Levalbuterol is non-formulary. Albuterol has been previously approved for automatic substitution at an equivalent dose for levalbuterol (two times levalbuterol dose at the same frequency).

·        All patients receiving levalbuterol (those who have orders stating dispense as written) will be converted to an equivalent dose of albuterol after 48 hours of therapy, unless they are allergic to albuterol, receiving levalbuterol at home, or have acute atrial fibrillation. Objective parameters will be monitored by respiratory therapy (heart rate, tremors, nervousness, and blood gases if ordered) from start of levalbuterol to 48 hours after albuterol is started. If a clinically significant decline is not seen, albuterol will be continued. DUE Montoring form

·      Data will be collected on all patients, during levalbuterol administration and after conversion to albuterol. This information will be presented to the committee for their review. (see accompanying monitoring tool).

·        Currently Levalbuterol accounts for 19% of doses, but 87% of $125,628 in total cost
 

Articles on Levalbuterol
Clinical Efficacy of Racemic Albuterol Versus Levalbuterol for the Treatment of Acute Pediatric Asthma
Changes in Heart Rate Associated with Nebulized Racemic Albuterol and Levalbuterol in Intensive Care Patients
Single Isomer R-salbutamol is not Superior to Racemate Regarding Protection for Hyperresponsiveness
Levalbuterol and Racemic Albuterol Are There Therapeutic Differences
The Therapeutic Ratio of R-albuterol is Comparable With That of RS Albuterol in Asthmatic Patients