Levalbuterol Hydrochloride, Inhalation

What are other names for this medicine?

Type of medicine: bronchodilator

Generic and brand names: levalbuterol hydrochloride, inhalation; levalbuterol, solution; Xopenex HFA; Xopenex Solution

What is this medicine used for?

This medicine is known as a bronchodilator. Bronchodilators are commonly used to treat the symptoms of lung diseases such as emphysema, bronchitis, and asthma. They relieve difficulty in breathing, shortness of breath, coughing, and wheezing. They may be used before exercise to prevent exercise-induced asthma.

What should my healthcare provider know before I take this medicine?

Before taking this medicine, tell your healthcare provider if you have:

• an allergy to any medicine
• diabetes
• high blood pressure
• heart disease including abnormal heartbeat and angina (chest pain)
• hypokalemia (low blood potassium)
• seizures
• thyroid problems

Talk with your healthcare provider if you are using any other short-acting aerosol bronchodilator or beta blocker medicine. When you use these medicines together with this one, it may affect your heart.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I use it?

This medicine is inhaled by mouth in one of two ways:

• a solution for use in a drops placed in a nebulizer
• aerosol spray from a metered dose inhaler (MDI), which delivers a measured dose each time you press down.

Check the label on the medicine for directions about your specific dose. Use this medicine exactly as your healthcare provider prescribes. Do not change your dosage without your healthcare provider's approval. Using too much may increase the risk of side effects. An adult should supervise the use of this medicine by a child.

Usually you will use this medicine according to a regular schedule. Ask your healthcare provider if you should use this medicine during an asthma attack.

If you are using any other inhaled medicine, wait at least 5 minutes between doses of your medicines.

Carefully read and follow all directions that come in your medicine package.

Aerosol products may come with a spacer for the MDI. The spacer helps you get the right amount of medicine.

Keep the aerosol mist away from your eyes to avoid irritation.

If you have the aerosol inhaler:

1. Wash your hands before using this medicine. Prime the aerosol unit before using it for the first time. Do this by pressing on the top of the canister with your index finger 4 times to release 4 puffs of mist into the air away from your face and eyes. You may also have to prime the aerosol unit if it hasn't been used for several days. If you are not using a spacer, the technique most often recommended is as follows:
2. Shake the metered dose inhaler (MDI) vigorously.
3. Hold the MDI upright so the mouthpiece is at the bottom.
4. Breathe out fully through the mouth expelling as much air from the lungs as possible.
5. Hold the unit upright between your index finger on top and your thumb at the bottom of the unit. The best way to use the MDI is to hold the mouthpiece 1-and-1/2 to 2 inches in front of an open mouth (about 2 to 3 finger widths). Try this technique first. It helps keep medicine from ending up in your mouth, which may cause increased side effects. It also helps medicine to reach your lungs rather than the back of the throat. If the open mouth technique is too hard, you may also place the MDI mouthpiece directly into your mouth and close your lips snugly around it. Talk with your provider or pharmacist about this.
6. Press the MDI down once so it releases a spray of medicine into your mouth while you breathe in slowly through the mouth. (One spray is called a puff.) Each time you press down, a metered (measured) dose is delivered.
7. Continue breathing in as slowly and deeply as possible.
8. Hold your breath for 5 to 10 seconds, or as long as is comfortable (this gives the medicine time to reach the airways). Before breathing out, remove the inhaler from your mouth and release your index finger from the canister.
9. Breathe out slowly through your nose.
10. Take a few normal breaths, wait at least 1 minute, and then repeat steps 1 through 8 for another inhalation (puff) if required. Take the number of puffs prescribed by your healthcare provider.

If you do not understand how to use the inhaler, ask your healthcare provider or pharmacist to demonstrate.

If you have the nebulizer solution:

1. Ask your healthcare provider or pharmacist which nebulizer to use and if you should use a mouthpiece or face mask. Be sure you know how and when to have nebulizer treatments and how much medicine (how many vials or drops) to use. Your healthcare provider will determine the exact dosage of medicine to use. Follow these steps when you use the nebulizer:
2. Do not use the solution if is cloudy or discolored.
3. Put medicine into the medicine cup, following the directions for that type of system. Attach the mouthpiece or mask to the medicine cup. Attach the tubing to the medicine cup.
4. If you are using a mouthpiece, put the mouthpiece in your mouth between your teeth and close your lips around it. If you are using a mask, place the mask over your nose and mouth, making it sure it fits snugly.
5. Hold the nebulizer in an upright position. This prevents spilling and promotes nebulization.
6. Gently breathe out.
7. Breathe in slowly and deeply through your mouth. Breathe out normally through your nose.
8. Tap the side of the nebulizer occasionally to help the solution drop to where it can be misted.
9. Continue these steps until the nebulizer starts sputtering or the medicine is gone (about 5 to 15 minutes).

What if I miss a dose?

If you miss a dose, use it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and use the next one as directed. Do not use double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: chest pain, fast or irregular heartbeat, seizures, tremors, nervousness, muscle cramps or weakness.

What should I watch out for?

Check with your healthcare provider or pharmacist before using any nonprescription medicines, especially other inhaled medicines.

If you need to use the medicine more often, if your symptoms do not improve, or if your condition gets worse, contact your healthcare provider right away.

Diabetics: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Chest pain, increased trouble breathing, irregular or fast heartbeat, hallucinations (seeing or hearing things that are not there).

Other: Hoarseness, coughing, dry mouth, nausea, dizziness, headache, restlessness, trouble sleeping, trembling, pounding heartbeat, weakness.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• beta blockers such as metoprolol (Lopressor, Toprol XL), propranolol (Inderal), and nadolol (Corgard)
• digoxin (Lanoxin)
• diuretics such as hydrochlorothiazide (HydroDIURIL, Esidrix, Oretic) and furosemide (Lasix)
• MAO inhibitor antidepressants such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• medicines that contain phenylephrine, pseudoephedrine, ephedrine, or caffeine (such as cough and cold medicines, pain medicines, stimulants, or weight loss medicines)
• other bronchodilators
• tricyclic antidepressants such as amitriptyline, nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), doxepin (Sinequan), and maprotiline (Ludiomil) (Do not take this medicine and a tricyclic antidepressant within 14 days of each other.)

Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Aerosol inhaler: Store at room temperature protected from heat. Do not puncture the canister. Do not use near heat or an open flame. Do not throw inhaler into an open fire or incinerator.

Nebulizer solution: Keep the bottles of this medicine in the foil pouch at room temperature away from bright light. Once you open the foil pouch, use the medicine in the bottle within 2 weeks. If you remove a vial from the foil pouch and do not use it right away, keep it out of bright light and use it within 1 week. Use the medicine only if it is clear and not cloudy.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicine in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.