Lindquist Desirae E, Cooper April A
Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA.
Duke Regional Hospital, Durham, NC, USA.
J Pharm Technol. 2014 Feb;30(1):13-17. doi: 10.1177/8755122513507700. Epub 2013 Nov 5.
: To determine the safety of levalbuterol versus albuterol in patients with a tachyarrhythmia. : A PubMed search was conducted using the MeSH search terms levalbuterol, albuterol, and tachyarrhythmia. Bibliographies of relevant articles were reviewed for additional citations. : Search results were limited to humans and randomized controlled trials. Those studies that excluded patients with predetermined tachyarrhythmias were excluded from this review. Trials that failed to compare levalbuterol and albuterol outcomes were excluded. : Beta-2 receptor agonists are the mainstay of treatment in patients with respiratory disease, such as asthma or chronic obstructive pulmonary disease. Racemic albuterol has been linked to poor outcomes due to the fact that it contains both the -isomer and the -isomer. Levalbuterol, the "pure" -isomer, has been thought to decrease cardiac side effects since it only contains the therapeutic component of the racemic mixture. Patients with tachyarrhythmias are at an increased probability to experience harmful, if not fatal, cardiac side effects from these drugs. Limitations of current studies include a lack of data in patient populations with baseline tachyarrhythmias. : Tachyarrhythmias put a patient at increased risk of poor outcomes, including death. Evidence for using either racemic albuterol or levalbuterol for respiratory disease management in these patients is lacking and insufficient. Randomized controlled trials show that in intensive care unit patient populations there is no clear advantage to using levalbuterol over albuterol; however, this did not hold true in pediatric populations. No clinical trials exist that look at a direct comparison of these 2 agents in patients with underlying tachyarrhythmias. Further research into the most efficacious and safe β-2 receptor agonists in this specialized patient population should be conducted to help reduce potential harmful outcomes.
确定左旋沙丁胺醇与沙丁胺醇在快速性心律失常患者中的安全性。：使用医学主题词表搜索词“左旋沙丁胺醇”、“沙丁胺醇”和“快速性心律失常”在PubMed上进行搜索。查阅相关文章的参考文献以获取更多引用文献。：搜索结果仅限于人类和随机对照试验。那些排除了预先确定的快速性心律失常患者的研究被排除在本综述之外。未能比较左旋沙丁胺醇和沙丁胺醇结果的试验被排除。：β2受体激动剂是呼吸系统疾病（如哮喘或慢性阻塞性肺疾病）患者治疗的主要药物。消旋沙丁胺醇由于同时含有左旋异构体和右旋异构体而与不良结局有关。左旋沙丁胺醇，即“纯”左旋异构体，被认为可减少心脏副作用，因为它仅含有消旋混合物的治疗成分。快速性心律失常患者使用这些药物发生有害甚至致命心脏副作用的可能性增加。当前研究的局限性包括缺乏基线快速性心律失常患者群体的数据。：快速性心律失常会使患者出现不良结局（包括死亡）的风险增加。缺乏且没有足够证据支持在这些患者中使用消旋沙丁胺醇或左旋沙丁胺醇来管理呼吸系统疾病。随机对照试验表明，在重症监护病房患者群体中，使用左旋沙丁胺醇并不比沙丁胺醇有明显优势；然而，在儿科患者群体中并非如此。没有临床试验直接比较这两种药物在有潜在快速性心律失常患者中的效果。应针对这一特殊患者群体对最有效且安全的β2受体激动剂进行进一步研究，以帮助减少潜在的有害结局。
