Drug Interaction Report

Levalbuterol and Nebivolol: Interaction Details

A pharmacist-reviewed analysis of the Levalbuterol and Nebivolol interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Nebivolol

Bystolic Bystolic®
+

Levalbuterol

Xopenex
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 16 documented Levalbuterol interactions, 14 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

Reduced efficacy of levalbuterol

Interaction Deep Dive

Concomitant use of levalbuterol, a beta-2 agonist, and a beta-adrenergic receptor antagonist (beta blocker) may interfere with the efficacy of levalbuterol due to pharmacological antagonism. Additionally, beta blockers may produce severe bronchospasm in patients with asthma. Therefore, use of beta blockers is usually not recommended in patients with asthma. If concomitant use is required or there are no acceptable alternatives, consider using a cardioselective beta blocker with caution12.

Why it happens (mechanism)

Pharmacological antagonism

Common questions

Can I take Levalbuterol and Nebivolol together?

Reduced efficacy of levalbuterol Always confirm with your pharmacist or prescriber before making any change.

How serious is the Levalbuterol and Nebivolol interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

Questions for your pharmacist

  • Does my dose of Levalbuterol or Nebivolol need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (2)

  1. Product Information: XOPENEX(R) inhalation solution, levalbuterol HCl inhalation solution. Akorn Inc (per FDA), Lake Forest, IL, 2019. DailyMed
  2. Product Information: XOPENEX HFA(R) oral inhalation aerosol, levalbuterol tartrate oral inhalation aerosol. Sunovion Pharmaceuticals Inc (per FDA), Marlborough, MA, 2017. DailyMed
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Nebivolol

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Levalbuterol

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All Levalbuterol interactions (16)
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Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Nebivolol + Activated Charcoal American Hellebore American Mistletoe Indian Snakeroot Tyramine 1,3-dmaa Acacia Rigidula Active Hexose Correlated Compound (ahcc) + 175 more
Levalbuterol + Black Tea Caffeine Cocoa Coffee Cola Nut Ephedra Green Coffee Green Tea + 7 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.