Xopenex (levalbuterol)

[ADSNWFLD]

At the start of 2002 we started to use Xopenex. We still have Albuterol and it is up to us what we use. The system encourages us to use the Xopenex for cardiac pts because of less cardiac side effects. Our EMS coordinator has just pulled the Xopenex because of fears of the drug going bad if exposed to light. One of our transport hospitals told our coordinator that once the 20 pack is opened the drug is good for only about 2 weeks.

Has anyone had a similar problem? We have a firefighter that uses Xopenex for his child and has had no problem with the drug. Anyone with experience with this I'd love to hear from you.

Thanks in advance

[flathead]

I was at a seminar about 5 -6 wks ago and one of the pulmonary doc's did a lecture on tne new resp. drugs. He did mention that once the foil pouch is opened, you should use the drug within two weeks and unused vials should be stored in the protective pouch. He also noted that xopenex should be protected from exposure to light. I looked up the packet insert and the recommendations there are almost verbatim.
The fellow who uses it for his child probably uses the twenty in the packet in a two week period so it's no problem. It could be a bit expensive if you were to open a pack and only use one or two over a two week period and then had to throw the rest away.
As a respiratory therapist, I find xopenex to be a very good option but good old albuterol is also effective. Again, it may be just a cost vs. waste factor with your EMS coordinator. Hope I've been some help.

[RoryEl]

Thanks, chf jstano
I wasn't aware of the photosensitivity, and shelf life issues related to Xopenex. Cost and indications, yes. Thanks again.

[DORCEMTDLPN]

Just a note-acording to the 2001 PDR Electronic library any vials in an opened pouch should be used in two weeks, although if removed from the pouch should be used in one week (if you're splitting doses between rigs). Also, again,according to the 2001 PDR The safety and effectiveness of Xopenex (levalbuterol HCL) Inhalation Solution in children less than 12 years of age have not been established
When in doubt - Albuterol works. It's also cheaper. :)

[ALSfirefighter]

I was waiting to post on this thread until I had the time to look up Xopenex and read a little about it. We only use Albuterol and Atrovent here ALS, 1st neb is mixed, all nebs after that are straight albuterol. I have attended seminars where they have doctors debate the subject of Albuterol and cardiac patients. It was quite a hoot. I for one have never witness any significant changes in a cardiac patient when they have received an Albuterol neb or an Albuterol/Atrovent mix neb. Only an increase of a few bpm on the monitor. So I don't forsee us ever adding Xonepex to our medication inventory. If they are asthmatic or other COPD and they need Albuterol, they need it. I think where some newer medics and some I'm sure some crusty's out there that have problems with diagnosing Cardiac Asthma, I missed my first one and I will never miss another. What does piss me off is a few, and thankfully a few medics around me who swear by slapping a nebulizer on the face of a CHF patient. :mad: Not only is it a protocol violation, its just plain inappropriate. The only medication I will not use on a patient with cardiac history is epi 1:1000, I use breathine instead. I also believe that BLS wise, albuterol is contraindicated in anyone with cardiac history and over the age of 55 or 60.
_____________________________
I.A.C.O.J. Bureau of EMS Chairman

[smurfe]

The only medication I will not use on a patient with cardiac history is epi 1:1000, I use breathine instead.

God, I miss Brethine. I don't know why we don't carry it where I work now.

Smurfe :D

[FFP210]

Our medical control director & EMS committee recently decided to add Xopenex to our medication inventory, which wouldn't necessarily be bad if they weren't also taking away the Albuterol/Atrovent that we are currently using. I also work part time in an ER & all of the RTs still use Albuterol & Atrovent without any problems. I don't know yet how ours is going to be packaged, but if its going to go bad in two weeks' time, it may end up being just another drug that expires & never gets used. (When was the last time any one used Tetracaine?!)

[RoryEl]

We too are joining the Xopenex bandwagon (about time) but we're removing AA from ofur bag of tricks just as our friends in Arlington are doing. I disagree with this as a practice issue and believe it is a short sighted decision that fails to compare the benefits and economic of each treatment regime. So in the ends we'll get good bronchodilation for all but at a much higher cost. No wonder healthcare cost continue to esclate out of control.

[WHFD322]

Never heard of this drug. I do like using albuterol with a combination of s.q. brethine.