Xopenex (Levalbuterol) – Inhalation

What Is Xopenex?

Xopenex (levalbuterol hydrochloride) is a prescription drug known as a rescue inhaler for the treatment or prevention of bronchospasms in adults, adolescents, and children 6 and older with asthma (reversible obstructive airway disease) or chronic pulmonary obstructive disease (COPD) in adults 18 and older.

Xopenex Inhalation Solution is in a drug class known as short-acting beta2-adrenergic agonists (SABA). These agonists make up a group of drugs prescribed to treat asthma. Xopenex works by relaxing the airways, making it easier to breathe.

Xopenex Inhalation Solution is available as a liquid administered via a nebulizer. A nebulizer turns liquid into a fine mist, which the person breathes in with a mouthpiece or mask.

Drug Facts

Generic Name: Levalbuterol

Brand Name(s): Xopenex, Xopenex HFA

Drug Availability: Prescription

Therapeutic Classification: Bronchodilator

Available Generically: Yes

Controlled Substance: N/A

Administration Route: Inhalation

Active Ingredient: Levalbuterol hydrochloride

Dosage Form(s): Nebulizer solution

What Is Xopenex Used For?

The Food and Drug Administration (FDA) approved Xopenex to prevent or treat bronchospasms in adults, adolescents, and children 6 and older with asthma.

It is also used in adults 18 and older with chronic pulmonary obstructive disease (COPD), which is a group of lung diseases that include emphysema and chronic bronchitis.

Emphysema causes shortness of breath due to damaged air sacs in the lungs, often developing after many years of smoking, while bronchitis is chronic and is an inflammation of the airways in the lungs that causes a mucus-filled cough for three months or longer.

How to Use Xopenex

If you are prescribed Xopenex:

  • Read the prescription label and the information leaflet that comes with your prescription.
  • Consult your healthcare provider if you have any questions.
  • Use Xopenex exactly as directed by your provider.

Speak to your healthcare provider if you have any questions or concerns about Xopenex.

Directions for using Xopenex are:

  • Open the foil pouch and remove one vial to use right away. Leave the rest of the vials in the pouch, protected from light and heat.
  • Hold the vial at the top. Twist the body of the vial to open.
  • Discard the top, and squeeze the contents of the vial into the nebulizer reservoir.
  • Connect the reservoir to the mouthpiece or face mask.
  • Connect the nebulizer to the compressor.
  • Sit down in a comfortable position and remain seated. Put the mouthpiece in your mouth, or put on the face mask. Turn the compressor on.
  • Breathe calmly, deeply, and evenly until there is no more mist in the reservoir. The treatment will take between five and 15 minutes. When there is no more mist in the reservoir, the treatment is complete.
  • Follow the manufacturer's instructions on cleaning and storing the nebulizer.

Storage

Store Xopenex solution in the foil pouch at room temperature, away from light and heat. Do not store it in the bathroom. Keep unopened vials in the pouch. Once the foil pouch is opened, use the vials within two weeks.

If a vial is removed from the pouch but not used right away, protect it from light and use it within seven days. Discard any vial where the solution is not colorless. Keep out of reach of children and pets.

Off-Label Uses

Sometimes Xopenex is used off-label for purposes that are not FDA-approved.

Healthcare providers may prescribe Xopenex nebulizer solution as an emergency treatment for high potassium levels until the person can have hemodialysis (a treatment that purifies the blood when the kidneys do not work properly).

Additionally, while Xopenex is approved for children 6 and older, some healthcare providers prescribe it off-label in younger children.

How Long Does Xopenex Take to Work?

Xopenex solution for the nebulizer starts working in about 10 to 17 minutes.

What Are the Side Effects of Xopenex?

The following is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

As with other medications, Xopenex can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.

Common Side Effects

Common side effects of Xopenex include:

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

  • Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, difficulty breathing, and require emergency medical attention.
  • Paradoxical bronchospasm: This is an unexpected narrowing of the airways that can occur after using the medication. Be alert to wheezing, choking, or difficulty breathing after using Xopenex.
  • Hypertension (high blood pressure): Symptoms may not occur at all, or you may have some symptoms like headaches and nosebleeds. Ask your healthcare provider if (and how often) you should monitor your blood pressure.
  • Hypotension (low blood pressure): Symptoms may include dizziness, light-headedness, fainting, and nausea.
  • Chest pain
  • Cardiac arrest: Also called a heart attack, this is a sudden loss of heart function, breathing, and consciousness due to an electrical disturbance in the heart.
  • Irregular heartbeat
  • Low potassium levels: Be alert to leg cramps, constipation, irregular heartbeat, fluttering in the chest, numbness/tingling, muscle weakness, or a limp feeling. You may also feel very thirsty and urinate more.
  • Hyperglycemia (high blood sugar): Symptoms may include fruity-smelling breath, excess thirst, hunger, excessive urination, weakness, tiredness, blurry vision, or weight loss.

Long-Term Side Effects

Xopenex is used as needed. Discuss potential long-term side effects with your healthcare provider.

You may or may not experience any long-term or delayed effects, which can include low potassium levels, high blood sugar, constipation, voice disorders, muscle cramps, weakness, or nosebleeds.

Report Side Effects

Xopenex may cause other adverse effects. Call your healthcare provider if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Xopenex Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For preventing or treating bronchospasm:
    • For inhalation aerosol dosage form:
      • Adults and children 4 years of age and older—Two puffs every 4 to 6 hours. In some patients one puff every 4 hours may be enough.
      • Children younger than 4 years of age—Use and dose must be determined by your doctor.
    • For inhalation solution dosage form (used with a nebulizer):
      • Adults and children 12 years of age and older—At first, 0.63 milligrams (mg) in the nebulizer 3 times a day, every 6 to 8 hours per day. Some patients may need to start at 1.25 mg in the nebulizer 3 times a day.
      • Children 6 to 11 years of age—0.31 mg in the nebulizer 3 times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 0.63 mg 3 times a day.
      • Children younger than 6 years of age—Use and dose must be determined by your doctor.

Modifications

Users should be aware of the following before beginning Xopenex:

Older adults: Generally, adults ages 65 years and older should start at a dose of 0.63 milligrams of Xopenex solution, with the healthcare provider closely monitoring the person. The healthcare provider may increase the dose if tolerated if more of a response is needed.

People with kidney problems: People with kidney problems may have a higher risk of toxic reactions. This includes older adults, who are more likely to have kidney problems. For these people, a lower dose may be warranted, along with frequent monitoring.

Pregnant people: There are no adequate and well-controlled studies of Xopenex in pregnant people. Therefore, pregnant people and people who are trying to become pregnant should consult their healthcare provider before using Xopenex.

Nursing people: There is no available data on the presence of Xopenex in human breast milk, the effects on the breastfed child, or the effects on milk production. Therefore, consult a healthcare professional before breastfeeding while using Xopenex.

Children: The safety and efficacy of Xopenex have been established in pediatric people 6 and younger in an adequate and well-controlled clinical trial. Due to a lack of comparable research, however, Xopenex is not prescribed for those younger than 6.

Missed Dose

If you miss a dose, use the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose.

Continue your regular dosing schedule. Do not use extra doses.

Overdose: What Happens If I Take Too Much Xopenex?

Taking too much Xopenex can cause seizures, chest pain, high or low blood pressure, fast heart rate, palpitations, irregular heartbeat, nervousness, headache, tremor, dry mouth, nausea, dizziness, and insomnia.

What Happens If I Overdose on Xopenex?

If you think you or someone else may have overdosed on Xopenex, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Xopenex, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

If you will be using this medicine for a long time, it is important that your doctor check your or your child's progress at regular visits. This will allow your doctor to see if the medicine is working properly and to check for any unwanted effects.

This medicine should not be used together with other similar inhaled medicines, such as albuterol (Accuneb®), isoproterenol (Isuprel®), metaproterenol (Alupent®), pirbuterol (Maxair®), or terbutaline (Brethaire®).

This medicine may cause paradoxical bronchospasm, which means your breathing or wheezing will get worse. Paradoxical bronchospasm may be life-threatening. Check with your doctor right away if you or your child have coughing, difficulty breathing, shortness of breath, or wheezing after using this medicine.

Talk to your doctor or get medical help right away if:

  • Your or your child's symptoms do not improve or they become worse after using this medicine.
  • Your inhaler does not seem to be working as well as usual and you need to use it more often.

You or your child may also be taking an antiinflammatory medicine, such as a steroid (cortisone-like medicine), together with this medicine. Do not stop taking the antiinflammatory medicine, even if your asthma seems better, unless you are told to do so by your doctor.

Levalbuterol may cause serious types of allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Check with your doctor right away if you or your child develop a skin rash, hives, itching, trouble breathing or swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Hypokalemia (low potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you or your child have more than one of the following symptoms: convulsions (seizures), decreased urine, dry mouth, increased thirst, irregular heartbeat, loss of appetite, mood changes, muscle pain or cramps, nausea or vomiting, numbness or tingling in the hands, feet, or lips, trouble breathing, or unusual tiredness or weakness.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Xopenex?

Xopenex is not appropriate for everyone. Before taking Xopenex, tell your healthcare provider about all of your medical conditions, your medical history, and your family history.

You should not take this medication if you are allergic to levalbuterol, albuterol, or any of the inactive ingredients in Xopenex. 

Xopenex may be prescribed with caution in some people and only if their healthcare provider determines it is safe.

This includes:

  • People who have taken a drug in the monoamine oxidase inhibitor (MAOI) class of drugs or a tricyclic antidepressant (TCA) within the past 14 days
  • People with ischemic heart disease (heart problems caused by narrow arteries)
  • People with high blood pressure
  • People with irregular heartbeat
  • People with low potassium levels
  • People with diabetes
  • People with seizure disorders
  • People with hyperthyroidism (overactive thyroid)
  • People with kidney problems
  • People in labor or delivery

What Other Medications May Interact With Xopenex?

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter (OTC) medicines, and vitamins or supplements. While taking Xopenex, do not start any new medications without approval from your healthcare provider.

Drugs that may cause interactions with Xopenex include:

Short-acting bronchodilators: Xopenex is a short-acting bronchodilator (a drug that increases airflow to the lungs). Other short-acting bronchodilators, such as albuterol, should not be combined with Xopenex. Combining drugs for the same purpose can cause heart problems.

Beta-blockers: People with asthma generally should not use beta-blockers. However, in some cases where there is no other choice, the healthcare provider may prescribe a cardioselective beta-blocker (a beta-blocker that only affects the heart, and not other body parts) with caution, such as Tenormin (atenolol) or Toprol XL (metoprolol succinate extended-release).

Diuretics: Combining a loop diuretic such as Lasix (furosemide) or thiazide diuretic such as hydrochlorothiazide, with Xopenex, may cause severely low potassium.

Lanoxin (digoxin): Xopenex may affect digoxin levels in the body, possibly making digoxin less effective. People who take both Lanoxin and Xopenex will need close monitoring of digoxin levels.

MAOIs and tricyclic antidepressants: Xopenex should not be combined with an MAOI (such as phenelzine or tranylcypromine) or a tricyclic antidepressant such as Elavil (amitriptyline) or Pamelor (nortriptyline). Xopenex should not be used for at least two weeks after the MAOI or TCA is stopped.

This is not a complete list of drug interactions. Other drug interactions may occur with Xopenex. Consult your healthcare provider for a complete list of drug interactions.

What Medications Are Similar?

Xopenex is a short-acting beta agonist (SABA). There is one other SABA on the market, with the generic name albuterol, which can be found under brand names such as ProAir HFA, Proventil HFA, and Ventolin HFA. Like Xopenex, albuterol is available as a solution for the nebulizer as well as an inhaler.

Often referred to as rescue medications, Xopenex and albuterol are drugs that open up the airways quickly, for fast relief of symptoms.

While SABAs are used for symptom relief, there are many drugs available for the maintenance treatment of asthma and COPD, which means they work to prevent symptoms.

Drugs called long-acting beta-agonists (LABAs) also open up the airways, but they are used as maintenance treatment because they do not work quickly as rescue medications do.

A LABA must always be used in combination with an inhaled corticosteroid (ICS).

This is because LABA alone can increase the risk of asthma-related death. When a LABA and an ICS are both needed, they can be prescribed as two individual products, or they can be prescribed as a combination inhaler that contains two ingredients, which can avoid the possibility of a person taking a LABA alone.

Examples of combination products include:

  • Advair, which contains the ICS fluticasone and LABA salmeterol
  • Breo Ellipta (fluticasone and vilanterol), which contains the ICS fluticasone furoate and LABA vilanterol
  • Dulera, which contains the ICS mometasone and LABA formoterol
  • Symbicort, which contains the ICS budesonide and LABA formoterol

There are also various other drugs that may be prescribed for asthma or COPD maintenance, such as oral medications like Singulair (montelukast)Biologics, which are injected, are sometimes used in people with difficult-to-control asthma.

The above is a list of drugs also prescribed for asthma/COPD. It is not a list of drugs recommended to take with Xopenex. Ask your pharmacist or a healthcare practitioner if you have questions.

Frequently Asked Questions

  • What is Xopenex used for?

    Xopenex contains the ingredient levalbuterol and is used to prevent or treat symptoms of lung conditions like asthma or COPD. Xopenex solution for the nebulizer can be used in adults and children 6 and older with asthma, or adults with COPD.

  • How does Xopenex work?

    Xopenex works by relaxing the airways, making it easier to breathe.

  • What drugs interact with Xopenex?

    Xopenex should not be taken with drugs in the MAOI or tricyclic antidepressant drug classes or within 14 days of stopping these other drugs. Other medications can interact with Xopenex, such as certain diuretics, beta-blockers, or heart medications.

    Before taking Xopenex, review your medication list with your healthcare provider.

  • How long does it take for Xopenex to work?

    The Xopenex HFA inhaler takes about five to 10 minutes to start working. Xopenex solution for the nebulizer takes about 10 to 17 minutes to start working.

  • What are the side effects of Xopenex?

    Common side effects may include vomiting, headache, nervousness, fast heart rate, palpitations, weakness, dizziness, chest pain, and symptoms of the flu or upper respiratory tract infection.

    Other, serious side effects may occur. Before taking Xopenex, discuss the side effects with your healthcare provider.

How Can I Stay Healthy While Taking Xopenex?

Before taking Xopenex, discuss your medical history and all medication you take with your healthcare provider.

When taking Xopenex, follow your healthcare provider’s instructions for use. Read the information leaflet that comes with your prescription and ask your provider if you have any questions about the drug or how to use or clean the nebulizer or inhaler.

Your healthcare provider will give you a treatment plan. You may use Xopenex alone as needed, or you may have other prescriptions that you take, too, depending on your symptoms and the severity of your condition.

While taking Xopenex, get medical help right away if your symptoms worsen, if the medicine does not work as well for your symptoms, or if you need to use your medicine more than usual. This may indicate that you need a change in your medication regimen.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. DailyMed. Label: Xopenex - levalbuterol hydrochloride solution.

  2. MedlinePlus. Levalbuterol oral inhalation.

  3. Prescribers’ Digital Reference. Levalbuterol hydrochloride - drug summary.

  4. American Academy of Allergy, Asthma & Immunology. Short-acting beta-agonists.

  5. American Academy of Allergy, Asthma & Immunology. Long-acting beta-agonists.

  6. Morales DR. LABA monotherapy in asthma: an avoidable problem. Br J Gen Pract. 2013;63(617):627-8. doi:10.3399/bjgp13X675250

By Karen Berger, PharmD
Karen Berger, PharmD, is a community pharmacist and medical writer/reviewer.