What is the difference between levalbuterol and albuterol?

Albuterol is a racemic mixture of R and S enantiomers. Levalbuterol contains only the R-enantiomer, which provides the bronchodilatory effect. The S-enantiomer was theorized to cause some side effects. Studies comparing levalbuterol to albuterol show similar bronchodilation with possibly slightly fewer cardiovascular side effects (tremor, palpitations) at equivalent doses, but clinical differences are modest. Albuterol is generally preferred for cost reasons; levalbuterol may benefit patients with significant cardiac side effects from albuterol.

My rescue inhaler is running out faster — should I be worried?

Yes. Increased rescue inhaler use is a critical warning sign that asthma control is worsening. Contact your prescriber — your controller therapy may need to be increased, you may need to treat an underlying trigger (allergen exposure, respiratory infection), or you may be heading toward an exacerbation requiring medical care.

Can I use levalbuterol for COPD?

Yes. Short-acting beta-2 agonists including levalbuterol are used for acute symptom relief in COPD exacerbations and as rescue therapy. COPD management differs from asthma — long-acting bronchodilators (LABAs, LAMAs) are the backbone of stable COPD therapy, with SABAs for rescue.

How do I know when my inhaler is empty?

The best method is counting doses — each MDI has a specified number of actuations (puffs). Track use and replace when near the stated number. The water float test is unreliable for MDIs. Some modern inhalers have dose counters built in. Never save an empty inhaler for an emergency — replace proactively.

What to Expect When Starting Levalbuterol

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Introduction

Levalbuterol (Xopenex) is a short-acting beta-2 agonist (SABA) used for relief of bronchospasm in asthma and COPD. It is the R-enantiomer of albuterol, purported to provide bronchodilation with less of the cardiac stimulant effect. It works within 5-15 minutes and provides relief for 4-6 hours. Like albuterol, it is a rescue inhaler — not a controller medication — and should not be needed more than twice weekly in well-controlled asthma.

Week-by-week timeline

Day 1

First Use — Relief Inhaler

Levalbuterol works within 5-15 minutes of inhalation. Use it when you have acute shortness of breath, wheezing, chest tightness, or cough. For adults: 1-2 puffs every 4-8 hours as needed. Common side effects: trembling, jitteriness, rapid heart rate, headache — these are dose-dependent and typical of beta-2 agonists.

Week 1-2

Understanding Rescue Use

Track how often you use your rescue inhaler each week. In well-controlled asthma, rescue use should be no more than 2 days per week. Needing it more frequently suggests asthma is not well controlled and a controller medication (inhaled corticosteroid) may be needed or your current controller therapy may need adjustment.

Week 2-4

Usage Pattern Assessment

Discuss your levalbuterol use frequency with your prescriber at each visit. Increased rescue inhaler use is a key indicator of poor asthma control and should prompt treatment step-up. Levalbuterol is not a substitute for daily controller therapy.

Month 1

Role Within Asthma Action Plan

Your asthma action plan should specify when to use your rescue inhaler, when to increase controller therapy, and when to seek emergency care. Levalbuterol has a role in the 'yellow zone' of most action plans.

Month 2-3

Ongoing Monitoring

If you have an asthma action plan and use levalbuterol properly within it, emergency visits and hospitalizations should be minimized. Regularly check that your inhaler is not expired and that you have a filled prescription — never run out of your rescue inhaler.

When to call your doctor

Contact your healthcare provider if you experience:

Worsening shortness of breath despite using levalbuterol (possible severe exacerbation — seek emergency care)
No improvement after 2-4 puffs during an acute attack (go to emergency room or call 911)
Rapid or irregular heartbeat that is new or worsening
Severe chest pain during or after using levalbuterol
Significantly increased need for rescue inhaler (more than 2 days per week) — call prescriber for treatment adjustment
Paradoxical bronchospasm: wheezing worsens immediately after using inhaler — use a different inhaler and seek care
Signs of low potassium with frequent use: muscle cramps, weakness, irregular heartbeat

Tips for getting started

Use your rescue inhaler for acute symptoms only — not as a scheduled daily medication. If you need it more than twice a week, contact your prescriber, as this indicates poor asthma control requiring treatment adjustment. Shake the inhaler well before each use. Prime before first use (4 puffs into air) and after non-use for 3+ days. Use a spacer with the MDI for better lung delivery and reduced mouth deposition. Check expiration dates regularly and always have a filled spare. Rinse your mouth after use to reduce throat irritation.

Frequently asked questions

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References

[Regulatory] FDA Label: Xopenex HFA (levalbuterol tartrate) Inhalation Aerosol https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/021602lbl.pdf Accessed 2026-03-01.
[Regulatory] NIH MedlinePlus: Levalbuterol Inhalation https://medlineplus.gov/druginfo/meds/a603025.html Accessed 2026-03-01.
[Regulatory] GINA Asthma Management Guidelines: Rescue Bronchodilators https://ginasthma.org/gina-reports/ Accessed 2026-03-01.

Written and fact-checked by PrescriptionDrugs.org Editorial Team

Last updated: March 1, 2026