Singulair vs. Xopenex
See how Singulair and Xopenex compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Singulair is a daily oral tablet that prevents asthma symptoms and allergic rhinitis over time, while Xopenex is a fast-acting inhaled bronchodilator used to treat or prevent sudden bronchospasm.
Singulair carries a boxed warning for serious mood and behavior changes, including suicidal thoughts, that Xopenex does not carry.
Only Xopenex works fast enough to relieve an asthma attack already in progress; Singulair is not approved for that use and must be taken every day instead.
Singulair vs. Xopenex Drug Summary
Singulair
Singulair (montelukast) is a leukotriene receptor antagonist taken as a once-daily oral tablet, chewable tablet, or granules. It is FDA-approved to prevent and control asthma symptoms, block exercise-induced bronchoconstriction, and relieve seasonal and perennial allergic rhinitis. It builds up its effect over time and does not work fast enough to stop an asthma attack that has already started.
Xopenex
Xopenex (levalbuterol) is a short-acting beta2-agonist bronchodilator delivered by nebulizer solution or HFA inhaler. It is FDA-approved to treat or prevent bronchospasm in people with reversible obstructive airway disease such as asthma, working within minutes. It does not treat allergies and is not meant to be used alone for daily maintenance.
Singulair vs. Xopenex Side Effects
Singulair
Xopenex
Singulair vs. Xopenex Dosage
Singulair
Xopenex
| STAGE | DOSE | WHEN |
| Starting dose | 4 mg once daily | At the start |
| Maximum dose | 10 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 inhalations) q4-6h | If needed |
| Dose changes | 4 increases | As tolerated |
Singulair
| STAGE | DOSE | WHEN |
| Starting dose | 4 mg once daily | At the start |
| Maximum dose | 10 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Xopenex
| STAGE | DOSE | WHEN |
| Starting dose | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 inhalations) q4-6h | If needed |
| Dose changes | 4 increases | As tolerated |
Singulair vs. Xopenex Indications
Singulair
Singulair is approved for long-term asthma control, exercise-induced bronchoconstriction prevention, and relief of seasonal and perennial allergic rhinitis symptoms. It is taken every day, even when symptoms are not present, to reduce airway inflammation over time. It is not approved to stop an asthma attack once it starts.
Prophylaxis and chronic treatment of asthma
Prevention of exercise-induced bronchoconstriction
Relief of seasonal allergic rhinitis symptoms
Relief of perennial allergic rhinitis symptoms
Xopenex
Xopenex is approved to treat or prevent bronchospasm in people with reversible obstructive airway disease such as asthma. It opens the airways within minutes, making it useful both for sudden symptoms and for use just before exercise. It does not treat allergies or provide long-term control of airway inflammation.
Treatment of acute bronchospasm episodes
Prevention of bronchospasm before exercise
Use in reversible obstructive airway disease
Rescue relief for sudden wheezing or breathlessness
Singulair vs. Xopenex Pros and Cons
Singulair
Singulair offers convenient once-daily dosing without needles or inhaler technique, and its chewable and granule forms make it easier to give to young children. It also covers allergic rhinitis, a benefit Xopenex does not offer, but it carries a boxed warning for serious mood and behavior changes and does not work fast enough for rescue use.
Pros
Once-daily oral dosing, no inhaler technique needed
Chewable tablets and granules for young children
Also relieves seasonal and perennial allergy symptoms
Non-steroidal option for daily asthma control
Cons
Boxed warning for suicidal thoughts and behavior changes
Not approved to treat an asthma attack in progress
Takes days to weeks to build its full effect
Costs more than Xopenex, roughly $289 to $375 a month without insurance
Xopenex
Xopenex works within minutes, making it the better choice for sudden asthma symptoms or as a pre-exercise treatment. It is delivered directly to the lungs by nebulizer or inhaler, which limits some whole-body exposure compared to a pill, but it must be dosed several times a day and carries cardiovascular risks if overused.
Pros
Works within minutes for sudden bronchospasm
Delivered directly to the lungs via nebulizer or inhaler
Available in nebulizer form for young children
Costs less than Singulair, roughly $55 to $120 a month without insurance
Cons
Needs dosing three times a day or every 4 to 6 hours
Risk of tachycardia, arrhythmia, and blood pressure changes
Does not treat allergy symptoms
Excessive use can be fatal if the recommended dose is exceeded
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