These medicines come with patient directions. Read them carefully before using the medicine. If you do not understand the directions or if you are not sure how to use the medicine, ask your health care professional to show you what to do. Also, ask your health care professional to check regularly how you use the medicine to make sure you are using it properly.

Use this medicine only as directed. Do not use more of it and do not use it more often than recommended on the label, unless otherwise directed by your doctor. Using the medicine more often may increase the chance of serious unwanted effects. Deaths have occurred when too much of an inhalation bronchodilator medicine was used.

For patients using the inhalation solution dosage form:

• If you are using this medicine in a nebulizer, make sure you understand exactly how to use it. If you have any questions about this, check with your health care professional.
• Do not use if solution becomes cloudy.
• Do not mix another inhalation medicine with levalbuterol in the nebulizer unless told to do so by your health care professional.

Dosing

The dose of levalbuterol will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of levalbuterol. If your dose is different, do not change it unless your doctor tells you to do so.

• For inhalation solution dosage form:
  • For preventing or treating bronchospasm:
    • Adults and children 12 years of age and older This medicine is used in a nebulizer and is taken by inhalation over a period of five to fifteen minutes. The usual dose is 0.63 milligrams (mg) to 1.25 mg three times a day, every six to eight hours.
    • Children up to 12 years of age Use and dose must be determined by your doctor.

Missed dose

If you miss a dose of this medicine, use it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If your dosing schedule is different from all of the above and you miss a dose of this medicine, or if you have any questions about this, check with your doctor.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light, in the foil pouch.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
• Once a foil pouch is opened, use the medicine within 2 weeks.

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For levalbuterol, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to levalbuterol, albuterol, or other inhaled asthma medicines. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Levalbuterol has not been studied in pregnant women. However, studies in animals have shown that albuterol, a very similar medicine, may cause birth defects or other problems. Levalbuterol has the potential to interfere with contractions during labor. Before taking this medicine, make sure your doctor knows if you are pregnant or may become pregnant.

Breast-feeding It is not known whether levalbuterol passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are taking this medicine and who wish to breast-feed should discuss this with their doctor.

Children This medicine has been tested in children 12 years of age and older. In effective doses, this medicine has not been shown to cause different side effects or problems than it does in other age groups.

Older adults Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same as they do in young adults. Although there is limited information comparing the use of levalbuterol in the elderly with use in other age groups, this medicine is not expected to cause different side effects or problems in older people than it does in younger adults. Your doctor may want to begin with a lesser dose and increase the dosage as tolerated.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your doctor and pharmacist if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicines, including the following:

• Aerosol bronchodilators, short-acting (albuterol [e.g., Proventil, Ventolin], bitolterol [e.g., Tornalate], ephedrine [OTC], epinephrine [OTC, e.g., Primatene], isoetharine [e.g., Bronkosol], isoproterenol [e.g., Isuprel], pirbuterol [e.g., Maxair], terbutaline [e.g., Brethaire]) Using levalbuterol while you are using short-acting aerosol bronchodilators may cause some heart problems

• Beta-adrenergic blocking agents, systemic (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin], betaxolol [e.g., Kerlone], carteolol [e.g., Cartrol], labetolol [e.g., Normodyne], metoprolol [e.g., Lopressor], nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Betapace, Sotacor], timolol [e.g., Blocadren]) Using levalbuterol while you are using beta-adrenergic blocking agents may block the relaxation of smooth muscle in the lungs to ease breathing

• Digoxin Levalbuterol may decrease the levels of digoxin in the blood. Blood levels of digoxin should be monitored when possible

• Diuretics, nonpotassium-sparing (bumetanide [e.g., Bumex], ethacrynic acid [e.g., Edecrin], furosemide [e.g., Lasix], indapamide [e.g., Lozol], thiazide diuretics [water pills]) Use may worsen salt imbalance in the blood

• Methylxanthines (caffeine, theophylline [e.g., Theo-Dur]) Using levalbuterol with methylxanthines may result in irregular heartbeat

• Monoamine oxidase (MAO) inhibitor activity (isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate]) or
• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine [e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Norpramin, Pertofrane], doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g., Aventyl, Pamelor], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil]) Taking levalbuterol while you are taking, or within 2 weeks of taking, MAO inhibitors or tricyclic antidepressants may cause a change in blood pressure or pulse rate

• Heart disease (irregular heartbeat or decreased blood flow through the heart) or
• High blood pressure Use of levalbuterol may worsen these conditions

• Diabetes mellitus (sugar diabetes) Levalbuterol may worsen blood glucose control

• Hyperthyroidism (overactive thyroid)

• Seizures Concurrent use may worsen this condition