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Comparison of Pediatric Levalbuterol and Albuterol Exposures Reported to Texas Poison Centers

Background: Levalbuterol is R-albuterol, which is the active isomer and accounts for the therapeutic activity of albuterol. The effects of S-albuterol are often the opposite of those of levalbuterol, and the effects of levalbuterol may be diminished in the presence of S-albuterol. Objective: To compare exposures among young children to levalbuterol and albuterol that were reported to poison centers. Methods: Cases included levalbuterol and albuterol exposures among patients age 0–5 years reported to Texas poison centers during 2000–2009. The distribution of total cases for each medication was determined for selected characteristics. For cases not involving other substances and where a final medical outcome was known, the distribution of each medication was determined for outcome and management site of the exposure and most common clinical effects and treatments. Comparisons were made by calculating the rate ratio (RR) and 95% confidence interval. Results: There were a total of 1,012 levalbuterol and 4,338 albuterol exposures. Other substances were involved in 11.8% of levalbuterol and 6.6% of albuterol exposures (RR 1.77, 95% CI 1.42 to 2.20). No effect was reported in 84.0% of levalbuterol and 71.9% of albuterol exposures (RR 1.17, 95% CI 1.03 to 1.32), and 91.7% of levalbuterol and 73.1% of albuterol exposures were managed on site (RR 1.26, 95% CI 1.11 to 1.41). The most common adverse clinical effects were reported more frequently among albuterol exposures. The most frequent treatments of levalbuterol and albuterol exposures were, respectively, dilution 59.5% and 42.0% (RR 1.42, 95% CI 1.22 to 1.64), food 18.9% and 12.8% (RR 1.48, 95% CI 1.12 to 1.94), single-dose activated charcoal 0.3% and 10.1% (RR 0.03, 95% CI 0.00 to 0.15), and cathartic 0.0% and 4.6% (RR 0.00, 95% CI 0.00 to 0.22). Conclusions: Among exposures involving children aged 0–5 years that were reported to Texas poison centers, levalbuterol was more likely to include other substances, have less serious outcomes, and be managed on site when compared to albuterol.