Xopenex (Levalbuterol): Overview and Practice Questions

Xopenex, known generically as levalbuterol, is a widely used bronchodilator in modern respiratory care. Designed to relieve acute bronchospasm, it works by relaxing the smooth muscles in the airways, allowing patients to breathe more easily. While it shares similarities with albuterol, its formulation contains only the active R-isomer, which may reduce the risk of certain side effects.

For respiratory therapists, understanding how Xopenex works, when to use it, and how to educate patients on its proper administration is essential for delivering safe and effective care.

What is Xopenex?

Xopenex (levalbuterol) is a short-acting beta-2 adrenergic agonist (SABA) used to treat bronchospasm. It is commonly prescribed for patients with asthma, chronic obstructive pulmonary disease (COPD), and other conditions that cause reversible airway obstruction.

Unlike albuterol, which is a racemic mixture containing two isomers (R- and S-albuterol), Xopenex contains only the R-isomer (levalbuterol). This active form is responsible for bronchodilation and is thought to cause fewer side effects, such as tremors or increased heart rate, although clinical experiences vary depending on the patient.

Mechanism of Action

Levalbuterol works by stimulating beta-2 adrenergic receptors in the smooth muscle of the airways. This stimulation leads to muscle relaxation, which in turn causes bronchodilation. By opening the airways, Xopenex helps relieve wheezing, shortness of breath, and airway tightness, making it a frontline therapy for acute bronchospasm.

Clinical Uses

Respiratory therapists and clinicians administer Xopenex to manage conditions such as:

• Asthma exacerbations – providing rapid relief of bronchospasm
• COPD flare-ups – helping improve airflow and oxygenation
• Exercise-induced bronchospasm – sometimes used preventively before exertion
• Hospitalized patients – especially those who may not tolerate the side effects of racemic albuterol

Note: Xopenex is available in inhalation solution for nebulizers and metered-dose inhalers (MDIs), making it versatile across different patient settings.

Why Xopenex is Relevant to Respiratory Therapists

Respiratory therapists play a central role in medication delivery, patient education, and monitoring therapeutic outcomes. Xopenex is particularly important in their practice because:

• Tailored Therapy – Some patients, especially children or those sensitive to stimulatory side effects, may tolerate Xopenex better than albuterol.
• Acute Care Management – It is often used in emergency departments, ICUs, and during rapid response situations for immediate relief.
• Nebulizer Administration – RTs frequently administer Xopenex via nebulization, ensuring correct dosage, technique, and monitoring for adverse effects.
• Patient Education – Teaching patients how to use MDIs or nebulizers correctly is a critical aspect of care.
• Clinical Decision-Making – Therapists must assess when Xopenex is appropriate, evaluate its effectiveness, and communicate with the healthcare team if adjustments are needed.

Considerations and Side Effects

While Xopenex may have a lower incidence of side effects compared to racemic albuterol, patients can still experience:

• Tremors
• Nervousness
• Headache
• Increased heart rate (tachycardia)
• Hypokalemia (in rare cases)

Note: Respiratory therapists must monitor patients closely, particularly those with cardiac conditions or those receiving frequent, high-dose treatments.

Xopenex Practice Questions

1. What is the generic name of Xopenex?  
Levalbuterol

2. What drug class does Xopenex belong to?  
Beta-2 adrenergic agonist (sympathomimetic)

3. What is the primary route of administration for Xopenex?  
Inhalation via MDI or nebulizer

4. What is the mechanism of action of Xopenex?  
It selectively stimulates beta-2 adrenergic receptors, relaxing bronchial smooth muscle and improving airflow.

5. What conditions is Xopenex indicated for?  
Acute bronchospasm and bronchospasm prophylaxis in asthma

6. What is the typical adult dose of Xopenex via nebulizer?  
0.63 mg three times per day

7. What is the usual adult MDI dosage for Xopenex?  
2 inhalations every 4–6 hours; up to 8 inhalations during acute exacerbations

8. What is the pediatric nebulizer dose of Xopenex for children aged 6–11 years?  
0.31 mg three times per day

9. What is the recommended MDI dose for children aged 4–12 years?  
2 puffs every 4–6 hours; 1 puff may be sufficient

10. What is the onset of action for Xopenex?  
Approximately 5 to 15 minutes

11. Which patient population should avoid using Xopenex with sotalol?  
Patients with a risk of QT prolongation or cardiac arrhythmias

12. What is a key precaution when administering Xopenex?  
Use caution in patients with underlying cardiovascular disease or ischemia

13. What is the primary therapeutic effect of Xopenex on the lungs?  
Bronchodilation by relaxing bronchial smooth muscle

14. What is a potential side effect of Xopenex related to electrolytes?  
Hypokalemia

15. Why should Xopenex not be used with phenothiazines?  
It may prolong the QT interval and increase the risk of arrhythmias

16. What adverse effect of Xopenex may mimic anxiety symptoms?  
Tremors and palpitations

17. What is the mechanism by which Xopenex differs from racemic albuterol?
It is the R-isomer of albuterol with greater beta-2 receptor affinity and fewer side effects

18. What adverse effects are common with Xopenex use?  
Tachycardia, headache, nausea, throat irritation, and insomnia.

19. What is a known contraindication for Xopenex use?  
Known hypersensitivity or angioedema

20. What is a key monitoring point when administering Xopenex?  
Auscultation of lung sounds before and after treatment

21. What dosage is used for acute exacerbation in adults via nebulizer?  
1.25–2.5 mg every 20 minutes for 3 doses, then 1.25–5 mg every 1–4 hours as needed

22. What pediatric nebulizer dose is used in acute exacerbations for children under 6 years old?  
1.25–2.5 mg every 20 minutes for 3 doses, then 1.25–5 mg every 1–4 hours as needed

23. What is the effect of Xopenex on blood pressure?  
It may cause hypertension.

24. Why should Xopenex be used with caution in lactating patients?  
Because safety during lactation has not been fully established

25. What is the therapeutic goal of Xopenex in asthma or COPD management?  
Relieve bronchospasm and improve airway ventilation.

26. What class of medications does Levalbuterol fall under?  
Sympathomimetic bronchodilators

27. What receptor does Xopenex selectively target?  
Beta-2 adrenergic receptor

28. How does Xopenex compare to racemic albuterol in terms of side effects?  
Xopenex generally has fewer beta-1 related side effects, like tachycardia

29. What is the usual nebulized Xopenex dose for pediatric patients under 6 with acute exacerbation?  
1.25–2.5 mg every 20 minutes for 3 doses, then every 1–4 hours as needed

30. What is one key benefit of using Levalbuterol over albuterol in sensitive patients?  
It causes less cardiac stimulation.

31. What is a serious cardiovascular adverse effect of Xopenex?  
Prolonged QT interval

32. Why should you avoid using Xopenex with beta-blockers like sotalol?  
They can reduce bronchodilatory effects and increase the risk of bronchospasm.

33. What is a respiratory-related adverse reaction that may occur with Xopenex?  
Throat irritation

34. What form does Xopenex HFA come in?  
Metered-dose inhaler (MDI)

35. What symptom may indicate an overdose of Xopenex?  
Severe tremors, chest pain, or irregular heartbeat

36. What is the frequency for routine adult MDI dosing of Xopenex?  
2 inhalations every 4 to 6 hours

37. How should Xopenex be stored?  
At room temperature away from direct light and moisture

38. Which age group has not had safety and efficacy of Xopenex MDI fully established?  
Children under 4 years of age

39. What is the concentration of a typical unit dose vial of nebulized Xopenex?  
0.63 mg/3 mL or 1.25 mg/3 mL

40. What is the difference in chemical structure between Xopenex and albuterol?  
Xopenex is the R-isomer of albuterol

41. What common neurological side effect is associated with Xopenex?  
Headache

42. Why should clinicians monitor potassium levels during frequent Xopenex use?  
It may cause hypokalemia.

43. How does Xopenex affect skeletal muscle vasculature?  
It relaxes the smooth muscle and promotes vasodilation.

44. What is one of the metabolic side effects of Xopenex?  
Hyperglycemia

45. What type of patients may benefit from Xopenex due to sensitivity to albuterol?  
Patients with cardiac arrhythmias or beta-1 sensitivity

46. What device can be used with Xopenex MDI for pediatric patients?  
Valved holding chamber with face mask

47. What should be done if a patient experiences paradoxical bronchospasm with Xopenex?  
Discontinue the medication immediately

48. How long does the effect of a nebulized dose of Xopenex typically last?  
4 to 6 hours

49. What monitoring should be done during repeated high-dose Xopenex administration?  
Vital signs, ECG, serum potassium

50. What is a benefit of Levalbuterol’s greater beta-2 selectivity?  
Improved bronchodilation with reduced beta-1 cardiac effects

51. What is the primary therapeutic goal of administering Xopenex?  
To relieve bronchospasm in patients with reversible airway disease

52. What electrolyte imbalance may Xopenex cause with frequent use?  
Hypokalemia

53. Why should caution be used when administering Xopenex to patients with cardiovascular disorders?  
It can increase heart rate and lead to arrhythmias.

54. What is the typical pediatric nebulized dose of Xopenex for children 6–11 years?  
0.31 mg three times daily

55. What should a clinician do if a patient using Xopenex develops chest pain and palpitations?  
Discontinue the drug and evaluate for cardiac effects.

56. What is a key distinguishing feature of Levalbuterol compared to racemic albuterol?  
It is the R-isomer, which is more selective for beta-2 receptors.

57. What precaution should be taken when using Xopenex in a lactating patient?  
Use with caution as safety has not been established

58. What is the onset of action for Xopenex when given via nebulizer?  
5 to 15 minutes

59. What condition is Xopenex primarily indicated to treat?  
Asthma and other reversible obstructive airway conditions

60. What potential interaction should be considered with patients taking phenothiazines?  
Increased risk of QT prolongation and arrhythmia

61. What is a possible gastrointestinal side effect of Xopenex?  
Nausea and vomiting

62. What form of Xopenex is preferred in emergency situations for acute bronchospasm?  
Nebulized solution

63. Why may Xopenex be preferred over albuterol in patients with a history of jitteriness or anxiety?  
It has fewer central nervous system side effects

64. How often can a nebulized dose of 1.25 mg of Xopenex be repeated in acute exacerbations?  
Every 20 minutes for up to 3 doses, then every 1–4 hours as needed

65. What is a common central nervous system side effect seen with Xopenex?
Tremor

66. When should clinicians reassess therapy after initiating Xopenex treatment?  
If symptoms persist or worsen after initial doses

67. How is Xopenex supplied for nebulization?  
In unit-dose vials of 0.31 mg, 0.63 mg, and 1.25 mg

68. What should be monitored in a patient with diabetes using Xopenex?  
Blood glucose levels due to risk of hyperglycemia

69. What is the mechanism of Xopenex in reducing airway resistance?  
Beta-2 receptor stimulation causes bronchial smooth muscle relaxation

70. Can Xopenex be used in COPD patients?  
Yes, for relief of reversible bronchospasm

71. What is the recommended dose of Xopenex MDI for acute asthma exacerbation in adults?  
4–8 inhalations every 20 minutes up to 4 hours

72. What device improves aerosol delivery of Xopenex MDI in young children?
A spacer or valved holding chamber with mask

73. Which population should avoid Xopenex due to a lack of safety data?  
Children under the age of 4 for MDI use

74. What must be done before administering Xopenex MDI for the first time?
Prime the inhaler by spraying it into the air away from the face

75. What is the typical frequency for scheduled Xopenex nebulizer treatments in stable patients?  
Every 6 to 8 hours

76. What should be assessed before and after administering Xopenex?  
Breath sounds, respiratory rate, heart rate, and oxygen saturation

77. What adverse effect might Xopenex cause in patients with a history of seizures?  
Increased risk of central nervous system stimulation

78. Why is Levalbuterol sometimes favored over racemic albuterol in sensitive patients?  
It may produce fewer side effects like tachycardia and tremors

79. What class of medication should be avoided when administering Xopenex due to potential cardiac effects?  
Beta-blockers

80. What is a serious cardiovascular side effect of Xopenex?  
Prolonged QT interval

81. What is the recommended action if a patient develops paradoxical bronchospasm after using Xopenex?  
Discontinue the medication immediately and provide supportive care

82. What is the preferred method of delivery for Xopenex in patients who cannot coordinate MDI use?  
Nebulization

83. How should Xopenex nebulizer solution be stored?  
At room temperature away from light

84. What should you do if the Xopenex solution becomes discolored?  
Discard the solution and do not use

85. What is the proper technique for administering Xopenex via MDI?  
Shake well, exhale fully, inhale deeply while pressing the canister, and hold breath for 10 seconds

86. What is the maximum nebulized dose of Xopenex for acute exacerbation in pediatric patients?  
5 mg every 1–4 hours as needed

87. What is the frequency of Xopenex administration in stable pediatric patients (6–11 years)?  
0.31 mg via nebulizer three times a day

88. Which side effect of Xopenex may worsen insomnia?  
CNS stimulation

89. What is a warning sign that the patient may be overusing Xopenex?  
Frequent need for rescue doses beyond prescribed frequency

90. What physiologic change indicates Xopenex is working?  
Improved airflow and decreased wheezing

91. What is the chemical relationship between Levalbuterol and Albuterol?  
Levalbuterol is the R-isomer of racemic albuterol

92. How does Xopenex affect serum potassium levels?  
It may cause hypokalemia

93. How does the use of sotalol impact Xopenex therapy?  
It may reduce effectiveness and increase risk of arrhythmias.

94. What is a common subjective symptom reported by patients after Xopenex use?  
Feeling jittery or anxious

95. What are signs of Xopenex overdose?  
Chest pain, hypertension, tremors, nervousness, and hypokalemia

96. Can Xopenex be mixed with other medications in a nebulizer chamber?  
Only if compatibility has been confirmed with the other drug

97. What is the average duration of bronchodilation after one dose of Xopenex?  
Approximately 5 to 8 hours

98. What is a rare but serious allergic reaction to monitor with Xopenex use?  
Angioedema

99. What is the proper action if a patient experiences dizziness and tachycardia after Xopenex use?  
Stop the treatment and evaluate the patient immediately

100. How does Xopenex improve oxygenation in obstructive airway disease?  
By reducing bronchospasm and improving airflow to the alveoli

Final Thoughts

Xopenex (levalbuterol) is a valuable medication in the arsenal of respiratory care. By offering effective bronchodilation with potentially fewer side effects, it provides an important alternative to albuterol for certain patients.

For respiratory therapists, understanding how and when to use Xopenex, teaching proper administration techniques, and monitoring patient outcomes are all critical responsibilities. Ultimately, Xopenex plays a key role in helping patients breathe easier and recover from acute respiratory distress.