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

Most common
pharyngitis (up to 5%)
respiratory infection (up to 5%)
fever (up to 5%)
headache (up to 5%)

Xopenex

Most common
pharyngitis (up to 2%)
bronchitis (up to 2%)
dizziness (up to 2%)
pain (up to 2%)

Singulair vs. Xopenex Dosage

Singulair

Dosage
Dosage Table
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

Dosage
Dosage Table
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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