A cumulative dose study of levalbuterol and racemic albuterol administered by hydrofluoroalkane-134a metered-dose inhaler in asthmatic subjects

Tripp, Kenneth; McVicar, William K; Nair, Parameswaran; Corren, Jonathan; Pleskow, Warren W.; Goodwin, Elizabeth; Baumgartner, Rudolf; Hanrahan, John P.

doi:10.1016/j.jaci.2008.06.015

Cited by 13 publications

(6 citation statements)

References 11 publications

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“…The selectivity of levosalbutamol theoretically maximizes the bronchodilating effects while minimizing systemic side effects such as tachycardia 25 and hypokalemia. 26 Small trials have shown mixed results, with some trials showing benefit in pulmonary function, 27,28 reduction in hospital admission rates, 29 and reduced side effects 26,30 ; whereas other studies have shown no difference. 30,31 Levosalbutamol is considerably more expensive than the conventional racemic mixture, and current guidelines do not recommend using one over the other.…”

Section: First-line Treatmentmentioning

confidence: 99%

Common Pediatric Respiratory Emergencies

Choi

Lee

2012

Emergency Medicine Clinics of North America

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Section: First-line Treatmentmentioning

confidence: 99%

Common Pediatric Respiratory Emergencies

Choi

Lee

2012

Emergency Medicine Clinics of North America

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“…We read with interest the results of Tripp et al, 1 who used a cumulative dose-response protocol to compare hydrofluoroalkane (HFA) formulations of either levalbuterol or racemic albuterol in asthmatic subjects. They found that plasma levels of R-albuterol were lower after levalbuterol (ie, R-enantiomer) than after racemic (ie, RS) albuterol in conjunction with reduced heart rate but not potassium response when levalbuterol was administered at a 1:2 mg dose ratio.…”

Section: Levalbuterol Kineticsmentioning

confidence: 99%

Levalbuterol kinetics

Lipworth¹,

Clearie²

2009

Journal of Allergy and Clinical Immunology

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5. Ogilvy CS, DuBois AB, Douglas JS. Effects of ascorbic acid and indomethacin on the airways of healthy male subjects with and without bronchoconstriction. J Allergy Clin Immunol 1981;67:363-9. 6. Schachter EN, Schlesinger A. The attenuation of exercise-induced bronchospasm by ascorbic acid. Ann Allergy 1982;49:146-51. 7. Cohen HA, Neuman I, Nahum H. Blocking effect of vitamin C in exercise-induced asthma. Arch Pediatr Adolesc Med 1997;151:367-70. 8. Tecklenburg SL, Mickleborough TD, Fly AD, Bai Y, Stager JM. Ascorbic acid supplementation attenuates exercise-induced bronchoconstriction in patients with asthma.

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“…In 2008, Tripp et al looked at the safety outcomes of levalbuterol HFA metered dose inhaler (MDI) and racemic albuterol HFA MDI in asthmatic patients in a randomized, modified-blind, active-controlled, multicenter, 2-way crossover study. 9 The 49 participating subjects were randomized to 16 cumulative doses of levalbuterol (45 µg per dose) or racemic albuterol (90 µg per dose) administered over a 2-hour period. After having a 7-day washout period, the subjects were then crossed over to the other treatment.…”

Section: Introductionmentioning

confidence: 99%

Safety of Levalbuterol Compared to Albuterol in Patients With a Tachyarrhythmia

Lindquist

Cooper

2013

Journal of Pharmacy Technology

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Objective: To determine the safety of levalbuterol versus albuterol in patients with a tachyarrhythmia. Data Sources: A PubMed search was conducted using the MeSH search terms levalbuterol, albuterol, and tachyarrhythmia. Bibliographies of relevant articles were reviewed for additional citations. Study Selection and Data Extraction: Search results were limited to humans and randomized controlled trials. Those studies that excluded patients with predetermined tachyarrhythmias were excluded from this review. Trials that failed to compare levalbuterol and albuterol outcomes were excluded. Data Synthesis: Beta-2 receptor agonists are the mainstay of treatment in patients with respiratory disease, such as asthma or chronic obstructive pulmonary disease. Racemic albuterol has been linked to poor outcomes due to the fact that it contains both the S-isomer and the R-isomer. Levalbuterol, the "pure" R-isomer, has been thought to decrease cardiac side effects since it only contains the therapeutic component of the racemic mixture. Patients with tachyarrhythmias are at an increased probability to experience harmful, if not fatal, cardiac side effects from these drugs. Limitations of current studies include a lack of data in patient populations with baseline tachyarrhythmias. Conclusions: Tachyarrhythmias put a patient at increased risk of poor outcomes, including death. Evidence for using either racemic albuterol or levalbuterol for respiratory disease management in these patients is lacking and insufficient. Randomized controlled trials show that in intensive care unit patient populations there is no clear advantage to using levalbuterol over albuterol; however, this did not hold true in pediatric populations. No clinical trials exist that look at a direct comparison of these 2 agents in patients with underlying tachyarrhythmias. Further research into the most efficacious and safe β-2 receptor agonists in this specialized patient population should be conducted to help reduce potential harmful outcomes.

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A cumulative dose study of levalbuterol and racemic albuterol administered by hydrofluoroalkane-134a metered-dose inhaler in asthmatic subjects

Cited by 13 publications

References 11 publications

Common Pediatric Respiratory Emergencies

Common Pediatric Respiratory Emergencies

Levalbuterol kinetics

Safety of Levalbuterol Compared to Albuterol in Patients With a Tachyarrhythmia

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