Xopenex vs. Albuterol
There are a number of products on the market that have been developed to treat asthma attacks and COPD. Xopenex and Albuterol are two well known and often used prescription bronchodilators that are inhaled to promote the dilation of airways. These prescription medications are for the temporary relief of asthma and COPD. They in no way cure these diseases. There has been an ongoing debate over Xopenex vs. Albuterol. The debate is over which one is better and which one produces fewer side effects. These medications are administered in products that are called nebulizers or atomizers. These are devices that vaporize liquid medications into a fine mist that is inhaled into the lungs using a mouth piece.
According to studies that have been done people can react identically to the medication in the nebulizers for Xopenex vs. Albuterol. However, Albuterol can raise the heart rate more than Xopenex. When it comes to the decision over which is better, Xopenex vs. Albuterol, Xopenex is most often chosen by physicians with patients who have a history of heart arrhythmias. This is because it is thought that Xopenex affects the β1-adrenergic receptors in the heart less directly. The medications in both products can produce a rapid heart beat and jitteriness. Most pediatricians will also prescribe Xopenex for their pediatric patients who have asthma and who experience hyperactivity or jitteriness when taking Albuterol.
Both Xopenex and Albuterol have the exact same active ingredient which is the “R” enantiomer molecule. An inactive “S” enantiomer molecule is also in Albuterol and is not included in Xopenex. Xopenex has only one-fourth the racemic dose of the “R” enantiomer molecule as Albuterol. Xenopex is a bronchodilator inhaler that was approved by the food and drug administration in 2005. Albuterol is an older medication and is much less expensive than Xopenex. Since Xopenex is prescribed in lower dosages it will produce less side effects so the argument is more favorable for Xopenex vs. Albuterol.
The normal side effects for Albuterol include cough, headache, nausea, nervousness, sinus inflammation, sore or dry throat, tremor, trouble sleeping, unusual taste in the mouth, vomiting, seizure, nosebleed, increased appetite, diarrhea and stomach pain. The side normal effects for Xopenex are dizziness, dry mouth, nervousness, runny or stuffy nose, sore or dry throat, and tremor. A severe allergic reaction to these medications will require immediate medical advice. Sever reactions include rash, hive, itching, difficulty breathing, swelling of the mouth, face, lips or tongue, chest pain, irregular heartbeat, worsening wheezing, coughing or trouble breathing, severe headaches or dizziness, sudden shortness of breath or unusual hoarseness. If any of these symptoms develop the patient should contact his or her doctor.
Pregnant women should not use Xopenex or Albuterol because the effects on an unborn baby are not known. Nursing mothers should not use these medications either. Xopenex is not approved for use in children who are younger than 6. Patients who have heart disease, diabetes, seizures or hypothyroidism may not be able to use these medications. Patients who have heart disease, high blood pressure, epilepsy, diabetes, liver disease, kidney disease or difficulty in swallowing should not take Albuterol. You should always consult with your medical doctor about any medication or health conditions you have before using Xopenex or Albuterol. Your physician will weigh the risks regarding Xopenex vs. Albuterol and prescribe the best medication for you.
When it comes to comparing the price of Xopenex vs. Albuterol, Albuterol is much cheaper. This is also one reason for the debate regarding the controversy over this medication. Medicare may not pay for Xopenex. The bottom line is that both medications are similar if efficacy only Xopenex is more expensive and Albuterol raises the heart rate more.
4 Responses for “Xopenex vs. Albuterol”
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What evidence do you have that albuterol causes a larger increase in heart rate than levalbuterol? I know this is an argument that has been peddled frequently by those promoting Xopenex, however, the evidence is lacking.
I know plenty of pediatricians who will not prescribe Xopenex, understanding that there is zero evidence to show improved outcomes of decreased adverse effects. At least one of the top 10 pediatric hospitals in the country has a strict policy of never ordering Xopenex, even as a non-formulary request due to this lack of evidence.
I suspect the Nelson article cited below may be the basis for your claim of lower heart rate in patients on levalbuterol. However, the comparison is absolutely ridiculous. The study used 0.63mg levalbuterol and compared it to 2.5mg albuterol. These are NOT equipotent doses (the equipotent dose of levalbuterol would have been 1.25mg). This is like giving one group of patients metoprolol 25mg and another metoprolol 50mg, and being surprised that the 50mg group had a lower heart rate.
Nelson HS, et al. J Allergy Clin Immunol. 1998 Dec;102(6 Pt 1):943-52.
If you peddle these claims, you are personally responsible for the outrageous cost of care in the United States. Xopenex is a good drug – as good as albuterol. I hope you pay for your own health insurance.
My 7 year old daughter has asthma, her Dr. recentl switched her from Albuterol to Xopenex because Albuterol indeed made her heart beat faster and made her very shaky. However she now has been complaining of chest pain since being on Xopenex. So back to the doctor we are going.
I would challenge you to sit down with your doctor, both wear heart rate monitors and one of you neb the 2.5 albuterol and the other neb the 0.63 Xopenex, even if neither of you has asthma or COPD. The efficacy from these two doses is supposed to be equal, but you may have different heart rate data and feel different when you are done nebbing.
I used albuterol when I first developed asthma as an adult. I hated the way it made my heart race, especially at night. I could never get back to sleep even though I was breathing easier. Then I heard about Xopenex (levalbuterol). Now I just feel my heart pump a little more (not out of my chest) and can go back to sleep after taking it.