Albuterol vs. Levalbuterol Rescue Inhalers: What’s the Difference?

Asthma and chronic obstructive pulmonary disease (COPD) are the two most common lung conditions in the U.S. They usually require long-term treatment 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 interactions.

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

What is a rescue inhaler?

A rescue inhaler is an inhaler that contains a fast-acting medication to help with sudden trouble breathing. Both asthma and COPD can cause sudden difficulty breathing, called an exacerbation. For people with asthma, they may refer to this as an asthma attack.

Rescue inhalers work by relaxing and opening the airways. They kick in within minutes of taking them. And their effects typically last for about 4 to 6 hours.

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 the abbreviation HFA, which stands for hydrofluoroalkane. This is a propellant which turns the medication into a fine mist that you can inhale.

Not all rescue inhalers use propellants, though. Some deliver the medication using a fine powder instead. These are called dry powder inhalers (DPIs). DPIs can be helpful for people who have trouble timing their breaths with traditional inhalers, such as children and people with mobility issues.

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The following are brand names of albuterol inhalers:

• ProAir HFA — generic version available

• ProAir Digihaler

• ProAir Respiclick

• Proventil HFA — generic version available

• Ventolin HFA — generic version available

Xopenex HFA is the only currently available brand name for levalbuterol. This rescue inhaler also has a generic version available.

How do rescue inhalers work?

When you breathe, air travels through many different tubes within your lungs, which eventually brings oxygen to your bloodstream. These are called the bronchial tubes, or bronchi. Trouble breathing — a hallmark in asthma and COPD — is caused by the bronchi tightening (bronchospasm).

Bronchospasms can cause:

• Coughing

• Shortness of breath

• Wheezing

• Trouble breathing overall

How do albuterol and levalbuterol work?

Albuterol and levalbuterol belong to the class of medications called short-acting beta agonists (SABAs). These medications attach to receptors (chemical binding sites) in the airways. Once activated by the medication, the receptors signal the airways to relax and open up, making breathing much easier.

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

Both albuterol and levalbuterol inhalers can be prescribed to people ages 4 years and older with bronchospasms caused by asthma or COPD. Albuterol inhalers are also FDA 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 medications are meant to be used as needed for asthma- or COPD-related breathing problems. They are not intended for everyday use as long-term maintenance treatment.

How do I use albuterol and levalbuterol inhalers?

It depends on the inhaler design. The instructions for individual inhalers are provided in their packages. GoodRx Health provides a helpful video demonstrating how to use the most common inhalers. You can also check out our other article on how to use DPIs for more detailed directions for powder-based inhalers. You can also talk to your healthcare provider or pharmacist about how to use these inhalers.

Your healthcare team can help you with tips for:

• Setting up the device

• Preparing the medication for use

• Storing it

• Cleaning it

• Using proper inhalation technique

What is the typical dose for rescue inhalers?

Rescue inhalers typically 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 healthcare provider will help you determine your daily maximum number of doses. Using rescue inhalers like albuterol or levalbuterol more frequently than recommended generally leads to more side effects. If you find yourself needing albuterol or levalbuterol more often than prescribed, talk to your healthcare provider to find a better option for managing your symptoms.

What are the most common side effects of rescue inhalers?

People who use rescue inhalers typically have mild or no side effects and minimal symptoms of drowsiness, but a few potential ones are worth mentioning. Keep in mind that this is not a complete 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 should help relieve the irritation.

• Rapid heart rate. For some people, these medications can 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 rescue inhalers 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.

• Anxiety or nervousness. This can go hand-in-hand with a fast heart rate or tremors. Some people also experience an anxious feeling with rescue inhalers. This is typically temporary and will pass quickly.

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 interactions?

Rescue inhalers have a lower risk of medication interactions compared to oral versions of the medications because they’re not greatly absorbed throughout the entire body. One interaction worth highlighting is with beta blockers (like atenolol and propranolol). Beta blockers are often prescribed to treat heart problems or high blood pressure. Albuterol and levalbuterol can potentially make them less effective. And on the flip side, beta blockers can make rescue inhalers less effective.

Other notable rescue inhaler interactions include:

• Loop diuretics (“water pills”) like furosemide (Lasix)

• Thiazide diuretics like hydrochlorothiazide

• Digoxin (Lanoxin, Digitek)

• Tricyclic antidepressants like amitriptyline

• Monoamine oxidase inhibitors like selegiline (Zelapar, Emsam)

Talk to your healthcare provider and pharmacist about what other medications may interact with rescue inhalers to get further guidance.

Do albuterol and levalbuterol inhalers require any special monitoring?

No. Some medications require that you take special tests to let your healthcare provider 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 in addition to your routine checkups and testing related to asthma and COPD.

Who should not take albuterol and levalbuterol inhalers?

Children 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 instructions to ensure proper medication delivery to the lungs. They should instead use a nebulizer.

Otherwise, unless you 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 to save on rescue inhalers

There are many ways to save on your rescue inhalers. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You can find rescue inhaler prices as low as $11 with a free GoodRx discount.

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Written by:

Timothy Aungst, PharmD

Timothy Aungst, PharmD, has worked in pharmacy practice for the past decade with different roles and responsibilities. He has served as an associate professor of pharmacy practice for almost a decade, a clinical pharmacist in outpatient cardiology management, and now in home healthcare.

Edited by:

Jennie Bedsworth, LCSW

Jennie Bedsworth, MSW, LCSW, is a licensed clinical social worker and therapist with 20 years of experience in journalism, teaching, and mental health. Prior to completing her master's degree, she wrote for The Furrow magazine and was editor of Missouri Ruralist magazine.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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