Symbicort vs. Xopenex

See how Symbicort and Xopenex compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Symbicort is a daily controller medicine that combines a steroid and long-acting bronchodilator, while Xopenex is a fast-acting rescue medicine for sudden bronchospasm, so they treat different problems and are often used together.

  • Symbicort carries a boxed warning about a small increased risk of asthma-related death from its LABA component, while Xopenex warns about paradoxical bronchospasm and heart-related effects if overused.

  • Symbicort is approved for asthma maintenance in children 6 and older plus COPD, while Xopenex is approved for treating or preventing bronchospasm in reversible airway disease but only for as-needed relief.

Symbicort vs. Xopenex Drug Summary

Symbicort

Symbicort is an inhaled corticosteroid and long-acting beta2-agonist (ICS/LABA) combination used for daily control of asthma and COPD. It is taken as two inhalations twice a day from a metered-dose inhaler, with a lower or higher strength depending on the condition being treated.

Xopenex

Xopenex is a short-acting beta2-agonist bronchodilator used to treat or prevent sudden bronchospasm in asthma and other reversible airway diseases. It comes as a nebulizer solution or HFA inhaler, taken multiple times a day as needed for quick symptom relief.

Symbicort vs. Xopenex Side Effects

Symbicort

Most common
nasopharyngitis (up to 3%)
headache (up to 3%)
upper respiratory infection (up to 3%)
pharyngolaryngeal pain (up to 3%)

Xopenex

Most common
bronchitis (up to 2%)
dizziness (up to 2%)
pain (up to 2%)
pharyngitis (up to 2%)

Symbicort vs. Xopenex Dosage

Symbicort

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 inh 80/4.5 mcg 2x daily At the start
Maximum dose 2 inh 160/4.5 mcg 2x daily If needed
Dose changes 1 increase As tolerated

Xopenex

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.31 mg three times daily At the start
Maximum dose 90 mcg (2 inh) q4-6h If needed
Dose changes 4 increases As tolerated

Symbicort vs. Xopenex Indications

Symbicort

Symbicort is FDA-approved for ongoing maintenance treatment of asthma in patients 6 years and older, and for maintenance treatment of COPD, including chronic bronchitis and emphysema. It is not intended for relief of sudden asthma attacks and should always be used alongside a separate rescue inhaler.

  • Maintenance treatment of asthma in patients 6 and older

  • Maintenance treatment of COPD (bronchitis/emphysema)

  • Reduces asthma and COPD exacerbations

  • Not for treating sudden asthma attacks

Xopenex

Xopenex is FDA-approved to treat and prevent bronchospasm in patients with reversible obstructive airway disease, such as asthma. It works quickly to open the airways during an attack, but it does not treat the underlying inflammation that causes asthma.

  • Treats acute bronchospasm episodes

  • Prevents bronchospasm before known triggers

  • Used in asthma and other reversible airway disease

  • Available as nebulizer solution or HFA inhaler

Symbicort vs. Xopenex Pros and Cons

Symbicort

Symbicort pairs a steroid and a long-acting bronchodilator in one inhaler for everyday asthma or COPD control, not for sudden symptoms. Because it includes a LABA, it carries a boxed warning and typically costs more than a short-acting rescue inhaler.

Pros

  • Combines a steroid and long-acting bronchodilator in one inhaler

  • Approved for children as young as 6

  • Also approved for COPD maintenance, not just asthma

  • Simple twice-daily dosing routine

Cons

  • Boxed warning for LABA-related asthma death risk

  • Not usable for sudden asthma attacks, needs a separate rescue inhaler

  • Higher cost, roughly $300 to $500 per month before savings programs

Xopenex

Xopenex works fast to relax the airways during an asthma attack, but it does not control the inflammation behind asthma, so it cannot replace a daily controller. It is a low-cost option compared with many maintenance inhalers, though it requires frequent dosing and carries its own overuse risks.

Pros

  • Low cost, roughly $55 to $120 per month before insurance

  • Fast onset for quick relief of bronchospasm

  • Available in both nebulizer and HFA inhaler forms

  • Single-isomer formulation, an alternative to racemic albuterol

Cons

  • Not a controller medicine, does not treat underlying inflammation

  • Requires frequent dosing, up to three times daily or every 4 hours

  • Risk of paradoxical bronchospasm and cardiovascular effects with overuse

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