (usually 5 to 15 minutes). The treatment is complete when no more mist is formed by the nebulizer and the drug chamber is empty.

  • Clean the nebulizer after each use. Follow the cleaning directions that came with your nebulizer.

Each single use vial (bottle) of this medicine is for one use only. Throw away after one use, even if there is still some medicine left in it after inhaling your dose.

If you also use a steroid inhaler, use your Xopenex nebulization solution first to open up your airways, then use the steroid inhaler as directed.

Do not mix other medicines for nebulization with a dose of Xopenex unless specifically directed to do so by your doctor.

It is very important that you use nebulized Xopenex properly, so that the medicine gets into your lungs. Talk to your doctor about proper nebulizer use.

Talk with your doctor if any of your asthma medications do not seem to work as well in treating or preventing attacks. If it seems like you need to use more of any of your medications in a 24-hour period, talk with your doctor.

An increased need for medication could be an early sign of a serious asthma attack.

Store Xopenex vials in the protective foil pouch at room temperature, away from moisture and heat. Protect from light.

Keep each vial in the foil pouch until you are ready to prepare a dose in the nebulizer. If you do not use a vial right away, protect the vial from light and use it within 1 week after removing it from the foil pouch. Once you have opened the foil pouch, all of the vials should be used within 2 weeks.

Keep the Xopenex inhaler away from open flame or high heat, such as in a car on a hot day. The canister may explode if it gets too hot. Do not puncture or burn an empty inhaler canister.

What happens if I miss a dose?

Use the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and use the next one as directed. Do not use a double dose of this medication.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Xopenex can be fatal.

Overdose symptoms may include severe forms of some of the side effects listed in this medication guide.

What should I avoid?

Avoid situations that may make your condition worse such as exercising in cold, dry air; smoking; breathing in dust; and exposure to allergens such as pet fur.

Xopenex side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Xopenex: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;

  • chest pain and fast, pounding, or uneven heart beats;

  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or

  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Less serious Xopenex side effects may include:

  • headache, tremors, feeling anxious or nervous;

  • sleep problems (insomnia);

  • cough, runny or stuffy nose;

  • mild nausea, vomiting;

  • dry mouth and throat;

  • muscle pain; or

  • diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Xopenex?

Tell your doctor about all other medicines you use, especially:

  • digoxin (Lanoxin, Lanoxicaps);

  • epinephrine (Adrenaclick, EpiPen, Twinject);

  • another inhaled bronchodilator;

  • an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan, Silenor), nortriptyline (Pamelor), and others;

  • a beta blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Dutoprol, Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), propranolol (Inderal, InnoPran), sotalol (Betapace), and others;

  • a diuretic (water pill) such as bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor HCT, Vaseretic, Zestoretic), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), torsemide (Demadex), and others; or

  • an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate).

This list is not complete and other drugs may interact with Xopenex. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about Xopenex.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

Copyright 1996-2014 Cerner Multum, Inc. Version: 6.01. Revision Date: 2012-07-12, 3:19:23 PM.

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