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

Most common
sinusitis (up to 6.5%)
headache (up to 5.7%)
pharyngitis (up to 12.5%)
constipation (up to 5.1%)

Dulera

Most common
sinusitis (up to 3%)
headache (up to 3%)
nasopharyngitis (up to 3%)
thrush (up to 3%)

Spiriva vs. Dulera Dosage

Spiriva

Dosage
Dosage Table
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

Dosage
Dosage Table
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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