Spiriva vs. Singulair
See how Spiriva and Singulair compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Spiriva is an inhaled LAMA bronchodilator for COPD and asthma maintenance, while Singulair is an oral leukotriene blocker for asthma and allergic rhinitis, and neither is a rescue medication for acute symptoms.
Spiriva requires daily use of an inhaler device, while Singulair is taken as a once-daily pill, chewable tablet, or granules, which may suit people who prefer not to use an inhaler.
Singulair carries a boxed warning for neuropsychiatric side effects, so patients and caregivers should watch for mood or behavior changes, a risk not associated with Spiriva.
Spiriva vs. Singulair Drug Summary
Spiriva
Spiriva is a long-acting muscarinic antagonist (LAMA) inhaler that relaxes airway muscles over 24 hours to reduce COPD symptoms and exacerbations. It is inhaled once a day using either the HandiHaler device or the Respimat spray, and the Respimat version is also approved for asthma maintenance in people 6 and older.
Singulair
Singulair is an oral leukotriene receptor antagonist that blocks inflammatory chemicals in the airways to prevent asthma symptoms and allergy-related breathing problems. It comes as a tablet, chewable tablet, or oral granules taken once daily, usually in the evening.
Spiriva vs. Singulair Side Effects
Spiriva
Singulair
Spiriva vs. Singulair Dosage
Spiriva
Singulair
| 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 | 4 mg once daily | At the start |
| Maximum dose | 10 mg once daily | If needed |
| Dose changes | 2 increases | 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 |
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 |
Spiriva vs. Singulair Indications
Spiriva
Spiriva is FDA-approved for long-term maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and emphysema, and for reducing COPD exacerbations. The Respimat form is also approved for long-term asthma maintenance in people 6 years and older, but it is not meant for sudden symptom relief.
Long-term maintenance treatment for COPD
Reduces the frequency of COPD exacerbations
Asthma maintenance in patients 6 and older (Respimat only)
Not for relief of acute bronchospasm or asthma attacks
Singulair
Singulair is FDA-approved for the prophylaxis and chronic treatment of asthma, prevention of exercise-induced bronchoconstriction, and relief of seasonal and perennial allergic rhinitis symptoms. It is taken daily as a preventive medication, not for treating an asthma attack in progress.
Chronic asthma prophylaxis and maintenance
Prevention of exercise-induced bronchoconstriction
Seasonal allergic rhinitis symptom relief
Perennial allergic rhinitis symptom relief
Spiriva vs. Singulair Pros and Cons
Spiriva
Spiriva is a long-acting inhaler used for daily COPD control and, in its Respimat form, for asthma maintenance in patients 6 and older. It has decades of clinical use behind it, but it requires correct inhaler technique and costs more out-of-pocket than many oral controllers.
Pros
Only one inhalation needed per day
Approved for both COPD and asthma maintenance (Respimat)
Specifically shown to reduce COPD exacerbation frequency
Over two decades of real-world safety data
Cons
Requires an inhaler device and correct technique to work
Can worsen narrow-angle glaucoma or urinary retention
Costs roughly $600 to $630 per month without insurance, notably more than Singulair
HandiHaler form is not approved for use under age 18
Singulair
Singulair is an oral leukotriene receptor antagonist used for daily asthma control, exercise-induced bronchoconstriction, and allergic rhinitis in one pill. It costs less than many inhaled options, but it carries a boxed warning for neuropsychiatric side effects that patients and caregivers should discuss with a prescriber.
Pros
Simple oral tablet, no inhaler technique to learn
Also relieves seasonal and perennial allergic rhinitis
Available in chewable tablets and granules for young children
Costs roughly $289 to $375 per month without insurance, less than Spiriva
Cons
Boxed warning for serious neuropsychiatric events, including suicidal thoughts
Not approved for COPD treatment
Rare risk of Churg-Strauss syndrome (systemic eosinophilia)
Chewable forms contain phenylalanine, a caution for phenylketonuria
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