It proves a point of marketing based medicine instead of evidence based.
xopenex is nothing more than r-albuterol, the active component of racemic albuterol mixture.
So equivalent dose of xopenex and albuterol are therapeutically equivalent.
The s-albuterol is beta inert. It's that simple.
However in peds who may metabolize albuterol slowly, double the amount of albuterol in the racemic mixture may result in a delayed elimination thereby potentially causing more cardiovascular effects, in theory.
Package insert will show that the rate of tachycardia is 2.7...for both xopenex and albuterol...
In the end.... same **** different price.
Not staying in your comfort zone and use the "choose your battle" card.
This is one time I will side with Sparda. I like to see more of this kind of stuff from him.
I agree with It's Z - I don't think xopenex is any different than albuterol. However, they have a very effective market-based medicine campaign and as a result, many PCPs (and parents) are led to believe in the wonders and miracles of Xopenex over plain albuterol.
In the ER or acute setting, when you have the nurses and parents insisting that the child can't get albuterol and needs Xopenex - you pick your battles. You can try to argue with the anxious parent and nurse that albuterol works just as well (and get paged every minute for persistent tachycardia with "see, you should have written for Xopenex"), and creating mistrust between the parents and her healthcare provider ("he doesn't know my child, he's a know-it-all doctor who didn't listen to me, I know my child best and Xopenex works while Albuterol doesn't"). You pick your battles, and Xopenex vs Albuterol is something that the parents and pharmacy can fight over ... I might order Xopenex, and if pharmacy refuses, then I'll just tell the nurse and parents that the pharmacy refuse to dispense (or its not available). I don't care what the child gets, as long as the child actually gets treatment instead of arguing over the bioavailable of stereo enantiomers and its cost. Sometimes we focus so much on "stupid doctor for not following formulary" or "stupid doctor for not listening to the parents/nurses" or the nurse going "stupid pharmacist for not giving the xopenex", we forget that there is a patient who probably needs the meds at that moment. You pick your battle. In an acute situation, the last thing I need is to create antagonism between the parents and her healthcare providers (in an already anxious environment) - if the pharmacist wants to fight that battle, then it's the pharmacist's prerogative. If I really want Xopenex available on formulary (or more readily available), then I'll just have to make my case to the hospital's P&T committee.
My hospital has Xopenex limited to pediatrics. When I take care of kids, albuterol is my first line drug unless the parents insist on Xopenex. Then I would order Xopenex. Usually the peds pharmacist will see the heart rate, approve it for 1 dose, and if there is improvement in HR, will approve its continued inpatient use (personally I think the improvement in HR is due to the fact the child can BREATH instead of xopenex/albuterol receptor effects). If it doesn't improve, then continued xopenex order is not approved.
I have only Rx Xopenex inhaler once for an adult and it was in an outpatient setting where the patient asked for it (and had coupons) and was not interested in albuterol (or Maxair). It's not available for inpatient adult use unless there are extreme circumstances.
So you pick your battles. I'm more interested in convincing parents that a virus should not be treated with antibiotics, and that vaccines is not a vast medical-pharmaceutical-industrial conspiracy to turn kids into zombies (television/ipad/xbox/ps3 have done that without our help). If you want to fight with the parents about xopenex vs albuterol, be my guest.
*just my perspective. Different providers and different hospitals will provide different experiences and perspectives.
