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

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

Singulair

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

Spiriva vs. Singulair 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

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

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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