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Thread Title: Xopenox Vs. Albuterol
Created On Sun Nov 13, 2005 1:15 PM


ALSFlyCarDude
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Sun Nov 13, 2005 1:15 PM

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In Upstate NY the treatment for "Respiratory Distress Secondary to Asthma" has been pretty straight forward with Oxygen via NRB, Albuterol 2.5mg mixed with Atrovent 0.5mg via Neb. repeat Albuterol if needed. If futher decline consider Intubation and/or Epi 1:1,000 0.3mg SQ.

A fairly new nebulized medication for the acute bronchospasm called Xopenox has been getting good reviews. Studies show Xopenex "improved lung function" and more rapidly airway improvement and the patients spend less time in the ER.

I know that hospitals in the Syracuse NY are using Xopenox over Albuterol and the MD, NP, & PA's that I know are very pleased with this medication. Patients experiance less side-effects from Xopenox then Albuterol.

SO... Are there any agencies out there using this new medication or doing a trial period on it? If so what is the protocol that your agency has in place?

What are your thoughts on this subject??

Stay Safe!

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Aliakey
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Sun Nov 13, 2005 2:20 PM

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I think the "Down on the Pharm" section has a thread on xopenex already, but we have been using it for a couple of years, and our protocol follows:



For asthma, COPD, SPO2 below 90%, and/or wheezing present: Albuterol x 2 first; if no relief, then Xopenex every 5 min or as needed by nebulizer.

Or, Xopenex as a first line med if the pt already received Albuterol x2 w/o relief or pt is already on Xopenex normally.

These protocols allow all levels of care (EMT-B, EMT-I, and EMT-P) to administer Xopenex and/or albuterol.


I've seen better results when I get to the xopenex step for our longer transports, but the question in my mind would it be the xopenex itself, or the combination of a couple of albuterol treatments and xopenex. It's one of those meds I really need to sit down and research more; unfortunately, I haven't. Good incentive to do so now. ;-)





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VanHelsing
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Sun Nov 13, 2005 2:26 PM

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I dont recognize the trade name, what is the generic name of the drug in question ?

we have fenoterol ( berotec ), hexaprenaline sulphate ( Ipradol ), and Salbutamol ( ventolin ) for asthma at ILS level, then obviously solu-corteff and solu-medrol IVI for ALS.

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Aliakey
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Sun Nov 13, 2005 2:45 PM

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"Xopenex" is levalbuterol HCL

Our adult (and now pedi) dose is 1.25mg in 3ml NS dumped into a nebulizer, just like our albuterol.



Just found the website:

http://www.xopenex.com/

Hope it helps!


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"Always do right. This will gratify some people and astonish the rest." Mark Twain (Samuel Longhorne Clemens) 1835-1910

Edited: Sun Nov 13, 2005 at 2:48 PM by Aliakey

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firefightertwr79
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Sat Nov 19, 2005 3:25 PM

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As of yet none of the systems in our area are using xopenox. I do however have good amount of expierience with the medication and the combination of xopenox and albuterol. Xopenox is a great drug, however its effects are best seen after our prehospital care ends. Xopenox is meant to be a drug with long lasting effects, that better opens a pt's airways. The combination of xopenox and albuterol (DuoNeb) mixes the best of both worlds. It takes albuterol's fast acting effects and mixes it with Xopenox's long lasting effects. From my experience I have seen it very effective in pt's that have chronic resp. issues and those having severe asthma attacks, as it gives the quick acting albuterol and the long lasting xopenox. It also from what I have seen tends not to raise a pt's heart as much as just straight albuterol, especially when you start getting into two or three treatments of albuterol. I have also seen it better manage a pt in one dose than two doses of albuterol. Now one medication we do use in my area, due to some 15mins + transport times is Solumedrol. That does quite a lot of good, but it takes about 15-20 mins to start working. I see it best in a regular pt who waits too long before calling. He is a end stage emphysemia(i think I spelt that wrong, sorry tired) and on a good day is in bad shape. But usually by the time we get him to the hospital, a 20 mins. trip on a good day, he is breathing easier and his stats start coming back up.

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stridor
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Sun Nov 20, 2005 7:50 AM

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Xopenox is albuterol, it is simply an R isomer of albuterol rather than a D isomer. The difference is kind of like the difference between the L and D isomers of methamphetamine. The different isomers act on different receptors in addition to the R isomer being more difficult to break down. I wish I could draw a diagram on here. There is lots of info present on the web. BTW, for any aspiring clandestine chemists who may be led here by a search engine, you cannot turn Levmethamphetamine found in vicks inhalers into D-meth. The isomer fairy just doesn't work that way.

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 One day you'll be alone face down in a combat zone. Bullets flying all around. Medics kneel down beside you on the ground. Don't you worry bout being alone delta medic's gonna bring you home.
Village armourer

Edited: Tue Nov 06, 2007 at 12:54 PM by stridor

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