Xopenex and albuterol are short-acting inhaled medicines used to relieve airway narrowing. Although they work in similar ways, research has not established that Xopenex is generally more effective or safer than albuterol.
Both medicines belong to a class known as short-acting beta-2 agonists (SABAs). They relax muscles surrounding the airways, helping air move in and out of the lungs more easily during episodes of bronchospasm, a narrowing of the airways that can cause wheezing, coughing and difficulty breathing.
Albuterol is widely used for rapid relief of asthma symptoms. Xopenex is a brand name for levalbuterol, a closely related medicine that is also used to treat or prevent bronchospasm.
The choice between them depends on factors including a patient’s medical history, response to treatment, possible drug interactions, availability and cost.
What distinguishes Xopenex from albuterol?
The main difference lies in their chemical composition.
Albuterol contains two forms of the same molecule, known as R-albuterol and S-albuterol. This combination is called a racemic mixture. Levalbuterol, the active ingredient in Xopenex, contains only the R-form, which produces the principal bronchodilator effect.
This distinction led researchers to investigate whether removing the S-form could improve treatment outcomes or reduce side effects.
However, the theoretical advantage has not translated into clear evidence that levalbuterol is superior in routine treatment of acute asthma.
A 2013 systematic review and meta-analysis examined seven clinical trials involving 1,625 participants. The researchers found no significant differences between levalbuterol and albuterol in measures including lung function, respiratory rate, oxygen saturation or overall side effects.
The findings do not establish that the medicines are identical for every patient. They indicate that the available trial evidence does not support routinely preferring levalbuterol over albuterol for acute asthma.
Effectiveness and possible side effects
Both medicines can relieve bronchospasm, but neither is free of side effects.
Common effects include tremors, nervousness, headache, dizziness and a rapid heartbeat. Some patients may also experience palpitations, the sensation that the heart is beating unusually fast or forcefully.
Both medicines can affect the cardiovascular system. People with heart rhythm disorders or other cardiovascular conditions should discuss their medical history with a healthcare professional before treatment.
Levalbuterol is sometimes considered when a patient experiences side effects with albuterol. However, evidence that it consistently causes fewer cardiovascular effects is limited.
A review examining levalbuterol use in patients with tachyarrhythmia, a condition involving an abnormally fast heart rhythm, found insufficient evidence to establish a clear safety advantage over albuterol in this group.
Patients should therefore not assume that Xopenex is automatically safer because it contains only the R-form of the molecule.
Both medicines can also cause paradoxical bronchospasm, a rare reaction in which breathing becomes worse immediately after inhalation. Sudden worsening of breathing after using either medicine requires urgent medical assessment.
Age, formulation and use
Xopenex is available in different formulations, and their approved age ranges are not the same.
In the United States, Xopenex HFA, an inhaled aerosol, is approved for patients aged four years and older. The nebulised Xopenex inhalation solution is approved for patients aged six years and older.
Albuterol products also have formulation-specific age indications. The appropriate product depends on the patient’s age, ability to use the device and clinical needs.
These age limits should not be generalised across all products or countries. Patients and caregivers should follow the instructions for the specific medicine prescribed and consult a healthcare professional if they are unsure which formulation is appropriate.
Both medicines may be administered through inhalers, depending on the product, while nebulised solutions are delivered using a machine that converts liquid medicine into a mist for inhalation.
Neither medicine should be used more frequently or at higher doses than prescribed. Needing a rescue medicine more often than usual may indicate that asthma is worsening and that the treatment plan needs reassessment.
Rescue medicines relieve acute airway narrowing but do not replace other treatments, including inhaled corticosteroids when these are prescribed to control underlying airway inflammation.
Drug interactions and precautions
Xopenex and albuterol can interact with other medicines, potentially affecting their effects or increasing the risk of adverse reactions.
Certain beta-blockers can reduce the bronchodilator effects of these medicines and may worsen bronchospasm in susceptible patients. Some diuretics can increase the risk of low potassium levels, while certain antidepressants may increase cardiovascular effects.
Patients should tell their healthcare provider or pharmacist about prescription medicines, non-prescription products and supplements they use.
People with existing heart conditions, high blood pressure, diabetes or other relevant medical problems may require additional assessment before treatment.
Pregnant patients should also discuss the benefits and potential risks of treatment with their healthcare provider rather than stopping or changing prescribed medication without advice.
Cost and availability
Cost may influence the choice between the two medicines.
A 2015 study of hospitalised adults treated for asthma or chronic obstructive pulmonary disease (COPD) found similar clinical outcomes with levalbuterol and albuterol, but higher average treatment costs among patients receiving levalbuterol.
The study involved a single hospital and examined treatment during hospital stays, so its cost findings should not be interpreted as a direct comparison of current retail inhaler prices.
Actual prices vary according to the formulation, country, pharmacy, insurance coverage and availability of generic alternatives. Patients should check local prices and discuss lower-cost options with a pharmacist or healthcare professional.
Which medicine is more appropriate?
Neither Xopenex nor albuterol has been shown to be consistently superior for all patients with asthma.
Albuterol remains a widely used option for rapid relief of bronchospasm. Levalbuterol offers an alternative for patients whose healthcare providers consider it appropriate, but its chemical composition alone does not establish a clinical advantage.
The decision should take account of symptom control, previous responses to treatment, side effects, other medical conditions and affordability.
Anyone experiencing severe or rapidly worsening breathing difficulty should seek emergency medical care rather than relying on repeated doses of a rescue inhaler. Patients who need their rescue medicine more often than recommended should contact their healthcare provider for reassessment.
