treats or prevents of airway spasms caused by asthma or COPD. Tell your doctor if you need to use levalbuterol more often than usual.

Levalbuterol Overview

Reviewed: July 9, 2014

Levalbuterol is a prescription medication used for the treatment or prevention of airway spasms caused by asthma or chronic obstructive pulmonary disease (COPD). Levalbuterol belongs to a group of drugs called beta agonists, or bronchodilators, which work by relaxing the tightened muscles around the airway passages to make breathing easier.

This medication comes in an inhaler to be breathed slowly into the lungs as needed during an asthma attack, or on a regular schedule, every 4 to 6 hours. Levalbuterol also comes as a solution (liquid) to be inhaled by mouth using a nebulizer every 6 to 8 hours. 
Common side effects of levalbuterol include sore throat, dizziness, and runny nose.

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Levalbuterol Cautionary Labels


Uses of Levalbuterol

Levalbuterol inhaler is an inhaled prescription medicine used to prevent or treat bronchospasm in patients, 4 years of age and older, with reversible bronchospasm including asthma and chronic obstructive pulmonary disease (COPD).

Levalbuterol solution (liquid) to be inhaled is a prescription medicine used to prevent or treat bronchospasm in patients, 6 years of age, and older with reversible bronchospasm including asthma and chronic obstructive pulmonary disease (COPD).

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.


Levalbuterol Brand Names

Levalbuterol may be found in some form under the following brand names:

Levalbuterol Drug Class

Levalbuterol is part of the drug class:

Side Effects of Levalbuterol

Levalbuterol can cause serious side effects. See "Drug Precautions" section.

The most common side effects of levalbuterol include:

  • accidental injury
  • bronchitis
  • dizziness
  • pain
  • sore throat
  • runny nose
  • vomiting
  • palpitations
  • chest pain
  • fast heart rate
  • tremors
  • nervousness

Tell your doctor if you have any side effects that bother you or that does not go away.

These are not all the possible side effects of levalbuterol. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Levalbuterol Interactions

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Levalbuterol may affect the way other medicines work, and other medicines may affect how levalbuterol works.

Especially tell your doctor if you take:

  • other asthma medicines
  • beta blockers such as metoprolol (Toprol XL, Lopressor), carvedilol (Coreg), bisoprolol (Zebeta), betaxolol (Kerlone), nebivolol (Bystolic), propranolol (Inderal, Pronol)
  • heart medicines
  • medicines that increase urination (diuretics) such as acetazolamide (Diamox), amiloride (Midamor), bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (Microzide, HCTZ), metolazone (Zaroxolyn), torsemide (Demadex), triamterene (Dyrenium, Dyazide, Maxzide)
  • Monoamine Oxidase Inhibitors such as tranylcypromine (Parnate), phenelzine (Nardil), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), and rasagiline (Azilect)
  • Tricyclic Antidepressants such as trimipramine (Surmontil), amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl), protriptyline (Vivactil), and clomipramine (Anafranil)
  • digoxin (Lanoxin)
  • medicine to treat chronic obstructive pulmonary disease (COPD) (methylxanthines)

Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.

Levalbuterol Precautions

Levalbuterol can cause serious side effects including:

  • sudden shortness of breath (bronchospasm). Sudden shortness of breath can happen right away after using levalbuterol.
  • worsening asthma
  • heart problems
  • death. If you use too much levalbuterol you can have heart or lung problems that can lead to death.
  • serious allergic reactions. Call your doctor and stop using levalbuterol right away if you have any symptoms of an allergic reaction such as:
    • swelling of the face, throat or tongue
    • hives
    • rash
    • breathing problems
  • low potassium levels in your blood

Call your doctor or go to the nearest hospital emergency room right away if you have any of the serious side effects listed above or if you have worsening lung symptoms.

Levalbuterol inhalation can sometimes cause wheezing and difficulty breathing immediately after it is inhaled, especially the first time you use a new canister of levalbuterol. If this happens, call your doctor right away. Do not use levalbuterol inhalation again unless your doctor tells you that you should.

Do not use levalbuterol if you are allergic to levalbuterol, racemic albuterol or any of the ingredients in levalbuterol.

Levalbuterol Food Interactions

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of levalbuterol there are no specific foods that you must exclude from your diet when receiving levalbuterol.

Inform MD

Before you use levalbuterol, tell your doctor if you have:

  • heart problems such as irregular heartbeat or any other type of heart disease
  • high blood pressure
  • seizures
  • diabetes
  • thyroid problems
  • kidney disease
  • any other medical conditions
  • are pregnant or plan to become pregnant
  • are breastfeeding

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Levalbuterol and Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Levalbuterol falls into category C. There are no good studies that have been done in humans with levalbuterol. But in animal studies, pregnant animals were given this medication, and the babies did not show any medical issues related to this medication.

Levalbuterol and Lactation

Tell your doctor if you are breastfeeding or plan to breastfeed. 

It is not known if levalbuterol crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using levalbuterol.

Levalbuterol Usage

Use levalbuterol exactly as your doctor tells you to. Do not change your dose without talking to your doctor first.

  • Your doctor will tell you how many times and when to use levalbuterol.
  • An adult should help a child use levalbuterol.
  • Do not use levalbuterol more often than your doctor tells you to.
  • Get medical help right away if levalbuterol:
    • does not work as well for your asthma symptoms
    • your asthma symptoms get worse
    • you need to use levalbuterol more often than usual
  • If you also use another medicine by inhalation, you should ask your doctor for instructions on when to use it while you are also using levalbuterol.

To use levalbuterol inhaler, follow these steps:

  1. Remove the protective dust cap from the end of the mouthpiece. Check the mouthpiece for dirt or other objects. Be sure that the canister is fully and firmly inserted in the mouthpiece.

  2. Shake the inhaler well.

  3. If you are using the inhaler for the first time or if you have not used the inhaler in more than 3 days, you will need to prime it. To prime the inhaler, press down on the canister four times to release four sprays into the air, away from your face. Be careful not to get levalbuterol in your eyes.

  4. Breathe out as completely as possible through your mouth.

  5. Hold the canister with the mouthpiece on the bottom, facing you, and the canister pointing upward. Place the open end of the mouthpiece into your mouth. Close your lips tightly around the mouthpiece.

  6. Breathe in slowly and deeply through the mouthpiece.At the same time, press down once on the container with your middle finger to spray the medication into your mouth.

  7. As soon as the medication is released, remove your finger from the canister and remove the mouthpiece from your mouth.

  8. Try to hold your breath for 10 seconds.

  9. If you were told to use two puffs, wait 1 minute and then repeat steps 4 to 8.

  10. Replace the protective cap on the inhaler.

To use the solution or the concentrated solution for oral inhalation (nebulizer treatment), follow these steps:

  1. Open the foil pouch by tearing through the rough edge along the side of the pouch and remove one vial. Leave the rest of the vials inside the foil pouch to protect them from light. Look at the solution in the vial to be sure it is colorless. If it is not colorless, call your doctor or pharmacist and do not use the solution.

  2. Twist off the top of the vial and squeeze all of the liquid into the reservoir of your nebulizer. Do not add any other medications to the nebulizer because it may not be safe to mix them with levalbuterol. Use all nebulized medications separately unless your doctor specifically tells you to mix them.

  3. If you are using the concentrated solution, add the amount of normal saline that your doctor told you to use to the reservoir. Gently swirl the nebulizer to mix the normal saline and the concentrated solution.

  4. Connect the nebulizer reservoir to your mouthpiece or face mask.

  5. Connect the nebulizer to the compressor.

  6. Sit upright and place the mouthpiece in your mouth or put on the face mask.

  7. Turn on the compressor.

  8. Breathe calmly, deeply, and evenly until mist stops forming in the nebulizer. This should take between 5 and 15 minutes.

  9. Clean the nebulizer according to the manufacturer's instructions.

Clean your inhaler or nebulizer regularly. Follow the manufacturer's directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler or nebulizer. If you do not clean your inhaler properly, the inhaler may become blocked and may not spray medication. If this happens, follow the manufacturer's directions for cleaning the inhaler and removing the blockage.


Levalbuterol Dosage

Levalbuterol Inhaler for Bronchospasm

The usual dosage of levalbuterol is 2 inhalations every 4 to 6 hours. For some people, one inhalation every 4 hours may be sufficient to control asthma symptoms.

Levalbuterol Nebulizer Treatment

The solution for oral inhalation is usually used three times a day, once every 6 to 8 hours.

  • Children 6–11 years old: The recommended dosage of Levalbuterol solution  for patients 6–11 years old is 0.31 mg administered three times a day, by nebulization. Routine dosing should not exceed 0.63 mg three times a day.
  • Adults and Adolescents ≥ 12 years old: The recommended starting dosage of Levalbuterol solution for patients 12 years of age and older is 0.63 mg administered three times a day, every 6 to 8 hours, by nebulization.
  • Patients 12 years of age and older with more severe asthma or patients who do not respond adequately to a dose of 0.63 mg of Levalbuterol solution may benefit from a dosage of 1.25 mg three times a day.

Do not use levalbuterol more often than your doctor prescribes it. Talk to your doctor if you need to use levalbuterol more often than prescribed. Your doctor may decide you need an additional asthma medication.


Levalbuterol Overdose

If you take too much levalbuterol, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

Other Requirements

  • Store levalbuterol inhaler and solution between 68°F to 77°F (20°C to 25°C).
  • Keep levalbuterol and all medicines out of the reach of children.

Levalbuterol Inhaler:

  • Keep levalbuterol inhaler away from heat or open flame.
  • Keep levalbuterol inhaler away from freezing temperatures and direct sunlight.
  • Do not puncture the levalbuterol inhaler.
  • Store levalbuterol inhaler with the mouthpiece down.
    The levalbuterol inhaler should be safely thrown away after using:
    • 200 actuations for the 15 gram canister.
    • 80 actuations for the 8.4 gram canister.
  • Do not throw levalbuterol inhaler into a fire or an incinerator.
  • Avoid spraying in eyes.

Levalbuterol Solution for Inhalation:

  • Protect from light and excessive heat.
  • Keep unopened vials in the foil pouch.
  • Once the foil pouch is opened, the vials should be used within 2 weeks.
  • Vials removed from the pouch, if not used immediately, should be protected from light and used within 1 week.
  • Discard any vial if the solution is not colorless.