Spiriva vs. Dulera
See how Spiriva and Dulera compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Spiriva is a once-daily LAMA bronchodilator approved for COPD and, through its Respimat form, for asthma in patients 6 and older.
Dulera is a twice-daily inhaled steroid and bronchodilator combination approved only for asthma, and it carries a boxed warning about LABA-related asthma death risk.
Neither drug relieves sudden symptoms, so both require a separate rescue inhaler for acute attacks.
Spiriva vs. Dulera Drug Summary
Spiriva
Spiriva is a long-acting muscarinic antagonist (LAMA) bronchodilator used for long-term maintenance of COPD, and, in its Respimat form, for asthma in people 6 and older. It is inhaled once daily and does not relieve sudden symptoms.
Dulera
Dulera combines an inhaled corticosteroid (mometasone) with a long-acting beta-agonist (formoterol) for daily asthma control in people 5 and older. It is inhaled twice daily and, like Spiriva, is not meant for sudden symptom relief.
Spiriva vs. Dulera Side Effects
Spiriva
Dulera
Spiriva vs. Dulera Dosage
Spiriva
Dulera
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mcg once daily | At the start |
| Maximum dose | 18 mcg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 2 inh 100/5 mcg BID | At the start |
| Maximum dose | 2 inh 200/5 mcg BID | If needed |
| Dose changes | 1 increase | As tolerated |
Spiriva
| STAGE | DOSE | WHEN |
| Starting dose | 2.5 mcg once daily | At the start |
| Maximum dose | 18 mcg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Dulera
| STAGE | DOSE | WHEN |
| Starting dose | 2 inh 100/5 mcg BID | At the start |
| Maximum dose | 2 inh 200/5 mcg BID | If needed |
| Dose changes | 1 increase | As tolerated |
Spiriva vs. Dulera Indications
Spiriva
Spiriva is approved for long-term maintenance treatment of COPD, including chronic bronchitis and emphysema, and for reducing COPD exacerbations. Its Respimat form is also approved for asthma maintenance in patients 6 and older. It is not a rescue medication for sudden breathing problems.
Long-term COPD maintenance treatment
Reduces COPD exacerbations
Asthma maintenance in ages 6+ (Respimat only)
Not for acute bronchospasm relief
Dulera
Dulera is approved only for twice-daily maintenance treatment of asthma in patients 5 and older. It is not approved for COPD or for relieving sudden asthma attacks. Its corticosteroid component also helps control airway inflammation over time.
Asthma maintenance in ages 5+
Not approved for COPD
Not for acute bronchospasm relief
Combines steroid and long-acting bronchodilator
Spiriva vs. Dulera Pros and Cons
Spiriva
Spiriva has a long safety record as a once-daily bronchodilator and covers both COPD and asthma depending on the device used. It has no boxed warning like Dulera's, but it does not address airway inflammation on its own and tends to cost more.
Pros
Only needs to be taken once a day
Approved for both COPD and asthma (Respimat)
More than two decades of clinical use
No boxed warning for increased death risk
Cons
Does not reduce airway inflammation on its own
HandiHaler form only approved for adults with COPD
Costs more than Dulera, roughly $600 to $630 a month without insurance
Not approved for children under 6
Dulera
Dulera pairs a corticosteroid with a bronchodilator in one inhaler, which can help control both inflammation and airway tightening in asthma. It carries a boxed warning for LABA-related risk and requires twice-daily use, but it is generally priced lower than Spiriva.
Pros
Combines a steroid and bronchodilator in one inhaler
Generally costs less than Spiriva, roughly $230 to $500 a month without insurance
Approved for asthma in children as young as 5
Treats airway inflammation as well as bronchospasm
Cons
Boxed warning for increased risk of asthma-related death
Must be inhaled twice daily instead of once
Not approved for COPD
Can cause oral thrush and other steroid-related effects
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