When prescribing this medication your doctor will likely instruct you on its use and may even provide a demonstration. The metered dose inhaler also comes with an informational pamphlet that has an illustrated guide. Call your doctor or pharmacist if anything is unclear as proper use of the device will yield the best results. One inhalation 90 mcg or 45 mcg levalbuterol free base every 4 hours may be sufficient to manage symptoms. Your strength and dosage may depend on your condition. When you first use the inhaler, or if it is left unused for a week you must prime the device. to prime the inhaler, discharge four sprays away from your face and eyes. If you happen to miss a dose, simply disregard the missed dose and continue treatment on schedule. Do not increase the number of inhalations to make up for the missed dose. Taking more than the recommended dose does not quicken treatment and may increase the risk of side effects. If you are taking another inhaler to manage symptoms wait a minute between switching between inhalers. If Xopenex HFA is not working as expected, contact your doctor to optimize your treatment options. To wash the actuator simply wipe it with a clean cloth. Do not soak or submerge the device to maintain proper operation. This medication can cause cardiovascular effects such as high blood pressure. There may be a risk of experiencing toxic effects for individuals with renal impairment. This should be discontinued if you experience paradoxical bronchospasm.