Levalbuterol (Xopenex): What It Does and How to Use It
Levalbuterol is a fast-acting bronchodilator used to open airways in asthma and COPD. It’s the active S-enantiomer of albuterol, which means it works similarly but some people tolerate it better. You’ll usually see it as a metered-dose inhaler (MDI) or a nebule for a nebulizer.
How people use levalbuterol and common doses
For quick relief, adults often use the MDI form labeled 45 mcg per puff — a common prescription is 2 puffs every 4–6 hours as needed. Nebulizer solutions are commonly 0.63 mg or 1.25 mg given by nebulizer every 6–8 hours, depending on symptom severity. Pediatric dosing varies by age and weight; follow the exact prescription from your doctor or the pharmacist’s label.
Always use the inhaler with a spacer if your provider suggests it — spacers help most medicine reach your lungs, not your mouth. If you use a nebulizer, make sure the machine and cups are clean and follow the device instructions each time.
What to watch for: side effects and interactions
Common side effects include tremor, nervousness, headache, increased heart rate, and mild throat irritation. These usually fade as the medicine wears off. Stop and call your provider or emergency services if you get chest pain, a very fast or irregular heartbeat, severe shortness of breath that doesn’t improve, fainting, or hives.
Levalbuterol can interact with beta-blockers (they can block its effect) and certain heart medicines or stimulants might increase the risk of fast heart rate or blood pressure changes. Tell your prescriber about heart disease, high blood pressure, seizures, thyroid disease, or diabetes before starting levalbuterol.
Pregnant or breastfeeding? Your doctor will weigh benefits and risks. Many prescribers consider short-acting bronchodilators acceptable when needed, but always check with your clinician.
If you’re switching from albuterol to levalbuterol, expect similar relief. Some patients report fewer side effects like jitteriness, but not everyone notices a difference. Never mix different inhaled medicines without guidance — your doctor can help set up the right schedule.
Store the inhaler and vials at room temperature away from direct heat. Check expiration dates and keep spare inhalers during allergy and cold seasons. If you rely on a rescue inhaler daily, talk to your clinician — needing it often usually means your long-term control needs adjustment.
Bottom line: levalbuterol is a quick rescue option for bronchospasm. Use the exact dose your provider prescribes, keep an eye on heart and tremor side effects, and get urgent care for severe breathing trouble or chest pain. If you have questions about dosing or interactions, your pharmacist is an easy, reliable resource to call.
