Gene,
What is The Medical Letter? Is it a scientific or stock publication?
In the Bioclinician the following was stated:
"As the medical community begins to hear and learn about Xopenex, the lower incidence of side effects and the improved dosing schedule should win converts at an increasing rate."
Further, JACI, Dec 1998;102(6Pt1):943-52
"Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function."
More, JACI April 1999 Vol 103, No 4, states:
"In airway smooth muscle cells, levalbuterol decreased intracellular calcium concentrations, although S-albuterol and racemic albuterol increased intracellular calcium AND INDUCED CELL SHORTENING.
Preincubation with levalbuterol or racemic albuterol decreased carbachol-induced contractions, but S-albuterol inhanced these contractile responses."
Admittedly, there is much to learn about the precise drug actions. But there is early evidence that S-albuterol is causing the reduced FEV1 and the cardiac and tremor reactions through the calcium and methacholine responses. If this is the case doctors will flock to Xopenex. While I am not qualified, it even looks to me like albuterol could be removed from the market if the reduced FEV1 functions are shown to result from S-albuterol/racemic albuterol.
Note: I am not medically or scientifically trained, so ample criticism is welcomed from the experts out there.
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