Albuterol vs. Xopenex....

Nurses Medications

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I was wondering if anyone can tell a difference between these two meds? When Xopenex was first released it was suppose to be superior to albuterol because it supposedly had few side effects such as not raising the HR like albuterol can. But now the resp therapists are telling me that Xopenex is not superior to albuterol and that Medicare will not pay for Xopenex....Some of the docs think Xopenex is better and others still go with albuterol. I really haven't been able to tell a difference between the two....anyone else with any opinions on this topic?

I think it is irresponsable for anyone-doctors included- to claim that one is better than the other. I have gone through he'll to try and afford xopenex because doctors tell insurance companies that albuterol works the same. FOR ME IT DOESNT WORK AT ALL. I think the only thing one should claim is that one works well for some while another works well for others. And now because there are so many "experts" crunching data and saying that xopenex does not have a significant edge on albuterol, the copayment assistance for xopenex is being taken away too. Well, I guess I'm the insignificant minority that albuterol does not work at all for. And because of claims by people who don't have to go through the difficulties of not being able to breath, I have to fight for breath and fight the people trying to shove albuterol down my throat. [b']I'm sorry but professionals should not state information that has such an impact on insurance and pharmaceutical opinion. They, as professionals, have the duty to not make claims unless proven 100 percent...[/b]

-angry because I have to pay an arm and a leg for air

Doctors do not set pharmaceutical prices....and they don't tell your insurance company, pharmacy, Medicare, or Medicaid how much to charge- they have nothing to do with drug prices at all... why would they set a price too high, and then prescribe it????? It's awful to not be able to afford medication- I've been there - a LOT....I'm on disability, so have to deal with this issue like you do... but some drugs do work better for MOST people because of new ways medications work.

Healthcare professionals only know what they see- and THEY don't decide prices or availability- being mad at them won't help :)

I've been very angry also, about pharmacy prices, and having to take meds that don't work as well. I can't get an insulin pump because I'm on Medicare. My chemo nearly wasn't covered (100K per year for that one). And my list goes on for another dozen or so meds...and those don't include the 'as needed' ones.....

Be angry- but know who/what the problem is :):up:

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These are questions best handled by your provider.

There are prescription drug programs though that can help if you qualify.

And many of those are set to help as few people as possible :) I'm lucky- I had a social worker help me find a good Medicare plan D... but I can understand where the pp is coming from :twocents:

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I guess if I were you I'd have no problem then huh? I've tried albuterol a few times before and it does not work at all FOR ME!

And yes I do have a choice, I pay for it full price. But ignorant claims and people assuming what works for one must work for all is what I was saying is irresponsible genius!

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Sorry, that was in response to the person who said "guess you have no choice but to take albuteral then...it works fine for me"

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Doctors do not set pharmaceutical prices....and they don't tell your insurance company, pharmacy, Medicare, or Medicaid how much to charge- they have nothing to do with drug prices at all... why would they set a price too high, and then prescribe it????? It's awful to not be able to afford medication- I've been there - a LOT....I'm on disability, so have to deal with this issue like you do... but some drugs do work better for MOST people because of new ways medications work.

Healthcare professionals only know what they see- and THEY don't decide prices or availability- being mad at them won't help :)

I've been very angry also, about pharmacy prices, and having to take meds that don't work as well. I can't get an insulin pump because I'm on Medicare. My chemo nearly wasn't covered (100K per year for that one). And my list goes on for another dozen or so meds...and those don't include the 'as needed' ones.....

Be angry- but know who/what the problem is :):up:

Yes, direct ally heard from my insurance company: they have a board of doctors who suggest what medications should be covered and which are not do to a lesser costing substitute.

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And about how doctors only know what they see... Pure ignorance. They are health care professionals and this type of closed mindedness is why people have such a hardvtime with health care today. I can appreciate your "life is wonderful, cup half full" attitude but that's not the real world

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Specializes in Vents, Telemetry, Home Care, Home infusion.

medscape.com posted: 03/30/2010

free registration required....great site. karen

[color=#1111cc]how does levalbuterol (xopenex®) compare with albuterol?

...cost is of primary interest when comparing the 2 agents. prior to january 2009, metered-dose inhaler (mdi) generic formulations of albuterol were widely available and were much less expensive than branded versions of albuterol (eg, proventil®, ventolin®) and levalbuterol. however, many mdi formulations contained chlorofluorocarbons and are no longer available in this country because they were banned by the food and drug administration for environmental reasons. thus, multisource generic albuterol mdi is no longer available and the cost of brand-name albuterol is nearly identical to that of levalbuterol. levalbuterol nebulization is still considerably more expensive than the available generic albuterol nebulization.[color=#004276][3,13]

because of the higher cost of levalbuterol and study limitations, such as small sample size and inadequate power, some have concluded that the use of levalbuterol in place of albuterol is not strongly supported by the literature.[color=#004276][3,13] however, levalbuterol may be preferred over racemic albuterol in the following situations:

  • patients with more severe asthma who need frequent doses of a beta-2 agonist despite appropriate use of controller therapies;
  • patients with asthma or copd and concurrent cardiac disease, especially if these conditions could potentially worsen with tachycardia (eg, poorly controlled cardiac arrhythmias, decompensated heart failure, and valvular heart disease); and
  • patients who often experience bothersome tachycardia with albuterol and dislike using it, which could potentially lead to poor adherence.

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Specializes in Critical Care.

I understand your frustration 'can'tbreath' as this has been one of the most frustrating issues to deal with as a Nurse. You will find some MD's who mistakenly believe that there is no difference between the two, but most MD's I work with understand the research involved and are aware of the circumstances where the research strongly supports the use of levalbuterol. There are MD's that work for insurance companies whose job it is to find as many ways as possible to reduce payouts, but they don't represent the medical community as a whole.

You may want to look into medication assistance programs since any medicare/medicaid associated program will cover levalbuterol, they may not cover it 100%, but medicare/medicaid has always covered levalbuterol, even before it went generic and the price dropped. They reimburse at the same rate as albuterol, so you may need to pay the remaining balance, but at least you'll get some coverage. If all else fails, you can now get 1.25 Nebs for about $1.25 a dose, and MDI's are $20 or less if you shop around.

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If a pt tends to be hypokalemic, take care with albuterol...too much albuterol can drive can lead to low serum potassium levels. Like insulin, albuterol drives potassium from the serum into the cells. Dependent on pt's serum potassium and HR the MD's will order albuterol or xopenex, it is dependent on the pt's overall clinical status at my facility.

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You will find some MD's who mistakenly believe that there is no difference between the two, but most MD's I work with understand the research involved and are aware of the circumstances where the research strongly supports the use of levalbuterol. There are MD's that work for insurance companies whose job it is to find as many ways as possible to reduce payouts, but they don't represent the medical community as a whole.

So actually the data aren't exactly a slam dunk and they definitely aren't strongly in favor. I would say they are overall, weakly in favor. Unfortunately there aren't any meta-analyses. Here are the RCTs.

L-albuterol is WORSE than racemic albuterol-

http://www.ncbi.nlm.nih.gov/pubmed/21275850

They are the same

http://www.ncbi.nlm.nih.gov/pubmed/18044102

http://www.ncbi.nlm.nih.gov/pubmed/15988423

http://www.ncbi.nlm.nih.gov/pubmed/11742271

http://www.ncbi.nlm.nih.gov/pubmed/10200010

L-albuterol is BETTER than racemic albuterol

http://www.ncbi.nlm.nih.gov/pubmed/16635694

http://www.ncbi.nlm.nih.gov/pubmed/15709454

http://www.ncbi.nlm.nih.gov/pubmed/14657817

If a pt tends to be hypokalemic, take care with albuterol...too much albuterol can drive can lead to low serum potassium levels. Like insulin, albuterol drives potassium from the serum into the cells. Dependent on pt's serum potassium and HR the MD's will order albuterol or xopenex, it is dependent on the pt's overall clinical status at my facility.

Albuterol and L-albuterol are the same for hyperkalemia- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726786/pdf/v022p00366a.pdf

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I get bronchitis chronically which usually turns into pneumonia if I don't catch it in time. Albuterol definitely works faster in opening up my airways. However, the violent headache that I get, not to mention the weird jittery feeling is not worth it to me. Xopenex is my second and "best" choice for me. I have to use the inhaler a bit more often than I would use the Albuterol but I'm fine with that because by the second day, Xopenex has caught up and I'm feeling much better. I just can't miss a dose. I agree with others saying that doctors shouldn't say which one is better or worse. It depends on the person and what condition they are taking it for. It's ridiculous for the drug companies to skyrocket the cost of medication just because they think they can.

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