5 Levalbuterol Interactions to Be Aware Of

Inhalers are the go-to medications for treating lung conditions such as asthma or chronic obstructive pulmonary disease (COPD). Short-acting inhalers, also called rescue inhalers, provide quick relief whenever your asthma or COPD is causing you trouble to breathe.

Levalbuterol (Xopenex HFA) is one type of rescue inhaler. It works by opening up the airways in your lungs to make breathing easier. It’s also available as a solution (Xopenex) that you inhale using a nebulizer machine.

If you’re prescribed levalbuterol, it’s a good idea to be aware of its potential drug interactions. Levalbuterol interactions can lead to side effects. Interactions can also cause levalbuterol or the interacting medication to work less effectively. We’ll discuss five potential levalbuterol interactions below.

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1. Beta blockers

Beta blockers treat a variety of heart conditions such as high blood pressure and heart failure. Examples include carvedilol (Coreg) and propranolol (Inderal LA).

Levalbuterol and beta blockers affect the same type of receptors (binding sites). These are called beta receptors. Levalbuterol works by turning on beta receptors, particularly in your lungs. This relaxes the airways that help you breathe.

Beta blockers have the opposite effect, causing your airways to tighten. So it’s possible that taking a beta blocker can make levalbuterol less effective. And since beta blockers can narrow your airways, they may cause a bronchospasm. This is more problematic in people with asthma or COPD.

However, certain beta blockers are less likely to interact with levalbuterol. Beta blockers that mainly affect beta receptors in the heart are less likely to affect your airways. These include atenolol (Tenormin), bisoprolol (Zebeta), metoprolol (Lopressor). So if you need a beta blocker (for example, after a heart attack), these may be good options.

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Good to know: It’s questionable just how much beta blockers impact your airways. Some research shows that beta blockers don’t constrict the airways to any major degree. Often, the benefits of using a beta blocker — even if you have asthma or COPD — may outweigh the risks. Still, beta blockers that mainly affect the heart are likely the safest option.

2. Some water pills

Diuretics (water pills) are medications that treat high blood pressure and fluid buildup (edema) from certain medical conditions such as heart failure. There are many types of diuretics, including loop and thiazide diuretics. Furosemide (Lasix) is an example of a loop diuretic. Hydrochlorothiazide (Microzide) is an example of a thiazide diuretic. These diuretics work by getting rid of extra fluids from your body. Along with fluids, diuretics also get rid of certain electrolytes, including potassium. 

Levalbuterol can also decrease potassium levels in your blood. So when taken with certain diuretics, the risk of low potassium (hypokalemia) is higher. Symptoms include weakness, heart palpitations, and muscle cramps.

If you’re taking loop or thiazide diuretics and levalbuterol, your healthcare professional (HCP) will likely monitor your potassium levels more closely. This is especially true when starting levalbuterol or if you’re using levalbuterol more often than usual. Make sure to keep your HCP updated on how often you’re using levalbuterol. This will help them decide how closely to monitor your potassium levels.

3. Tricyclic antidepressants

Tricyclic antidepressants (TCAs) treat anxiety, depression, and other mental health conditions. Examples include doxepin (Silenor), nortriptyline (Pamelor), and amitriptyline.

TCAs can cause serious heart rhythm problems. This includes a condition called long QT syndrome, which causes irregular heartbeats. Symptoms of long QT syndrome include dizziness, fainting, and heart palpitations. More seriously, a life-threatening arrhythmia (abnormal heartbeats) can develop. 

Levalbuterol can also cause heart problems such as long QT syndrome. So taking levalbuterol and TCAs together can increase your risk of heart issues. If you use levalbuterol and need an antidepressant, there are many options besides TCAs. It's likely that your HCP can recommend an antidepressant that doesn't interact with levalbuterol.

In rare cases where you may need to take TCA while using levalbuterol, watch for symptoms of long QT syndrome. In fact, anytime you’re using levalbuterol within two weeks of taking a TCA, watch closely for symptoms such as weakness, heart palpitations, and chest pain. If you experience these symptoms and they feel severe, seek immediate medical care or call 911.

4. Monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAOIs) are medications that treat depression and Parkinson’s disease. Examples include selegiline (Zelapar), phenelzine (Nardil), and rasagiline (Azilect).

Similar to TCAs, MAOIs can cause heart problems and high blood pressure. So it’s best to avoid taking levalbuterol and MAOIs together. You should even avoid taking levalbuterol within 2 weeks of your last MAOI dose.

In rare cases, when an MAOI is needed, your HCP will monitor you more closely. Let them know if you experience any symptoms that may indicate a heart problem, such as chest pain, blurry vision and headaches, or heart palpitations.

5. Digoxin

Digoxin (Lanoxin) is a medication that treats heart conditions such as heart failure and arrhythmias. Using levalbuterol may decrease digoxin levels in your body. This means that digoxin may not work as well.

The idea that levalbuterol decreases digoxin levels comes from smaller older studies on albuterol (ProAir, Ventolin). Albuterol is a medication that's closely related to levalbuterol. These studies showed that albuterol lowered digoxin levels in the blood. But whether this interaction actually makes digoxin less effective isn’t clear. 

Still, if you use levalbuterol and take digoxin, your HCP will likely monitor your digoxin levels more closely. They may need to raise your digoxin dose if your levels are too low.

When should you contact your healthcare professional about a levalbuterol interaction?

Before starting levalbuterol, give your HCP and pharmacist an updated list of all medications, over-the-counter products, and supplements you take. This will help them check for potential levalbuterol interactions before they occur.

Sometimes, a levalbuterol interaction may be unavoidable. In this case, your provider may monitor you more closely. If you experience symptoms like weakness, tiredness, or muscle cramps, let your provider know immediately. If your symptoms feel severe, like chest pain or trouble breathing, call 911 or seek emergency care.

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Written by:

Makaela Premont, PharmD

Makaela Premont, PharmD, is a pharmacist and the founder of uniquelymickie.com, a website dedicated to helping pharmacy students and pharmacists create a life that they enjoy. She received her Doctorate of Pharmacy from the University of South Carolina and is a licensed pharmacist in North Carolina.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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