Medications Directory

Approved indications: Xopenex HFA is FDA-approved for the treatment or prevention of bronchospasm in adults, adolescents, and children 4 years and older who have reversible obstructive airway disease, such as asthma.

Off-label uses: Clinicians may prescribe levalbuterol inhalers off label to relieve acute bronchospasm in chronic obstructive pulmonary disease (COPD) or to help prevent exercise-induced bronchospasm, based mainly on experience with short-acting beta2-agonists and limited supportive studies rather than large dedicated trials.

Efficacy expectations: Most patients feel breathing relief within a few minutes of a dose, with lung function typically improving measurably within 5 to 10 minutes and benefit lasting about 4 to 6 hours; when used correctly as a rescue inhaler, it effectively reverses short-term bronchospasm, and overall symptom relief is comparable to albuterol, so choice between them usually depends on individual response, side effects, availability, and cost.

Typical dosing: For adults and children 4 years and older, the recommended dose is 2 inhalations (90 micrograms total) every 4 to 6 hours as needed for bronchospasm, with some patients adequately controlled on 1 inhalation every 4 hours; more frequent use or more puffs per dose should not be done unless specifically directed by a clinician.

How to take it: Xopenex HFA is for oral inhalation through the mouth only; shake the inhaler well before each use, prime it by spraying 4 times into the air before first use or if unused for more than 3 days, then exhale fully, place the mouthpiece between the lips, begin a slow deep breath while pressing the canister once, hold your breath about 10 seconds, and then exhale; spacers or holding chambers can improve delivery, especially in children, if recommended.

Device care: At least once a week, remove the metal canister, rinse the plastic actuator and mouthpiece under warm running water, shake off excess water, and let it air-dry completely before reassembling; check the dose counter regularly and replace the inhaler when it reaches zero or is expired.

Special dosing instructions: Xopenex HFA is intended as a quick-relief (rescue) inhaler, not as a replacement for daily controller medications such as inhaled corticosteroids; needing it more often than usual or for many days in a row may signal worsening asthma and should prompt medical review.

Missed doses and overdose: If you use it only when you have symptoms, there is no fixed schedule and “missed doses” are not an issue; if you are on a scheduled preventive plan and forget a dose, take it when remembered unless it is almost time for the next one, and never double doses; using too many puffs can cause severe tremor, chest pain, very fast or irregular heartbeat, marked nervousness, or seizures—if overdose is suspected, seek emergency care or contact poison control immediately.

Common side effects: Frequently reported effects include sore throat, runny or stuffy nose, cough or bronchitis, mild asthma worsening, vomiting (in children), dizziness, headache, tremor, nervousness, palpitations, and a fast heartbeat; these are usually mild and often appear soon after a dose, improving as the medicine wears off.

Serious or rare adverse effects (seek immediate care):

• Sudden worsening wheezing or shortness of breath right after using the inhaler (possible paradoxical bronchospasm).
• Chest pain, very fast or irregular heartbeat, fainting, or signs of stroke (severe cardiovascular reaction).
• Severe allergic reaction with rash, hives, swelling of the face, lips, tongue, or throat, or trouble breathing.
• Severe muscle weakness, cramps, or heart rhythm changes that could signal low potassium.

Warnings and precautions: Use with caution in people with heart disease, high blood pressure, arrhythmias, hyperthyroidism, seizures, diabetes, or significant kidney impairment; it is not approved for children younger than 4 years; in pregnancy and breastfeeding, the drug should be used only if the expected benefit justifies potential but uncertain risks, taking into account that uncontrolled asthma itself is harmful.

Safety compared with similar drugs: As a short-acting beta2-agonist, Xopenex HFA has a safety profile similar to albuterol inhalers; some individuals feel they tolerate one product better than another, but large studies have not consistently shown major safety differences.

Reporting side effects and safety updates: Side effects can be reported to the FDA MedWatch program (online or at 1-800-FDA-1088) or to the manufacturer, and up-to-date safety information is available in the Medication Guide, the prescribing information, and FDA drug safety communications.

Drug interactions: Using Xopenex HFA with other short-acting or long-acting beta-agonist bronchodilators can increase side effects; nonselective beta-blockers (such as propranolol or timolol) may reduce its effectiveness and can trigger bronchospasm; loop or thiazide diuretics, systemic corticosteroids, and xanthines (like theophylline) can add to the risk of low potassium; tricyclic antidepressants and monoamine oxidase inhibitors may enhance cardiovascular effects; and beta-agonists can lower digoxin blood levels, so digoxin monitoring may be needed.

Other substances: There are no specific food restrictions, but large amounts of caffeine or other stimulants may worsen jitteriness or palpitations, and alcohol should be used cautiously in people with heart disease because both alcohol and beta-agonists can stress the cardiovascular system.

Conditions and co-medications requiring caution: Extra care is needed in patients with coronary artery disease, arrhythmias, hypertension, hyperthyroidism, diabetes, seizure disorders, or significant renal impairment, and in those taking multiple medications that affect heart rhythm or potassium levels; Xopenex HFA is not approved for children under 4 years of age.

Monitoring needs: Depending on the patient’s underlying conditions and dose, clinicians may periodically monitor heart rate and blood pressure, consider an ECG in patients with cardiac risk, and check blood potassium and glucose levels in high-risk or high-dose situations.

Q: What is Xopenex HFA used for?
A: Xopenex HFA is a rescue inhaler containing levalbuterol that is used to treat or prevent sudden episodes of wheezing and shortness of breath (bronchospasm) in adults and children 4 years and older with reversible obstructive airway disease, such as asthma.

Q: How fast does Xopenex HFA work and how long does it last?
A: Most people start to feel relief within a few minutes of taking 1 or 2 inhalations, with peak effect in about 30 minutes and improvement typically lasting around 4 to 6 hours.

Q: Can I use Xopenex HFA every day?
A: It can be used whenever you need quick relief of symptoms, but if you find you need it more often than usual (for example, every day or many times per day), that may mean your asthma is not well controlled and you should see your clinician to adjust your long-term treatment.

Q: Is Xopenex HFA the same as albuterol?
A: Both are short-acting beta2-agonist rescue inhalers, but Xopenex HFA contains only the R-isomer of albuterol (levalbuterol) while standard albuterol has both R- and S-isomers; in practice, many patients get similar relief from either, and the choice is based on individual response, side effects, and cost.

Q: Can I use Xopenex HFA if I am pregnant or breastfeeding?
A: There are limited data in pregnancy and breastfeeding, so the medicine is used when the expected benefit outweighs potential risks, and because poorly controlled asthma is dangerous for both parent and baby, treatment decisions should be made together with your obstetric and pulmonary or primary-care providers.