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. 2011 Jul;16(3):191-8.
doi: 10.5863/1551-6776-16.3.191.

Comparison of levalbuterol and racemic albuterol based on cardiac adverse effects in children

Laura L Bio, Vincent J Willey, Cathy Y Poon

Comparison of levalbuterol and racemic albuterol based on cardiac adverse effects in children

Laura L Bio et al. J Pediatr Pharmacol Ther. 2011 Jul.

Abstract

Objective: To compare the cardiac effects of levalbuterol with those of racemic albuterol based on changes in heart rate (HR) in pediatric patients.

Methods: The medical records of hospitalized children ages 1 month to 12 years, who received either levalbuterol or racemic albuterol via nebulizer for 3 consecutive doses between January 2006 and December 2008 were reviewed. The documented HR was collected prior to and after each administered dose of bronchodilator. The primary outcome was the largest percentage of change in HR between groups. Secondary outcomes of comparisons of the number of patients who had more than a 10% change in HR and incidence of tachycardia were included.

Results: A total of 50 patients, 25 in each group, was included in the study. All patients in the racemic albuterol group received 2.5 mg per dose, while most of the patients in the levalbuterol group received 0.63 mg per dose (19 patients, 76%). Only 6 levalbuterol patients received a dose of 1.25 mg. Nineteen of 25 patients (76%) in the levalbuterol group were tachycardic prior to the first recorded dose compared to 15 patients (60%) in the racemic albuterol group (p = 0.36). The median of the largest percentage of change in HR was 4.1% (interquartile range [IQR], 1.8-8.7) in the levalbuterol group compared to 5% (IQR, 1.9-7.8) in the racemic albuterol group (p = 0.763). Four patients in the levalbuterol group experienced an HR increase of more than 10% compared to 5 patients in the racemic albuterol group (p = 1.0).

Conclusion: Levalbuterol and racemic albuterol bronchodilator therapies produced similar effects on HR. No clinically significant differences were detected in HR changes between the two treatment groups, despite administration of a larger equipotent albuterol dose in the racemic albuterol group than in the levalbuterol group.

Keywords: adverse drug effects; albuterol; beta agonists; cardiac; heart rate; levalbuterol; pediatric; tachycardia.

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Figures

Figure 1.
Figure 1.
Study Design
Figure 2.
Figure 2.
Identification of Study Cohort EPI, epinephrine; LEV, levalbuterol; NA, Not applicable; neb, nebulization; RAC, racemic albuterol
Figure 3.
Figure 3.
The Largest Percentage of Heart Rate Change Stratified by the Presence of Baseline Tachycardia* HR, heart rate □ = levalbuterol ▪ = Racemic albuterol * Baseline tachycardia was determined using the HR just prior to the first dose of bronchodilator therapy administered after admission to the general pediatric unit and was defined as a heart rate >98th percentile for age.
See this image and copyright information in PMC

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