Spiriva vs. Xopenex
See how Spiriva and Xopenex compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Spiriva is a once-daily long-term controller for COPD and asthma, while Xopenex is a fast-acting bronchodilator taken multiple times a day for quick symptom relief.
Spiriva does not relieve sudden breathing problems and is not a rescue inhaler, whereas Xopenex is designed to open airways quickly during an asthma or COPD flare.
Both drugs treat bronchospasm from obstructive airway disease, but they work through different mechanisms and are typically used together rather than as substitutes.
Spiriva vs. Xopenex Drug Summary
Spiriva
Spiriva (tiotropium) is a long-acting anticholinergic bronchodilator used for long-term maintenance of COPD and, with the Respimat device, asthma in patients 6 and older. It is inhaled once daily and is not meant to relieve sudden breathing symptoms.
Xopenex
Xopenex (levalbuterol) is a short-acting beta2-agonist bronchodilator used to treat or prevent bronchospasm in asthma, COPD, and other reversible airway conditions. It is delivered by nebulizer solution or HFA inhaler, typically several times a day as needed.
Spiriva vs. Xopenex Side Effects
Spiriva
Xopenex
Spiriva vs. Xopenex Dosage
Spiriva
Xopenex
| 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 | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 puffs) q4-6h | If needed |
| Dose changes | 4 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 |
Xopenex
| STAGE | DOSE | WHEN |
| Starting dose | 0.31 mg three times daily | At the start |
| Maximum dose | 90 mcg (2 puffs) q4-6h | If needed |
| Dose changes | 4 increases | As tolerated |
Spiriva vs. Xopenex Indications
Spiriva
Spiriva is FDA-approved for long-term maintenance treatment of COPD, including chronic bronchitis and emphysema, and for reducing COPD exacerbations. The Respimat device is also approved for asthma maintenance in patients 6 and older. It is not for relief of sudden bronchospasm.
Long-term COPD maintenance treatment
Reduces COPD exacerbations
Asthma maintenance, ages 6+ (Respimat only)
Not for acute bronchospasm relief
Xopenex
Xopenex is FDA-approved to treat or prevent bronchospasm in patients with reversible obstructive airway disease such as asthma or COPD. It works quickly to relax airway muscles during a flare-up of breathing symptoms. It is not approved for managing preterm labor.
Treats acute bronchospasm episodes
Prevents trigger-induced bronchospasm
Used in asthma and COPD flare-ups
Not approved for preterm labor
Spiriva vs. Xopenex Pros and Cons
Spiriva
Spiriva is a once-daily long-acting bronchodilator that helps control COPD and asthma symptoms over time, but it does not relieve sudden breathing difficulty and requires a separate rescue inhaler. It carries anticholinergic risks like worsened glaucoma or urinary retention that patients with those conditions should discuss with their doctor.
Pros
Only needs to be taken once a day
Long-acting control that reduces COPD exacerbations
FDA-approved for both COPD and asthma (Respimat)
Two device options tailored to indication
Cons
Not for acute symptoms; needs a separate rescue inhaler
Roughly $600 to $630 per month without insurance, before savings programs
May worsen glaucoma or urinary retention
Slower onset, unsuitable for sudden breathing distress
Xopenex
Xopenex is a fast-acting bronchodilator used for quick relief or prevention of bronchospasm, delivered through a nebulizer or inhaler multiple times a day. It does not treat the underlying airway inflammation behind asthma or COPD, so it is often paired with a long-term controller like Spiriva.
Pros
Fast onset for quick relief of bronchospasm
Available in both nebulizer and inhaler forms
Roughly $55 to $120 per month without insurance, before savings programs
Single-isomer formula may cause fewer side effects than albuterol
Cons
Requires dosing multiple times a day, up to every 4 hours
Does not treat underlying airway inflammation
Risk of cardiovascular effects like rapid heartbeat
Excessive use can be dangerous or fatal
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