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Levalbuterol (Xopenex) vs Albuterol
Differences, Effectiveness, and Which Is Right for You
- Posted On:
- 14 Sep, 2026
- 10 min read
-
Proair Respiclick (Albuterol) is a fast-acting inhaler used to relieve sudden shortness of breath due to asthma and chronic lung conditions.
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Both albuterol and levalbuterol are bronchodilators and short-acting beta-2 agonists. They are used for the treatment of various breathing-related conditions such as Chronic Obstructive Pulmonary Disease (COPD) and asthma. They are also used for the treatment of issues such as bronchospasm. Many patients wonder whether these two medications are the same. They also wonder whether one medication is stronger than the other and which is better tolerated. This article helps compare these similarities/differences and how effective each of the medications is.
- Proair Respiclick (Albuterol) is a fast-acting inhaler used to relieve sudden shortness of breath due to asthma and chronic lung conditions.
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- Both albuterol and levalbuterol are SABAs that quickly open the airways and are commonly used for asthma, COPD, and EIB
- Albuterol is the first-line option for most patients and is usually more affordable
- Levalbuterol contains only the active (R)-isomer of albuterol and may cause fewer side effects
- Both medications have similar effectiveness and onset times
- Cost and insurance coverage usually cause a bigger interest in albuterol
- Levalbuterol may be preferred for patients who do not tolerate albuterol well
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What Is Albuterol?
This medication is also sometimes referred to as salbutamol. It is a type of approved SABA that works by relaxing the muscles in the airway. This can help patients start feeling relief within minutes. This medication can be found in the form of nebulized solutions and inhalers. It can also be found in the form of tablets and syrups.
This medication is sold under many different U.S. brand names. These brands include Accuneb and ProAir. They also include Ventolin and Proventil. Different brand names for this medication—such as Salbutamol, Apo-Salvent, and Alti-Salbutamol—can also be found in Canada.
What Is Levalbuterol (Xopenex)?
This is another similar medication that is newer on the market. This medication is marketed as “Xopenex.” Levalbuterol is used to open the airways by relaxing the muscles. It is made using the active parts found in albuterol’s chemical structure. Both medications have the same R-enantiomer. However, this levalbuterol is also designed to eliminate the parts that are thought not to have any therapeutic benefit to the patient. This way it can have the same positive benefits with lessened side effects. It can be found in the form of an inhaler and a nebulizer solution.
Differences Between Albuterol and Levalbuterol (Xopenex)
| Albuterol | levalbuterol | |
|---|---|---|
| Composition | 50:50 ratio of stereoisomers ((S)-albuterol and (R)-albuterol) | The therapeutically active part of racemic albuterol |
| Brand Names | U.S. Brand Names
Canadian Brand Names
| Xopenex |
| Onset/Duration | 5-10 min/4-6 hours | 5-10 min/4-6 hours |
| Side Effects |
|
Note: Side effects may be less common |
| Cost Considerations |
|
|
| Cost Without Insurance (in the U.S.) | Around $35 per month (without insurance) | About $55 or more (without insurance) |
| Cost With Insurance (in the U.S.) | Usually under $5 when covered by insurance (copays may vary) | About $10 or less with insurance |
| Use in Practice | First-line, standard SABA | For patients sensitive to albuterol |
| Dosages Available | Inhalers
Tablets
Nebulized solutions
Oral syrup
| Inhalers (HFA)
Nebulized Solutions – Adults
Nebulized Solutions – Pediatrics
|
| Available Forms |
|
|
| Brand/Generic Status | Both Available | Both Available |
| Length of Treatment | Intermittent or short-term | Intermittent or short-term |
| Age Group for Medication Users | All ages |
|
Conditions Treated by Albuterol and Levalbuterol
Asthma
Both of these medications are commonly used for acute asthma treatment. These medications can be used to provide quick relief for breathlessness associated with the condition by helping open up the airways. They are often used as rescue inhalers that can also eliminate coughing or wheezing in addition to shortness of breath. These medications have also been approved for the treatment of severe bronchospasm in patients with reversible obstructive airway disease.
Chronic Obstructive Pulmonary Disease (COPD)
These medications are also used to provide short-term relief from COPD—especially during hospitalizations. Clinical studies show that levalbuterol may be a little more beneficial for doing so and less nebulizations are required with its use. These SABAs help with short-term relief from bronchospasm and may be used alongside long-acting inhalers.
Exercise-Induced Bronchoconstriction (EIB)
Patients with EIB are also sometimes prescribed these medications to be taken before exercise. These medications help relax the smooth muscles in the airway before the stress of physical activity and inhibit mast cell degranulation. These medications are usually taken somewhere around 5 to 20 minutes before the exercise occurs to prevent exercise-triggered asthma symptoms.
Other Off-Label Uses
These medications may also be prescribed for certain off-label purposes that are not specifically approved by the FDA. These include uses for conditions such as medical issues like hyperkalemia and acute respiratory infections with bronchospasm. These medications should not be used for these issues without specific medical guidance. These medications are also not recommended to be used as monotherapy treatment for these issues.
Note: Both medications work similarly and are approved for similar uses. However, levalbuterol may be chosen when patients experience side effects from albuterol. Albuterol is often more affordable and a more common first choice.
Levalbuterol vs. Albuterol: Are They the Same Drug?
These medications are very similar. However, they are not exactly the same. Both medications are commonly used for asthma and COPD treatment. They are also both SABAs and are used as rescue treatments.
Albuterol is a racemic mixture that is made up of both R- and S-enantiomers. Levalbuterol contains only the R-enantiomer since the S-enantiomer is believed to cause Albuterol’s side effects. This is also why levalbuterol is thought to have more therapeutic effects. Both of these medications last about four to six hours.
Is Levalbuterol (Xopenex) Stronger Than Albuterol?
Clinical studies suggest similar effectiveness between the medications in bronchodilation. However, research also suggests that levalbuterol may cause fewer side effects in sensitive patients. These side effects include those such as jitteriness and heart palpitations. Levalbuterol is made from only the active (R)-form of the drug, while albuterol includes a 50/50 mix of both the (R)- and (S)-forms. Levalbuterol may have a higher potency per milligram. However, dosing guidelines differ. Albuterol works just as well for most patients without sensitivities.
Side Effects and Safety
These medications have shared possible side effects of:
- Shakiness
- Nervousness
- Headache
- Dizziness
- Chest pains
- Fast heartbeat
- Runny nose
- Sore throat
These side effects may be reduced for patients using levalbuterol instead of albuterol. However, this is not guaranteed for all patients. Studies show that the side effects experienced by the two medications are similar when they are dosed the same. Both are generally safe when used as prescribed.
Some patients on the medications may also experience more serious side effects in rare cases. These side effects include:
- Worsening asthma or bronchospasm
- Allergic reactions
- Serious heart problems
- Low blood potassium
Cost Considerations
Albuterol is generally the more affordable choice. It can be found for around $35 per month without insurance coverage, instead of the closer to $55 or more that levalbuterol usually costs. This medication also has more brand names to choose from and more generic options available. It is also easier to find insurance coverage for than levalbuterol. Sometimes this may even mean full coverage. This medication is covered by most Medicare and Medicaid plans. It is also often covered by private insurance.
Levalbuterol is harder to find being sold outside of its Xopenex brand name. This medication is also usually more expensive and harder to find coverage options for. This is why cost may be a deciding factor for many patients deciding which medication is right for them.
Availability may also be a consideration. Albuterol has been on the market for more than 50 years and is offered in both brand-name and generic versions. Levalbuterol was introduced in 1999 under a brand name and generic options became available in 2016. Albuterol is generally the easier medication to find. However, both medications can be found being sold in many different countries and pharmacies.
Which One Should You Use?
Most patients start by using albuterol because it has been clinically proven to be just as effective and usually comes at a much lower cost. Most patients who are prescribed levalbuterol are put on the medication because they were facing bothersome side effects after using albuterol. Patients with a heart condition may also take this medication as a gentler option.
Albuterol may be the only option for children needing the medication who are under four years old. However, both medications may be used and are equally effective for children with asthma issues above this age. They may be given to these children in lower doses than adults—often determined by the child’s weight. Both of these medications should only be used by patients with a doctor’s recommendation and guidance.
The Bottom Line
Both albuterol and levalbuterol are effective and fast-acting bronchodilators. Some patients may take levalbuterol in an attempt to experience fewer side effects if they have certain sensitivities. However, this medication is the more expensive option. Albuterol is still generally the preferred and most-used choice. Levalbuterol may be reserved for those who can not tolerate albuterol well.
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FAQs
Is levalbuterol safer than albuterol?
Not necessarily. Both are generally safe when used as prescribed. Some patients may tolerate levalbuterol better. However, most do well with albuterol.
Which works faster: albuterol or levalbuterol?
Both usually start working within about 5-10 minutes.
Why is levalbuterol more expensive?
Levalbuterol is newer and has fewer generic options. It is most commonly found under its brand name “Xopenex.” Albuterol is easier to find in cheaper generic forms.
Can I switch from albuterol to levalbuterol?
Patients should only switch between these medications under a doctor’s guidance. Switching is usually considered if albuterol causes side effects that are hard to manage for the specific patient using it.
Do both medications require a prescription?
Yes. Both albuterol and levalbuterol require a prescription in the U.S. and Canada.
Sources
Disclaimer: The information presented here is intended solely for educational purposes and should not be interpreted as medical advice, a diagnosis, or specific treatment recommendations. It does not imply endorsement of any particular medication or therapy. Health conditions and treatment responses can differ significantly between individuals; thus, this information is not a guarantee of safety, suitability, or effectiveness for anyone in particular. Always seek the guidance of a healthcare professional for personalized medical advice and consult them before making any health or treatment decisions.
