Levalbuterol nebulizer solution: Is it worth five times the cost of albuterol?

Albuterol is a 50:50 mixture of R-albuterol, the active enantiomer, and S-a lbuterol, which appears to be inactive in humans. The Food and Drug Adminis tration recently approved levalbuterol, the pure K-isomer, as a preservativ e-free nebulizer solution. Published studies indicate that it is neither sa fer nor more effective than an equimolar dose of racemic albuterol (levalbu terol 1.25 mg = albuterol 2.5 mg). However, these studies were conducted in patients with stable asthma (at the top of the dose-response curve), where as a nebulized bronchodilator most likely would be used by patients with an acute exacerbation. Because such patients, in the hospital setting, often require higher doses of albuterol, the manufacturer's recommended dose of l evalbuterol is likely to be too low for rescue therapy. Levalbuterol may co st as much as 5 times more than racemic albuterol, depending on purchase me thod. We conclude that levalbuterol offers no advantage over albuterol but is likely to be more costly.