Nurses Compass
Drug Guide
Levalbuterol Tartrate
Classification
Therapeutic: Bronchodilator for asthma and COPD
Pharmacological: Selective beta2-adrenergic receptor agonist
FDA Approved Indications
- Relief of bronchospasm in patients with reversible airway obstruction due to asthma or COPD
Mechanism of Action
Levalbuterol stimulates beta2-adrenergic receptors in smooth muscle of the airways, leading to relaxation of bronchial muscles and resulting in bronchodilation.
Dosage and Administration
Adult: 90 mcg inhaled every 4 to 6 hours as needed; maximum dose varies based on patient's response
Pediatric: Same as adult, typically 45 mcg or 90 mcg per inhalation, based on age and severity; dosing should be individualized
Geriatric: Use with caution due to increased risk of cardiovascular side effects; start at lower end of dosing range
Renal Impairment: No specific adjustment; monitor for increased side effects
Hepatic Impairment: Use with caution; no specific dose adjustment
Pharmacokinetics
Absorption: Rapid after inhalation
Distribution: Widely distributed, minimal protein binding
Metabolism: Primarily metabolized in the liver by conjugation
Excretion: Excreted mainly in urine as metabolites
Half Life: Approximately 3.3 hours
Contraindications
- Hypersensitivity to levalbuterol or other sympathomimetics
Precautions
- Use with caution in patients with cardiovascular disorders, especially arrhythmias, hypertension, or ischemic heart disease; monitor for tachycardia, hypokalemia, and paradoxical bronchospasm
Adverse Reactions - Common
- Tremor (Common)
- Nervousness (Common)
- Headache (Less common)
- Throat irritation (Less common)
Adverse Reactions - Serious
- Cardiac arrhythmias (Rare)
- Hypokalemia (Rare)
- Paradoxical bronchospasm (Rare)
Drug-Drug Interactions
- Other sympathomimetics, tricyclic antidepressants, and MAO inhibitors may increase adrenergic side effects
Drug-Food Interactions
- No significant interactions reported
Drug-Herb Interactions
- Limited data; caution advised when combining with herbal supplements that have stimulant properties
Nursing Implications
Assessment: Monitor lung function (PEF, FEV1), heart rate, blood pressure, and potassium levels before and during therapy
Diagnoses:
- Ineffective airway clearance
- Risk for cardiovascular complications
Implementation: Educate patient on proper inhaler technique, monitor for adverse effects, and assess response to therapy
Evaluation: Determine improvement in airway function and symptom control, monitor for adverse reactions
Patient/Family Teaching
- Use inhaler as prescribed, do not exceed recommended dose
- Notify healthcare provider if paradoxical bronchospasm occurs or if symptoms worsen
- Report new cardiovascular symptoms such as chest pain or irregular heartbeat
- Carry rescue inhaler at all times
Special Considerations
Black Box Warnings:
- None specifically for levalbuterol
Genetic Factors: None identified
Lab Test Interference: None known
Overdose Management
Signs/Symptoms: Severe tachycardia, hypokalemia, hypertension, tremors, nervousness, seizures in extreme cases
Treatment: Discontinue drug, monitor vital signs, treat symptoms supportively, administer beta-blockers cautiously if needed for severe reactions
Storage and Handling
Storage: Store at room temperature, away from heat and moisture
Stability: Stable when stored properly