What Is Levalbuterol? Uses, Dosage, and What You Need to Know in 2026

If you or someone in your family has been prescribed Levalbuterol, you may have questions: What is it, exactly? How does it differ from albuterol? How do you use it correctly? This guide answers all of those questions with clear, accurate information for patients and caregivers in 2026.

What Is Levalbuterol?

Levalbuterol is a prescription bronchodilator — a medication that opens up the airways in your lungs. It's available under the brand names Xopenex (nebulizer solution) and Xopenex HFA (metered-dose inhaler). Generic versions of both are also available.

Levalbuterol is classified as a short-acting beta2-adrenergic agonist (SABA) — the same drug class as albuterol. It's called a "rescue inhaler" or "quick-relief inhaler" because it works rapidly (within 5-15 minutes) to relieve bronchospasm. It is NOT a long-term controller medication and should not be used in place of inhaled corticosteroids if those are prescribed.

What Is Levalbuterol Used For?

Levalbuterol is FDA-approved for:

Treatment or prevention of bronchospasm in adults, adolescents, and children with reversible obstructive airway disease — including asthma

HFA inhaler approved for ages 4 and older; nebulizer solution approved for ages 6 and older

Levalbuterol is also used off-label for:

COPD exacerbations (per GOLD guidelines, may be used as first-line in Group A and additional therapy in Groups B, C, D)

Exercise-induced bronchospasm prevention

Emergency treatment of hyperkalemia (high blood potassium) — a hospital-based use

How Is Levalbuterol Different From Albuterol?

Albuterol (also called racemic albuterol) is a 50/50 mixture of two mirror-image molecules: the R-enantiomer and the S-enantiomer. Levalbuterol contains only the R-enantiomer — the pharmacologically active half. The S-enantiomer has little bronchodilatory activity and may contribute to some side effects.

In practice, both drugs produce equivalent bronchodilation. Some studies suggest levalbuterol may cause fewer cardiovascular side effects (tremor, tachycardia) in some patients, though clinical trial data on this are mixed. The main practical difference is cost: levalbuterol is significantly more expensive than generic albuterol.

What Dosage Forms and Strengths Are Available?

Levalbuterol comes in two main delivery forms:

Inhalation Solution (for nebulizer use):

0.31 mg/3 mL unit-dose vials — pediatric strength (ages 6-11)

0.63 mg/3 mL unit-dose vials — standard adult starting dose

1.25 mg/3 mL unit-dose vials — adult maximum dose

HFA Metered-Dose Inhaler (Xopenex HFA):

45 mcg per actuation — two puffs (90 mcg) is the standard dose

Available as 80-actuation (8.4 g) or 200-actuation (15 g) canisters

How Do You Take Levalbuterol?

Nebulizer solution: Open one unit-dose vial and pour the entire contents into the nebulizer reservoir. Connect the nebulizer to a jet compressor with a face mask or mouthpiece. Breathe the mist over 5-15 minutes until the reservoir is empty. No dilution needed for the 3 mL vials. Use only a standard jet nebulizer — ultrasonic nebulizers have not been tested.

HFA inhaler: Shake well before each use. Prime with 4 test sprays before first use or if not used for more than 3 days. Exhale completely, place the mouthpiece between your lips, press the canister while inhaling slowly and deeply, hold for 10 seconds, then breathe out. Wait 1-2 minutes between puffs. Clean the plastic actuator with warm water at least once a week to prevent blockage.

What Are the Standard Doses?

Adults and adolescents ≥12 yrs (nebulizer): 0.63 mg three times daily every 6-8 hours; may increase to 1.25 mg TID with monitoring

Children 6-11 yrs (nebulizer): 0.31 mg three times daily; do not exceed 0.63 mg TID

Adults and children ≥4 yrs (HFA inhaler): 2 puffs (90 mcg) every 4-6 hours as needed; 1 puff every 4 hours may suffice for some

Important Storage Notes

Store at room temperature (68-77°F / 20-25°C). Do not freeze.

Keep nebulizer vials in the foil pouch until ready to use; protect from light and excessive heat.

Discard any vial with solution that is not colorless.

Once a foil pouch is opened, use the vial immediately. Do not store opened vials.

Want to understand how levalbuterol works in your body? Read our guide on how Levalbuterol works (mechanism of action). Need help finding it in stock? Visit medfinder.com.