Levalbuterol vs Albuterol: What’s the Difference?

By Alicia Wooldridge, MD
Medically reviewed checkmarkMedically reviewed
August 1, 2022

If you’ve ever been treated for asthma attacks, you may be familiar with the medications albuterol (ProAir) and levalbuterol (Xopenex). 

Whereas albuterol has been used for decades in rapid inhalers and nebulizer to treat asthma attacks, levalbuterol was introduced later alongside marketing that sold it as an innovative new treatment option.

Both are commonly prescribed to people with asthma, a condition that causes tightening (or constriction) of the small air passages in your lungs.

In this article I’ll explain the differences between albuterol and levalbuterol. I’ll discuss how both medications work and how effective they are in treating asthma attacks and other respiratory conditions. 

I’ll review the relative costs of these two treatments, and I’ll tell you when to talk to a healthcare provider about your asthma treatment.

What is Albuterol?

Albuterol, also known as salbutamol, is what’s known as a short-acting beta-agonist.

These are often the first choice for quick relief of asthma symptoms.

Albuterol was first discovered and used in the 1960s, and soon gained favor for offering fast relief with relatively few side effects.

If you have asthma, your lungs are sensitive to triggers in the environment.

When you make contact with an asthma trigger, the airways that carry air in and out of your lungs can react, becoming inflamed and swollen. 

The smooth muscles that surround your airways can also begin to spasm and tighten, and your lungs may start to produce excess mucus, or phlegm. 

When this happens, albuterol delivered to your lungs using a rescue inhaler or nebulizer (a device that creates an inhalable liquid mist) may be helpful.

Albuterol uses

Albuterol can be used to treat asthma attacks in both adults and children. It can also be taken preventatively before physical exercise.  

Typically, you’ll give yourself a dose of albuterol by inhaling via an aerosol-propelled metered-dose inhaler, or a dry powder inhaler. Albuterol can also be taken via nebulizer, or as a tablet or syrup. 

During an asthma attack, you may be advised to take repeated doses of albuterol several times an hour. Talk to your healthcare provider about the exact schedule you should use to dose yourself during an attack.

Albuterol can also be used to treat breathing difficulties associated with chronic obstructive pulmonary disease (COPD), a type of lung damage that includes emphysema caused by smoking cigarettes. 

How albuterol works

As symptoms worsen during an asthma attack, you may find that you have shortness of breath, that you are wheezing, coughing, and that you feel chest tightness or pain.

That is the smooth muscles that surround your airways contracting.

Albuterol works in minutes by setting off a series of chemical signals and interactions that ultimately cause the smooth muscles of your lungs to relax, so that you can breathe easily again. 

The most common side effects of albuterol include nervousness or agitation, shaky hands or tremor, heart palpitations, headache, dizziness, anxiety, nausea, upset stomach, and diarrhea

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What is Levalbuterol?

Researchers have long known that the substance that is called albuterol, is made up of equal parts of two related but distinct compounds: (S)-albuterol and (R)-albuterol. 

Further research has shown that (R)-albuterol alone is responsible for interacting directly with cells in the respiratory system during an asthma attack: to relax smooth airway muscles, calm inflamed lung tissue, and otherwise end an episode.

From there, researchers began looking for ways to isolate (R)-albuterol directly, and give it to patients in a purer form separate from (S)-albuterol.

Some scientists believed that in doing so, could increase speed and effectiveness of asthma attack treatment. 

They also theorized that isolating (R)-albuterol could lessen the side effects associated with albuterol, especially if it turned out that these side effects were mostly tied to (S)-aAlbuterol all along.

When researchers were successful in separating out (R)-aAlbuterol and delivering it as a distinct asthma treatment, they gave that medication a new name: levalbuterol.

Levalbuterol uses

By design, levalbuterol has many of the same uses as albuterol: serving as a rescue inhaler or nebulizer; alleviating COPD symptoms, and serving as a preventative treatment before exercise. 

It is primarily taken using an inhaler or nebulizer, and is approved for both children and adults.

How levalbuterol works

Levalbuterol also works much like albuterol.

That’s because it is synthesized to isolate only the “active” parts of albuterol’s chemical structure, while cutting out all the parts that seem to have no direct therapeutic effect on the body.

The most common side effects of albuterol include nervousness or agitation, shaky hands or tremor, heart palpitations, headache, dizziness, anxiety, nausea, upset stomach, and diarrhea.

As with albuterol, these side effects are typically mild to moderate in intensity.

Effectiveness of Albuterol vs Levalbuterol

Since Xopenex’s introduction in 1999, each year has brought new studies measuring the effectiveness of levalbuterol against its “parent” medication albuterol. 

And with each passing year, it seems more and more the case that the two medications are basically just as effective as each other in treating asthma attacks and other related respiratory concerns.

Both are effective in opening up airways in the event of an asthma attack. At the same time, both have demonstrated similar patterns of side effects while performing this task.

This research isn’t totally conclusive, however, but most reviews of the available literature have found no clear advantage for levalbuterol in restoring breathing rate or oxygen intake, nor in reducing the severity or duration of an asthma attack. 

One possible difference between the two drugs is that albuterol may lead to slightly greater heart rate increases, in children more so than adults.

But most researchers do not see these differences as clinically significant, as any differences in heart rate are generally not big enough to lead to different medical outcomes. 

Still, if you have a history of heart problems and feel alarmed by racing heartbeats, you may perhaps gain some peace of mind by taking levalbuterol rather than albuterol.

Cost

Because it has been around for decades, albuterol has long been available in both lower-cost generic and in name-brand forms.

Costs vary depending on the type of delivery method, but in general albuterol is less expensive than similar formats for name-brand Xopenex. 

Levalbuterol first came on the market in 1999 and was exclusively sold as Xopenex. In 2016, the first generic forms of levalbuterol came on the market. 

After that, levalbuterol and albuterol could be bought at roughly the same price. Today, price need not be a major factor in whether your doctor prescribes you albuterol or levalbuterol.

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When to Seek Medical Attention

Your asthma can change over time, so maintain regular contact with your health care provider and report any changes so your treatment can be adjusted accordingly.

Call 911 or go to your nearest emergency room to seek medical attention immediately if you are experiencing: 

  • Chest pain 
  • Severe shortness of breath
  • Rapid breathing
  • Difficulty speaking 
  • Feeling weak or faint
  • Feeling forced to use your chest muscles to help you breathe
  • A bluish tinge to your face, mouth, or lips

Frequently Asked Questions

Which is better, albuterol or levalbuterol?
Albuterol and levalbuterol are both good options for providing fast-acting, short-term relief for asthma symptoms.
Will levalbuterol increase heart rate?
Levalbuterol can sometimes cause a noticeable but not dangerous increase in heart rate.
What is better, Xopenex or albuterol?
Albuterol and Xopenex (levalbuterol) are both good options for providing fast-acting, short-term relief for asthma symptoms.
Can you take levalbuterol with albuterol?
While there is no negative interaction between the two medications, you will either take albuterol or levalbuterol.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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Alicia Wooldridge, MD

Dr. Alicia Wooldridge is a board certified Family Medicine physician with over a decade of experience.