Levalbuterol: pharmacologic properties and use in the treatment of pediatric and adult asthma.
OBJECTIVE
To review the rationale supporting the use of levalbuterol [(R)-albuterol] for the treatment of pediatric and adult asthma.


METHODS
Peer-reviewed articles, selected abstracts from studies presented at recent professional meetings, and the Xopenex [levalbuterol, (R)-albuterol; Sepracor, Marlborough, MA] Summary Basis of Approval and package insert.


METHODS
Institutional review board-approved clinical study protocols.


RESULTS
Levalbuterol is a single isomer beta2-agonist that differs from racemic albuterol by elimination of (S)-albuterol. Levalbuterol is an effective bronchodilator whose primary mechanism of action is unimpeded by (S)-albuterol. Thus, when compared with racemic albuterol, clinically comparable bronchodilation can be achieved with doses that substantially lessen beta-mediated side effects. In chronic or acute treatment of asthma, this favorable therapeutic profile cannot apparently be duplicated by increasing or decreasing the dose of racemic albuterol or by the addition of anticholinergic agents such as ipratropium bromide.


CONCLUSIONS
Levalbuterol seems to provide efficacy and safety advantages in pediatric and adult patients suffering from asthma. Its use may afford a cost benefit as well. More clinical studies are required to extend these observations for use in the treatment of other pulmonary diseases in both adults and children and to determine levalbuterol's impact on long-term therapy of respiratory diseases.
Berger
William E
WE
Southern California Research, Mission Viejo, California 92691, USA. weberger@uci.edu
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D004305:Dose-Response Relationship, Drug; D006801:Humans; D014481:United States
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D000420:Albuterol