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Xopenex Side Effects Center
Medical Editor: John P. Cunha, DO, FACOEP
Xopenex (levalbuterol HCl) is used to treat reversible obstructive airway conditions such as asthma, bronchitis, and emphysema. It is a bronchodilator. This medication is available in generic form in some strengths. Common side effects include headache, nervousness, shaking (tremor), dizziness, trouble sleeping, dry mouth, nausea, stomach upset, diarrhea, cough, sore throat, or runny nose.
The recommended dosage of Xopenex Inhalation Solution for patients 6-11 years old is 0.31 mg administered three times a day, by nebulization. Routine dosing should not exceed 0.63 mg three times a day. The recommended starting dosage of Xopenex for patients 12 years of age and older is 0.63 mg administered three times a day, every 6 to 8 hours, by nebulization. Xopenex may interact with beta-blockers, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), diuretics (water pills), digoxin, other inhaled bronchodilators, caffeine, diet pills, or decongestants. Xopenex should be used only when prescribed during pregnancy. It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
Our Xopenex (levalbuterol HCl) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
What is Patient Information in Detail?
Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.
Xopenex in Detail - Patient Information: Side Effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have a serious side effect such as:
- bronchospasm (wheezing, chest tightness, trouble breathing), especially after starting a new canister of this medicine;
- chest pain and fast, pounding, or uneven heart beats;
- low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling); or
- dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).
Less serious side effects may include:
- headache, tremors, feeling anxious or nervous;
- sleep problems (insomnia);
- cough, runny or stuffy nose;
- mild nausea, vomiting;
- dry mouth and throat;
- muscle pain; or
Read the entire detailed patient monograph for Xopenex (Levalbuterol) »
What is Patient Information Overview?
A concise overview of the drug for the patient or caregiver from First DataBank.
Xopenex Overview - Patient Information: Side Effects
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: fast/pounding/irregular heartbeat, muscle cramps/weakness, increased thirst/urination.
Get medical help right away if you have any very serious side effects, including: chest pain, rapid breathing, confusion.
Rarely, this medication has caused severe (rarely fatal), sudden worsening of breathing problems/asthma (paradoxical bronchospasm). If you experience sudden wheezing, get medical help right away.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire patient information overview for Xopenex (Levalbuterol)»
What is Prescribing information?
The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.
Xopenex FDA Prescribing Information: Side Effects
The following serious adverse reactions are described below and elsewhere in the labeling:
- Paradoxical bronchospasm [see WARNINGS AND PRECAUTIONS]
- Cardiovascular effects [see WARNINGS AND PRECAUTIONS]
- Immediate hypersensitivity reactions [see WARNINGS AND PRECAUTIONS]
- Hypokalemia [see WARNINGS AND PRECAUTIONS]
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of the drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Adults and Adolescents 12 Years of Age and Older
Adverse reaction information concerning XOPENEX Inhalation Solution in adults and adolescents is derived from one 4-week, multicenter, randomized, double-blind, active-, and placebo-controlled trial in 362 patients with asthma 12 years of age and older. Adverse reactions reported in ≥ 2% of patients receiving XOPENEX Inhalation Solution or racemic albuterol and more frequently than in patients receiving placebo are listed in Table 1.
Table 1: Adverse Reactions Reported in a 4-Week,
Controlled Clinical Trial in Adults and Adolescents ≥ 12 Years Old
|XOPENEX 1.25 mg
|XOPENEX 0.63 mg
|Racemic albuterol 2.5 mg
|Body as a Whole|
|Central Nervous System|
|a One treatment group, racemic albuterol 1.25 mg, with 68 subjects is omitted|
The incidence of certain systemic beta-adrenergic adverse reactions (e.g., tremor, nervousness) was slightly less in the XOPENEX Inhalation Solution 0.63 mg group compared with the other active treatment groups. The clinical significance of these small differences is unknown.
Changes in heart rate 15 minutes after drug administration and in plasma glucose and potassium 1 hour after drug administration on day 1 and day 29 were clinically comparable in the XOPENEX Inhalation Solution 1.25 mg and racemic albuterol 2.5 mg groups (see Table 2). Changes in heart rate and plasma glucose were slightly less in the XOPENEX Inhalation Solution 0.63 mg group compared with the other active treatment groups (see Table 2). The clinical significance of these small differences is unknown. After 4 weeks, effects on heart rate, plasma glucose, and plasma potassium were generally diminished compared with day 1 in all active treatment groups.
Table 2: Mean Changes from
Baseline Heart Rate at 15 Minutes and Glucose and Potassium at 1 Hour after
First Dose (Day 1) in Adults and Adolescents ≥ 12 Years Old
|Treatment||Mean Changes (day 1)|
|Heart Rate (bpm)||Glucose (mg/dL)||Potassium (mEq/L)|
|XOPENEX 0.63 mg, n=72||2.4||4.6||-0.2|
|XOPENEX 1.25 mg, n=73||6.9||10.3||-0.3|
|Racemic albuterol 2.5 mg, n=74||5.7||8.2||-0.3|
No other clinically relevant laboratory abnormalities related to administration of XOPENEX Inhalation Solution were observed in this study.
In the clinical trials, a slightly greater number of serious adverse events, discontinuations due to adverse events, and clinically significant ECG changes were reported in patients who received XOPENEX 1.25 mg compared with the other active treatment groups.
The following adverse reactions, considered potentially related to XOPENEX, occurred in less than 2% of the 292 subjects who received XOPENEX and more frequently than in patients who received placebo in any clinical trial:
Body as a Whole: chills, pain, chest pain
Hemic and Lymphatic System: lymphadenopathy
Musculoskeletal System: leg cramps, myalgia
Nervous System: anxiety, hyperesthesia of the hand, insomnia, paresthesia, tremor
Special Senses: eye itch
The following reactions, considered potentially related to XOPENEX, occurred in less than 2% of the treated subjects but at a frequency less than in patients who received placebo: asthma exacerbation, cough increased, wheezing, sweating, and vomiting.
Pediatric Patients 6 to 11 Years of Age
Adverse reaction information concerning XOPENEX Inhalation Solution in pediatric patients is derived from one 3-week, multicenter, randomized, double-blind, active-, and placebo-controlled trial in 316 pediatric patients 6 to 11 years of age. Adverse reactions reported in ≥ 2% of patients in any treatment group and more frequently than in patients receiving placebo are listed in Table 3.
Table 3: Most Frequently
Reported Adverse Reactions ( ≥ 2% in Any Treatment Group) and Those
Reported More Frequently Than in Placebo during the Double-Blind Period (ITT
Population, 6-11 Years Old)
|Body System Preferred Term||Percent of Patients|
|XOPENEX 0.31 mg
|XOPENEX 0.63 mg
|Racemic albuterol 1.25 mg
|Racemic albuterol 2.5 mg
|Body as a Whole|
|Hemic and Lymphatic|
|Skin and Appendages|
|Note: Subjects may have more than one adverse event per body system and preferred term.|
Changes in heart rate, plasma glucose, and serum potassium are shown in Table 4. The clinical significance of these small differences is unknown.
Table 4: Mean Changes from
Baseline Heart Rate at 30 Minutes and Glucose and Potassium at 1 Hour after
First Dose (Day 1) and Last Dose (Day 21) in Children 6-11 Years Old
|Treatment||Mean Changes(Day 1)|
|Heart Rate (bpm)||Glucose (mg/dL)||Potassium (mEq/L)|
|XOPENEX 0.31 mg, n=66||0.8||4.9||-0.31|
|XOPENEX 0.63 mg, n=67||6.7||5.2||-0.36|
|Racemic albuterol 1.25 mg, n=64||6.4||8||-0.27|
|Racemic albuterol 2.5 mg, n=60||10.9||10.8||-0.56|
|Mean Changes (Day 21)|
|Treatment||Heart Rate (bpm)||Glucose (mg/dL)||Potassium (mEq/L)|
|XOPENEX 0.31 mg, n=60||0||2.6||-0.32|
|XOPENEX 0.63 mg, n=66||3.8||5.8||-0.34|
|Racemic albuterol 1.25 mg, n=62||5.8||1.7||-0.18|
|Racemic albuterol 2.5 mg, n=54||5.7||11.8||-0.26|
In addition to the adverse reactions reported in clinical trials, the following adverse reactions have been observed in postapproval use of XOPENEX Inhalation Solution. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion due to their seriousness, their frequency of reporting, or their likely beta-mediated mechanism: angioedema, anaphylaxis, arrhythmias (including atrial fibrillation, supraventricular tachycardia, extrasystoles), asthma, chest pain, cough increased, dysphonia, dyspnea, gastrooesophageal reflux disease (GERD), metabolic acidosis, nausea, nervousness, rash, tachycardia, tremor, urticaria.
In addition, XOPENEX Inhalation Solution, like other sympathomimetic agents, can cause adverse reactions such as hypertension, angina, vertigo, central nervous system stimulation, sleeplessness, headache, and drying or irritation of the oropharynx.
Read the entire FDA prescribing information for Xopenex (Levalbuterol) »
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