When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to levalbuterol or albuterol.

How to Use This Medicine:
Spray, Liquid

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Do not swallow or inject the medicine. Only inhale the medicine.
• You will use this medicine with an inhaler device called a nebulizer. The nebulizer turns the medicine into a fine mist that you breathe in through your mouth and to your lungs. Your caregiver will show you how to use your nebulizer. Do not mix levalbuterol with other medicines in a nebulizer, unless told to do so by your doctor.
• Aerosol inhaler:
  
  • You will use this medicine with a device called a metered-dose inhaler. The inhaler fits on the medicine canister and turns the medicine into a fine spray that you breathe in through your mouth and to your lungs. You may be told to use a spacer, which is a tube that is placed between the inhaler and your mouth. Your caregiver will show you how to use your inhaler and the spacer (if needed).
  • Shake the inhaler well just before each use. Avoid spraying this medicine into your eyes.
  • Remove the cap and look at the mouthpiece to make sure it is clean.
  • Prime the inhaler the first time you use it. Point the inhaler away from your face. Spray into the air 4 times. You also need to prime it when you do not use the inhaler for more than 3 days in a row.
  • To inhale this medicine, breathe out fully, trying to get as much air out of the lungs as possible. Put the mouthpiece just in front of your mouth with the canister upright.
  • Open your mouth and breathe in slowly and deeply (like yawning), and at the same time firmly press down on the top of the canister once.
  • Hold your breath for about 5 to 10 seconds, and then breathe out slowly.
  • If you are supposed to use more than one puff, wait 1 to 2 minutes before inhaling the second puff. Repeat these steps for the next puff, starting with shaking the inhaler.
  • Clean the inhaler with warm water and air dry it thoroughly. Do this at least once a week.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Solution (for nebulizer): Keep the medicine in the foil pouch until you are ready to use it. Store the vials at room temperature, away from heat and direct light. The vials in the pouch must be used within 2 weeks after you open the foil pouch.
• Inhaler: Store the canister at room temperature, away from heat and direct light. Do not freeze. Do not keep this medicine inside a car where it could be exposed to extreme heat or cold. Do not poke holes in the canister or throw it into a fire, even if the canister is empty.
• Inhaler: Throw away the canister after either 80 or 200 sprays have been used. Ask your pharmacist if you are not sure. Do not place the canister in water to see if the canister is full (float test).

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• This medicine should not be used together with similar inhaled medicines, such as albuterol, isoproterenol, metaproterenol, pirbuterol, or terbutaline.
• Some medicines can affect how levalbuterol works. Tell your doctor if you are using the following:
  
  • A diuretic or water pill
  • An MAO inhibitor
  • Blood pressure medicine (a beta blocker)
  • Digoxin
  • Medicine for depression

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, diabetes, heart disease, heart rhythm problems, high blood pressure, an overactive thyroid, or seizures.
• This medicine may cause increased trouble breathing (paradoxical bronchospasm), which may be life-threatening.
• If you use a corticosteroid medicine to control your asthma, keep using it as instructed by your doctor.
• If any of your asthma medicines do not seem to be working as well as usual, call your doctor right away. Do not change your doses or stop using your medicines without asking your doctor.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Chest pain, fast, pounding, or uneven heartbeat
• Dry mouth, increased thirst, muscle cramps, nausea or vomiting, uneven heartbeat
• More trouble breathing
• Tremors or shaking

If you notice these less serious side effects, talk with your doctor:

• Diarrhea
• Dizziness or nervousness
• Headache
• Runny nose, sore throat

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088