Levalbuterol (Generic Xopenex)

What is generic Xopenex?

Xopenex is the US brand of levalbuterol (levosalbutamol), a short-acting rescue medicine that opens tightened airways within minutes. People searching for generic Xopenex often find Cipla's Levolin range, which contains the same active ingredient as an inhaler, Rotacaps, nebulizer respules and tablets. Levolin is made and licensed in India; use it only as your doctor prescribes.

Levalbuterol is the active "R" form of albuterol (salbutamol). It relaxes the muscle around the airways, easing wheeze and breathlessness. Xopenex HFA is labeled to treat or prevent bronchospasm in people aged 4 and older with reversible obstructive airway disease, such as asthma (Xopenex HFA label on DailyMed).

Which Levolin products are available?

Rotacaps need a Rotahaler Inhalation Device (from $4), and respules need a nebulizer. Prices can change. Delivery to the USA takes about 6–15 days, and customs can add delays, so reorder early.

Is Levolin 50 mcg the same as Xopenex HFA 45 mcg?

They contain the same medicine at a similar dose, but the two labels do not describe the dose the same way. The Xopenex HFA label states that each puff releases 51.6 mcg of levalbuterol from the valve and delivers 45 mcg from the mouthpiece. Levolin Inhaler is usually labeled as 50 mcg per puff. Check your canister, and ask your doctor how many puffs to take if you switch.

Is levalbuterol better than albuterol?

Regular albuterol is a 50:50 mix of two mirror-image forms. Levalbuterol contains only the R form, which opens the airways, so it works at a smaller dose, and the hope was that it would cause fewer side effects.

The evidence for a real advantage is limited. In an adult and teen study described in the US nebulizer label, 0.63 mg of levalbuterol and 2.5 mg of albuterol gave clinically comparable results, and in children aged 6 to 11, onset and duration were comparable to albuterol (Xopenex inhalation solution label). A 2009 chart review at one US community hospital found no clinically significant difference in heart-rate change between the two, and noted that levalbuterol's theoretical advantage had not been well proven in hospitalized patients (Pharmacy and Therapeutics, 2009).

Switching is a decision for your doctor. For albuterol options, see Asthalin vs Ventolin.

How do you choose a form?

• Levolin Inhaler: the closest match to Xopenex HFA and the easiest to carry. A spacer helps anyone who struggles to press and breathe in at the same time.
• Levolin Rotacaps: a powder capsule breathed in quickly and deeply from a Rotahaler, which can be hard during a bad flare. Xopenex has no dry-powder version. Check the leaflet for lactose if you have a milk-protein allergy.
• Levolin Respules: for people who find a handheld inhaler hard to use, in the same three strengths as Xopenex inhalation solution.
• Levolin tablets: Xopenex does not come as a tablet, so there is no US label to compare doses with. Tablets act more slowly than an inhaled dose and do not replace a rescue inhaler.

What is the usual dose?

These are US label doses for Xopenex. Follow your own prescription, and the Levolin leaflet for Rotacaps and tablets.

• Inhaler, age 4 and older: 2 puffs every 4 to 6 hours; for some people, 1 puff every 4 hours is enough.
• Nebulizer, age 12 and older: 0.63 mg three times a day, every 6 to 8 hours. People with more severe asthma, or who do not respond well enough, may be prescribed 1.25 mg three times a day, the maximum labeled dose.
• Nebulizer, age 6 to 11: 0.31 mg three times a day, and routinely no more than 0.63 mg three times a day. It is not labeled for children under 6.

Needing more doses than usual can mean your asthma is getting worse, so see your doctor promptly.

How do you use each form?

Inhaler

1. Shake well. The Xopenex HFA label says to prime with 4 sprays away from your face when new or unused for more than 3 days; follow the Levolin leaflet for its own advice.
2. Breathe out fully, seal your lips around the mouthpiece, and press the canister once as you start a slow, deep breath in.
3. Hold your breath for about 10 seconds. If a second puff is prescribed, wait about 1 minute (MedlinePlus).
4. Weekly, remove the canister, rinse the plastic actuator in warm water and air-dry it. Replace the canister after 200 puffs.

Rotacaps

Place one capsule in the Rotahaler, twist to open it, and breathe in quickly and deeply. Never swallow the capsules, and keep them dry.

Respules

Squeeze one respule into the nebulizer cup, and do not add other medicines unless your doctor says so. Sit upright and breathe calmly until no more mist appears, usually 5 to 15 minutes. Use only a clear, colorless solution.

What side effects can levalbuterol cause?

Common effects include nervousness, shakiness (tremor), headache, dizziness, a sore throat and a runny nose. In US studies of the inhaler, vomiting was more common than with placebo in children aged 4 to 11. In the US nebulizer study, nervousness and tremor were more frequent at 1.25 mg than at 0.63 mg.

Get urgent help if wheezing or breathlessness suddenly worsens right after a dose (paradoxical bronchospasm), or if you develop hives, a rash, chest pain, a fast or pounding heartbeat, or swelling of the face, lips or throat. Levalbuterol can lower blood potassium, and using much more than prescribed can be dangerous.

Who should not use levalbuterol?

Do not use it if you are allergic to levalbuterol or albuterol. Tell your doctor first if you have heart disease, an irregular heartbeat, high blood pressure, seizures, an overactive thyroid, diabetes or kidney disease, or if you are pregnant or breastfeeding.

Interacting medicines include beta-blockers, which can trigger severe bronchospasm, water pills that are not potassium-sparing, digoxin, and MAO inhibitors or tricyclic antidepressants taken within the past 2 weeks. The US label also advises against using another short-acting bronchodilator inhaler, such as albuterol, or epinephrine at the same time.

Frequently asked questions

Is Levolin the same as Xopenex?

It contains the same active ingredient, levalbuterol, but comes from a different maker, in different devices, with puffs labeled differently. Levolin is made and licensed in India.

Is levalbuterol a preventer?

No. It is a short-acting reliever, and the US label says it is not a substitute for corticosteroids. If you need it often, ask about a daily preventer; see our guide to asthma inhalers.

Does levalbuterol cause fewer jitters than albuterol?

That was the hope, but studies have not shown a clear, consistent advantage, and both can cause tremor and a fast heartbeat.

How long does a Levolin inhaler last?

It holds 200 puffs, so it depends on how often you need it. At 2 puffs four times a day, it would last 25 days, and priming sprays use up puffs too.

This article gives general information and does not replace advice from your doctor or pharmacist. Levalbuterol is a prescription medicine; use it only as prescribed, and get emergency care if a rescue dose does not ease a severe attack.