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Levalbuterol versus albuterol.
Curr Allergy Asthma Rep 2009; 9(5):401-9CA

Abstract

Albuterol has been used for more than 40 years to treat acute asthma exacerbations as a racemic mixture of isomers: the active form, (R)-albuterol, or levalbuterol, and (S)-albuterol, classically considered inert. The single-isomer formulation, levalbuterol, has been synthesized recently and used therapeutically when the racemate is deemed less desirable. Basic investigations indicate that racemic albuterol and levalbuterol can produce effects that favor asthma remediation, including corticosteroid amplification and reduction of inflammatory mediators; in contrast, (S)-albuterol produces opposite effects. With inhalation of racemic albuterol, circulating (S)-albuterol persists 12 times longer than levalbuterol, suggesting potential for paradoxical effects observed clinically. Although mainly consistent with basic findings, clinical studies suggest no overwhelming superiority of levalbuterol over racemic albuterol; however, levalbuterol's effects may be greatest in moderate to severe asthma patients, especially with racemic albuterol overuse. Recent adoption of the hydrofluoroalkane formulation has narrowed the cost gap between levalbuterol and racemic albuterol metered-dose inhalers, but it remains for the nebulized formulations. Thus, physician selection of these drugs has remained dependent on experience, pharmaceutical knowledge, and established prescribing habits combined with cost factors, formulary structures, and availability, such that racemic albuterol is still used significantly compared with levalbuterol to treat acute asthma exacerbations.

Authors+Show Affiliations

University of Texas Medical Branch, 4.118 John Sealy Annex, Galveston, TX 77555-0568, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19671384

Citation

Ameredes, Bill T., and William J. Calhoun. "Levalbuterol Versus Albuterol." Current Allergy and Asthma Reports, vol. 9, no. 5, 2009, pp. 401-9.
Ameredes BT, Calhoun WJ. Levalbuterol versus albuterol. Curr Allergy Asthma Rep. 2009;9(5):401-9.
Ameredes, B. T., & Calhoun, W. J. (2009). Levalbuterol versus albuterol. Current Allergy and Asthma Reports, 9(5), pp. 401-9.
Ameredes BT, Calhoun WJ. Levalbuterol Versus Albuterol. Curr Allergy Asthma Rep. 2009;9(5):401-9. PubMed PMID: 19671384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Levalbuterol versus albuterol. AU - Ameredes,Bill T, AU - Calhoun,William J, PY - 2009/8/13/entrez PY - 2009/8/13/pubmed PY - 2009/10/22/medline SP - 401 EP - 9 JF - Current allergy and asthma reports JO - Curr Allergy Asthma Rep VL - 9 IS - 5 N2 - Albuterol has been used for more than 40 years to treat acute asthma exacerbations as a racemic mixture of isomers: the active form, (R)-albuterol, or levalbuterol, and (S)-albuterol, classically considered inert. The single-isomer formulation, levalbuterol, has been synthesized recently and used therapeutically when the racemate is deemed less desirable. Basic investigations indicate that racemic albuterol and levalbuterol can produce effects that favor asthma remediation, including corticosteroid amplification and reduction of inflammatory mediators; in contrast, (S)-albuterol produces opposite effects. With inhalation of racemic albuterol, circulating (S)-albuterol persists 12 times longer than levalbuterol, suggesting potential for paradoxical effects observed clinically. Although mainly consistent with basic findings, clinical studies suggest no overwhelming superiority of levalbuterol over racemic albuterol; however, levalbuterol's effects may be greatest in moderate to severe asthma patients, especially with racemic albuterol overuse. Recent adoption of the hydrofluoroalkane formulation has narrowed the cost gap between levalbuterol and racemic albuterol metered-dose inhalers, but it remains for the nebulized formulations. Thus, physician selection of these drugs has remained dependent on experience, pharmaceutical knowledge, and established prescribing habits combined with cost factors, formulary structures, and availability, such that racemic albuterol is still used significantly compared with levalbuterol to treat acute asthma exacerbations. SN - 1534-6315 UR - https://www.unboundmedicine.com/medline/citation/19671384/Levalbuterol_versus_albuterol_ L2 - https://medlineplus.gov/asthma.html DB - PRIME DP - Unbound Medicine ER -