What is contained within a quick-relief rescue inhaler

Asthma and chronic obstructive pulmonary disease (COPD) are the two most common lung conditions in the United States. They usually require long-term management with medication. Inhalers tend to be a go-to since the medication is released directly into the lungs and doesn’t get absorbed much by the rest of the body. This lowers the possibility of side effects and drug interactions.

While the specific medications can vary, people with asthma or COPD often require a rescue inhaler (bronchodilator) to help when they have sudden difficulty breathing. There are several of them on the market, including albuterol and levalbuterol. Read on to learn more about their differences and similarities.

What types of rescue inhalers are available?

There are two rescue inhaler medications that are commonly used in the U.S.: albuterol and levalbuterol. They work similarly, but they come in many different inhaler versions. With some, you’ll see “HFA,” which stands for hydrofluoroalkane, a chemical used to send the medication into your lungs.

Albuterol inhalers

Levalbuterol inhalers

• Xopenex

• Xopenex HFA

• Levalbuterol (generic)

How do albuterol and levalbuterol inhalers work?

When you breathe, air travels through many different tubes within your lungs, which eventually brings oxygen to your bloodstream. The smallest tubes are called bronchioles. Trouble breathing — a hallmark in asthma and COPD — is often caused by these the bronchioles squeezing shut (bronchospasm). This can cause:

• Chest tightening

• Shortness of breath

• Wheezing

• Trouble breathing overall

Albuterol and levalbuterol belong to the class of drugs called beta2-adrenergic agonists that cause the bronchioles to relax and open up, making breathing much easier. 

Because albuterol and levalbuterol can be delivered directly to the lungs via inhalation, they generally work very fast. This is why they are called rescue inhalers.

When are albuterol and levalbuterol inhalers used for asthma and COPD?

Both albuterol and levalbuterol inhalers are prescribed to people over the age of 4 with bronchospasms caused by asthma or COPD. Albuterol inhalers are specifically also approved for exercise-induced bronchospasms, or difficulty breathing during intense physical exercise. Taking albuterol 15 to 30 minutes before you exercise can help prevent breathing issues.

Both drugs are meant to be used as needed for severe asthma- or COPD-related breathing problems. They are not intended for everyday use as long-term maintenance treatment. If you find yourself needing albuterol or levalbuterol more often than prescribed, talk to your provider to find a better option for managing your symptoms.

How do I use albuterol and levalbuterol inhalers?

It depends on the inhaler design. Talk to your healthcare provider or pharmacist about how to use these inhalers. They can help you with tips for: 

• Setting up the device

• Shaking it and preparing the medication for use

• Storing it

• Cleaning it

• Using proper inhalation technique

What is their typical dose?

Albuterol and levalbuterol both require two inhalations by mouth every 4 to 6 hours. You should wait 60 seconds between each inhalation for better absorption. Some people may only need one inhalation for either inhaler.

Your provider will help you determine your number of doses. Using either albuterol or levalbuterol more frequently than recommended generally leads to more side effects.

What are the most common side effects of albuterol and levalbuterol inhalers?

People who use these inhalers typically have no side effect issues, but a few potential ones are worth mentioning. Keep in mind that this is not an all-inclusive list of side effects that can happen with these medications.

• Throat irritation. Because these medications are inhaled, they may cause throat irritation as they pass into the lungs. A drink of water after the inhalation will help relieve the irritation.

• Rapid heart rate. For some people, these medications can cause palpitations or increase their heart rate. This may be more noticeable with albuterol, or if you use either medication more than every 4 to 6 hours.

• Headache and dizziness. Both medications can cause blood vessels to narrow, possibly leading to headache or dizziness.

• Hyperactivity or tremor. Because the medications can cause blood vessels to constrict, they may make you feel more hyperactive or cause shaky hands. Again, this generally occurs when too much of the medication is taken.

Researchers don’t know for sure whether levalbuterol or albuterol causes more side effects. Clinicians are still debating this topic, and research is inconclusive. However, levalbuterol is thought to be less bothersome because it acts mainly on the lungs, while albuterol is more likely to affect other parts of the body.

Do albuterol and levalbuterol inhalers have any drug interactions?

These medications have a low risk of drug interactions because they are not absorbed throughout the entire body. One interaction worth mentioning is with beta blockers (like atenolol and propranolol). Beta blockers are often prescribed to treat heart problems or high blood pressure, and albuterol and levalbuterol can potentially make them less effective.

Albuterol and levalbuterol should also be taken carefully if you are taking certain antidepressants, as the combination can lead to heart problems. Talk to your provider and pharmacist about what other medications may interact with albuterol or levalbuterol to get further guidance.

Do albuterol and levalbuterol inhalers require any special monitoring?

Some medications require that you take special tests to let your doctor know if they need to adjust your dosing. That’s not the case with albuterol and levalbuterol inhalers. Usually, no special tests are needed with these inhalers on top of your routine checkups and testing related to asthma and COPD.

Who should not take albuterol and levalbuterol inhalers?

People under the age of 4 generally should not be using these inhalers. This is because such young children may not be able to follow the inhalation instructions to ensure proper medication delivery to the lungs. They should instead use a nebulizer.

Otherwise, unless you have know you have serious allergies (like if you’ve experienced hives or a swollen throat) to these medications, they are relatively safe to take. 

How much do albuterol and levalbuterol inhalers cost?

Brand-name rescue inhalers can be quite expensive, but fortunately, both albuterol and levalbuterol are available as generic medications. The retail price for a typical prescription of either is around $60.

Albuterol and levalbuterol are covered by most insurance plans, but always remember to shop around. If you don’t use insurance, patient assistance programs, pharmacy memberships, and coupons can help you save.

To find the lowest price of these medications in your area, search for the drug on goodrx.com or the GoodRx mobile app, select your dose and quantity, and set your location.

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Overall, both albuterol and levalbuterol are useful medications if you have asthma or COPD and have trouble breathing. They belong to the same class of medications, so they work similarly. Some providers believe that levalbuterol has fewer side effects, so it could be a good option if you have any issues with albuterol. Otherwise, which is best for you may likely come down to cost.

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