Our hospital has a very high usage of levalbuterol as opposed to racemic albuterol (most of it actually not motivated by pulmonary). It is often prescribed in higher frequency than the q8 hour use. Pharmacy has been trying to rein this in because of cost differences.
There is a lot of data available (some conflicting) and most of it sponsored by Sepracor (such as Truitt's paper on Chest 2003).
What is your opinion on the use and have you noticed similar patterns with levalbuterol?
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I have noticed increasing usage of levoalbuterol, both in patients referred to us (by both primary care physicians and by pulmonologists) and especially in patients admitted from the ER.
So, before commenting, I will give full disclosure and say that I have owned shares in Sepracor for the past 3-4 years. During that time, I have given Levoalbuterol to patients a grand total of 3 times. More often than not, I switch patients from levoalbuterol to racemic albuterol.
I have, on two occasions, seen patient with status asthmaticus respond well to Levoalbuterol, with decreased tachycardia and decreased tremulousness. Otherwise, I have no intention to use it if the patient can tolerate racemic albuterol (and most obviously do tolerate it.)
I think cost is the big issue. Or to say it another way, albuterol is dirt cheap so it;s hard to justify switching unless there is a very compelling reason. A little bit lower tachycardia won't usually cut it. Also, as you said there is little data that is more efficacious than racemic albuterol, and what data does exist conflicts. We don't use it (yet) at our hospital.
I have seen the same problem in our small community hospital and like mentioned in earlier commnets, the data is conflicting and not very convincing .The data maybe is better in the pediatric asthmatic poulation and not good or convincing for adult COPD patients.It is being used by primary care physcians in wrong doses/frequency which has same side effect profile as racemic albuterol.The pulmonologist probably feel the pressure to add/offer something new to the drug regimen when they are consulted ,so incresed use by them.
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