Dose-response evaluation of levalbuterol versus racemic albuterol in patients with asthma

Albuterol, in all marketed forms, is sold as a racemate, composed of a 50:5 0 mixture of (R)- and (S)-isomers. Racemic albuterol and the single isomer version (R)-albuterol (levalbuterol) were compared in a randomized, double- blind, dose-ranging five-way crossover study in patients (n = 20) with mild persistent to moderate Persistent asthma. Placebo, racemic albuterol (2.50 mg), or levalbututerol (0.37, 0.63, or 1.25 mg) were delivered as single, nebulized doses to 5 male and 15 female nonsmoking patients with asthma age d 18-50 years. Serial pulmonary function was assessed at 15-min intervals a nd mean time to onset of activity and duration of improvement of forced exp iratory volume in 1 sec (FEV1) were measured. In addition, blood chemistrie s, electrocardiogram (ECG) readings, and patient subjective assessment of a dverse symptoms were recorded. Levalbuterol was found to provide significan t bronchodilatory activity and was well tolerated, Levalbuterol 1.25 mg pro vided the greatest increase and duration in FEV1 improvement, whereas racem ic albuterol (2.50 mg) and levalbuterol 0.63 mg provided comparable effects . The lower doses of levalbuterol were associated with a less marked effect on heart rate and potassium than racemic albuterol or high-dose levalbuter ol. These data suggest that 0.63 mg levalbuterol provides bronchodilation e quivalent to 2.50 mg racemic albuterol with less beta-mediated side effects .