Posted by Dr. Jim Joyner
Hospice Medication Management: Xopenex & Albuterol for Asthma and COPD
Xopenex (levalbuterol) is a beta-agonist type bronchodilator. Xopenex is very similar to, and is in fact an isomer of the earlier beta-agonist bronchodilator albuterol. Albuterol and Xopenex are both beta-2 selective agonist bronchodilators indicated for asthma and COPD.
Xopenex is more potent than Albuterol on a milligram per milligram basis, so theoretically Xopenex may have an advantage by having less risk of side effects since less drug is required for therapeutic effects. This theoretical advantage is not proven out by the clinical studies which have demonstrated comparable efficacy and safety between Albuterol and Xopenex in both short-term and long-term studies. The safety and efficacy of levalbuterol inhalation solution was evaluated in a 4-week, multi-center, randomized, doubleblind, placebo-controlled study in 362 adult and adolescent patients 12 years of age and older, with mild-to-moderate asthma. Efficacy was measured by the mean percent change from baseline in FEV1. A dose of 0.63 mg of levalbuterol and 2.5 mg of albuterol sulfate produced a clinically comparable mean percent change from baseline in FEV1 on both day 1 and day 29. No significant difference in side effects was demonstrated as measured by heart rate, blood pressure, and tremor. (Xopenex [package insert]. Marlborough, MA: Sepracor Inc.; 2003)
Albuterol is a more cost-effective alternative to Xopenex which appears to have very similar efficacy and a similar safety profile.
Xopenex should be reserved only for those hospice patients which exhibit intolerable adverse effects to albuterol, specifically: increased heart rate, elevated blood pressure, and/or tremor.