Levalbuterol Oral Inhalation (patient information)

# Why this medication is prescribed
Levalbuterol is used to prevent or relieve the wheezing, shortness of breath, and difficulty breathing caused by asthma. Levalbuterol is in a class of medications called beta agonists. It works by relaxing and opening air passages, making it easier to breathe.

# How this medication should be used
Levalbuterol comes as a solution to inhale using a nebulizer. It is usually used three times a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use levalbuterol exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Levalbuterol controls asthma but does not cure it. Continue to use levalbuterol even if you feel well. Do not stop using levalbuterol without talking to your doctor.
To use the solution for oral inhalation, follow these steps:
- Tear the serrated edge on the foil pouch to open and remove one vial. 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.
- 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.
- Connect the nebulizer reservoir to your mouthpiece or facemask.
- Connect the nebulizer to the compressor.
- Sit upright and place the mouthpiece in your mouth or put on the facemask.
- Turn on the compressor.
- Breathe calmly, deeply, and evenly until mist stops forming in the nebulizer. This should take between 5 and 15 minutes.
- Clean the nebulizer according to the manufacturer's instructions.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Specil precautions
Before using levalbuterol:
- tell your doctor and pharmacist if you are allergic to levalbuterol, albuterol (Proventil, Ventolin, others), or any other medications.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); digoxin (Digitek, Lanoxin); diuretics ('water pills') such as bumetanide (Bumex), chlorthalidone (Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), and hydrochlorthiazide (HydroDIURIL, Microzide); epinephrine (Epipen, Primatene Mist); medications for colds; and other inhaled medications for asthma such as metaproterenol (Alupent) and pirbuterol (Maxair). Also tell your doctor or pharmacist if you are taking the following medications or have stopped taking them within the past two weeks: antidepressants (mood elevators) such as amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Asapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); and monoamine oxidase inhibitors including phenelzine (Nardil) and tranylcypromine (Parnate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had high blood pressure, irregular heartbeat, any other type of heart disease, seizures, diabetes, or hyperthyroidism (overactive thyroid gland).
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking levalbuterol, call your doctor.

# Special dietary instructions
Unless your doctor tells you otherwise, continue your normal diet.

# What to do if you forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# Side effects

## Minor side effects
Levalbuterol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- headache
- dizziness
- nervousness
- shaking hands that you cannot control
- upset stomach
- vomiting
- flu-like symptoms
- cough
- runny nose
- weakness
- fever
- diarrhea
- constipation
- frequent urination

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- chest pain
- fast or pounding heartbeat
- hives
- skin rash
- itching
- increased difficulty breathing or difficulty swallowing
- hoarseness
- swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
- depression
- muscle pain, weakness, or cramping
- difficulty moving a part of the body
Levalbuterol may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
Levalbuterol must be protected from light. Store unused vials in the foil pouch, and discard all unused vials 2 weeks after you opened the pouch. If you remove a vial from the pouch, you should protect it from light and use it within one week.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- seizures
- chest pain
- fainting
- dizziness
- blurred vision
- upset stomach
- fast, pounding, or irregular heartbeat
- nervousness
- headache
- dry mouth
- shaking hands that you cannot control
- extreme tiredness
- weakness
- difficulty falling or staying asleep
- frequent urination
- depression
- muscle weakness or cramps
- constipation
- vomiting
- difficulty moving a part of the body

# Other information
Keep all appointments with your doctor
If your asthma symptoms become worse, if levalbuterol inhalation becomes less effective, or if you need more doses than usual of the asthma medications you use as needed, your condition may be getting worse. Call your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Xopenex

# Other names
- R)-Salbutamol