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
Xopenex
Symbicort vs. Xopenex Dosage
Symbicort
Xopenex
| 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 |
| 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
| 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
| 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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