Comprehensive medication guide to Levalbuterol including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$5–$45 copay for generic at Tier 2–3 on most commercial plans; Medicare Part D plans include a $2,000 annual out-of-pocket cap as of 2025. Some plans may require step therapy (prior albuterol trial). Contact your insurer to confirm tier placement.
Estimated Cash Pricing
Generic levalbuterol nebulizer solution ranges from $22–$117 retail per 25-vial carton; as low as $30–$52 with GoodRx or SingleCare coupons. Xopenex HFA inhaler (brand) ~$116 retail; generic inhaler from ~$51 with discount coupons.
Medfinder Findability Score
72/100
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Levalbuterol is a prescription bronchodilator used to treat and prevent bronchospasm in patients with asthma, COPD, and other reversible obstructive airway diseases. It is available under the brand names Xopenex (nebulizer solution) and Xopenex HFA (metered-dose inhaler), with generic versions of both forms available. It is classified as a short-acting beta2-adrenergic agonist (SABA) and is commonly called a rescue inhaler or quick-relief medication.
Levalbuterol is the pure R-enantiomer of racemic albuterol — the active half of the albuterol molecule. It is FDA-approved for adults, adolescents, and children ages 4 and older (HFA inhaler) or 6 and older (nebulizer solution). The nebulizer solution is available in three strengths: 0.31 mg/3 mL (pediatric), 0.63 mg/3 mL (standard adult), and 1.25 mg/3 mL (adult maximum dose).
Because levalbuterol is significantly more expensive than generic albuterol, some patients and providers specifically choose it when cardiovascular side effects (tremor, tachycardia) are a concern. For most patients without these specific sensitivities, both drugs produce equivalent bronchodilation.
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Levalbuterol works by selectively binding to beta2-adrenergic receptors in the smooth muscle surrounding the airways (bronchi and bronchioles). Once bound, it activates adenylyl cyclase, which increases cyclic AMP (cAMP) inside the muscle cell. Elevated cAMP then activates protein kinase A, which inhibits myosin phosphorylation and lowers intracellular calcium concentrations — causing the smooth muscle to relax and the airway to widen.
This mechanism provides relief from bronchospasm within 5-15 minutes of inhalation, with peak effect at approximately 60-90 minutes and duration of action up to 6-8 hours. As the pure R-enantiomer of albuterol, levalbuterol binds beta2 receptors with higher selectivity than the racemic mixture, which is the pharmacological basis for its potentially reduced cardiovascular side effect profile.
Levalbuterol is a functional antagonist to bronchospasm — it relaxes the airways regardless of the underlying cause of bronchoconstriction, protecting against all types of spasmogens. It is not an anti-inflammatory medication and does not address the underlying inflammation in asthma, which is why inhaled corticosteroids remain essential for asthma control.
0.31 mg/3 mL — Nebulizer inhalation solution
Pediatric strength — for children ages 6-11; 3 mL unit-dose vial
0.63 mg/3 mL — Nebulizer inhalation solution
Standard adult starting dose; 3 mL unit-dose vial
1.25 mg/3 mL — Nebulizer inhalation solution
Adult maximum dose; 3 mL unit-dose vial
45 mcg/actuation — HFA metered-dose inhaler (Xopenex HFA)
For adults and children ages 4+; typical dose is 2 puffs (90 mcg) every 4-6 hours
Levalbuterol is not on the FDA's official drug shortage list as of 2026, and the American Society of Health-System Pharmacists (ASHP) reports that most levalbuterol presentations are available at the wholesale level. However, patients regularly encounter empty pharmacy shelves — especially for the 0.31 mg/3 mL pediatric nebulizer strength.
Several factors contribute to localized unavailability: levalbuterol costs 5-10x more than generic albuterol, leading pharmacies to maintain minimal stock; the albuterol nebulizer shortage (ongoing since 2022) created cross-demand spikes that strained levalbuterol supply chains; and seasonal respiratory virus surges temporarily exhaust local inventory. Hospital outpatient pharmacies and mail-order pharmacies typically maintain more consistent supply than retail chains.
The fastest way to find Levalbuterol in stock near you is to use medfinder, which calls pharmacies on your behalf and texts you which ones have your specific formulation and strength in stock. This saves you from the frustrating process of calling pharmacies one by one.
Because levalbuterol is not a DEA-scheduled controlled substance, any licensed prescriber in the United States can write a levalbuterol prescription. There are no DEA registration requirements or additional documentation needed beyond a standard prescription. Prescriptions can be written electronically, called in by phone, or faxed.
The most common types of providers who prescribe levalbuterol include:
Pulmonologists — specialists in lung and respiratory disease
Allergists and Immunologists — especially for allergic asthma
Primary Care Physicians (PCPs) — family medicine and internal medicine physicians
Pediatricians — for children ages 4+ (HFA inhaler) and 6+ (nebulizer solution)
Nurse Practitioners (NPs) and Physician Assistants (PAs) — within their state-specific scope of practice
Emergency Medicine Physicians — for acute bronchospasm treatment
Levalbuterol is also available via telehealth. Since it is not a controlled substance, telehealth providers can prescribe it without requiring an in-person examination in most states. Platforms such as Teladoc, MDLive, and Amazon Clinic offer respiratory care consultations.
No. Levalbuterol (Xopenex, Xopenex HFA) is not a DEA-scheduled controlled substance. It has no abuse potential or addiction risk that would place it under the Controlled Substances Act. Any licensed prescriber — including primary care physicians, nurse practitioners, physician assistants, and telehealth providers — can prescribe levalbuterol without the additional documentation requirements that apply to controlled medications.
There are no refill restrictions based on scheduling. Most insurance plans allow standard 30-day fills at retail pharmacies and 90-day fills via mail-order. Levalbuterol can be prescribed electronically and can be called in by phone by the prescriber's office without the restrictions that apply to Schedule II-V medications.
Levalbuterol is generally well-tolerated. The most frequently reported side effects include:
Tremors (shakiness) — caused by beta2 receptor stimulation in skeletal muscle
Nervousness or anxiety
Headache
Dizziness
Fast or pounding heartbeat (tachycardia, palpitations)
Sore throat and runny nose (especially with inhaler use)
Mild chest discomfort
Paradoxical bronchospasm: Breathing worsens immediately after use — stop and call 911
Severe chest pain or irregular heartbeat
Severe allergic reaction (anaphylaxis): hives, facial swelling, throat tightening
Severe hypokalemia: muscle weakness, cramps, irregular heartbeat (especially with diuretics)
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Albuterol (Ventolin HFA, ProAir, generic)
Racemic albuterol; clinically equivalent for most patients at equivalent doses; much less expensive than levalbuterol; first-line SABA for most patients with asthma or COPD
Ipratropium (Atrovent HFA)
Anticholinergic bronchodilator; different mechanism from levalbuterol; primarily used for COPD; no cardiovascular side effects but slower onset; not recommended as primary asthma rescue
Albuterol/Ipratropium (DuoNeb, Combivent Respimat)
Combination SABA + SAMA for greater bronchodilation; used in COPD patients and severe acute asthma; available as nebulizer solution (DuoNeb) and soft mist inhaler (Combivent Respimat)
Formoterol (Foradil) or Salmeterol (Serevent)
Long-acting beta2-agonists (LABAs); NOT rescue inhalers — used as daily maintenance medication; must be combined with an inhaled corticosteroid in asthma
Prefer Levalbuterol? We can find it.
Non-selective beta-blockers (carvedilol, propranolol, labetalol)
majorAntagonize beta2 bronchodilatory effects; may cause bronchospasm in asthma/COPD patients; use cardioselective beta-blockers (metoprolol, atenolol) when possible
MAOIs (phenelzine, isocarboxazid, selegiline, linezolid)
majorRisk of acute hypertensive episode and cardiac arrhythmias; avoid within 2 weeks of MAOI use
Tricyclic antidepressants (amitriptyline, nortriptyline, doxepin)
majorMay potentiate cardiovascular effects; increased risk of tachyarrhythmias; avoid within 2 weeks; use extreme caution
Non-potassium-sparing diuretics (furosemide, hydrochlorothiazide)
moderateAdditive hypokalemia risk; monitor serum potassium; consider potassium supplementation
Digoxin (Lanoxin)
moderateBeta-agonists may reduce serum digoxin levels by 16-22%; monitor digoxin levels when initiating or changing SABA therapy
Other sympathomimetics (epinephrine, pseudoephedrine, albuterol)
moderateAdditive cardiovascular stimulation; increased risk of palpitations, tachycardia, hypertension
Levalbuterol (Xopenex, Xopenex HFA) is a well-established rescue bronchodilator for asthma and COPD. As the pure R-enantiomer of albuterol, it provides effective bronchodilation with a theoretical advantage in cardiovascular side effect profile for sensitive patients. It is not in an official national shortage in 2026, but localized pharmacy stock gaps are common and can be frustrating for patients who depend on it.
Key points for patients: refill early to avoid running out; know your exact formulation and strength; consider hospital outpatient pharmacies or mail-order for more consistent supply; and use GoodRx or SingleCare coupons to reduce cash prices to $30-52 per nebulizer carton or $51-62 for the HFA inhaler. If cost is a barrier, discuss whether generic albuterol — which is clinically equivalent for most patients — could work for you.
When you need help finding Levalbuterol at a pharmacy near you, medfinder calls pharmacies on your behalf and texts you which ones have your specific formulation in stock — eliminating the time and frustration of calling pharmacies one by one.
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