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Wixela vs Dulera
Introduction
For patients with respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD), certain drugs that modify the inflammation and constriction in the airways can help in managing symptoms. Wixela and Dulera are two such medications often prescribed for these conditions. They each work to relax and open up the airways, aiding in better breathing, but their components differ slightly. Wixela is a combination of fluticasone, a steroid that decreases inflammation, and salmeterol, a long-acting beta agonist (LABA) that helps keep the airways open. On the other hand, Dulera combines mometasone, another potent steroid with anti-inflammatory properties similar to fluticasone's function in Wixela; it also includes formoterol which is another LABA like salmeterol used in Wixela - it aids prolonged bronchodilation assisting smoother respiration.
Wixela vs Dulera Side By Side
| Attribute | Wixela | Dulera |
|---|---|---|
| Brand Name | Wixela | Dulera |
| Contraindications | Should not be taken if using or have recently used MAOIs or tricyclic antidepressants | Should not be taken if using or have recently used MAOIs or tricyclic antidepressants |
| Cost | Around $125 for Wixela Inhub (100 mcg/50 mcg) | About $340 for Dulera (100mcg/5mcg) |
| Generic Name | Fluticasone propionate and salmeterol | Mometasone furoate and formoterol fumarate dihydrate |
| Most Serious Side Effect | Allergic reactions, eye problems including glaucoma and cataracts, increased heart rate, high blood sugar level, decreased potassium levels | Allergic reactions, unexpected weight gain, tremors or nervousness, changes in vision, irregular heartbeat, extreme restlessness |
| Severe Drug Interactions | MAOIs and tricyclic antidepressants | MAOIs and tricyclic antidepressants |
| Typical Dose | 100-250 mcg twice daily for adults, 50-100 mcg twice daily for children aged 4 years and older | 100 mcg/5 mcg or 200 mcg/5 mcg, taken as two inhalations twice daily |
What is Wixela?
Wixela Inhub and Dulera are both combination inhalers that contain a corticosteroid and a long-acting beta agonist (LABA). These medications were designed to manage the symptoms of chronic obstructive pulmonary disease (COPD) and asthma. Wixela, the generic version of Advair Diskus, was approved by the FDA in 2019. It contains fluticasone propionate, which reduces inflammation in the lungs, and salmeterol, which helps to relax and open air passages in the lungs. This medication is prescribed for COPD as well as different forms of asthma.
On the other hand, Dulera contains mometasone furoate - an anti-inflammatory corticosteroid - combined with formoterol fumarate dihydrate - a bronchodilator LABA. Although it has similar mechanisms like Wixela Inhub, its usage is limited only for treating asthma; it's not recommended for COPD patients. Both medications have their unique side effects profile but generally include risks such as oral thrush or potential worsening of existing tuberculosis or fungal infections if not used correctly.
What conditions is Wixela approved to treat?
Wixela is approved for the treatment of different forms of pulmonary conditions:
- Chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema
- Asthma in patients aged 4 years and older, as a maintenance treatment.
It's important to note that Wixela should not be used as a rescue therapy for sudden breathing problems.
How does Wixela help with these illnesses?
Wixela aids in managing asthma by increasing the amount of bronchodilator and anti-inflammatory medication available in the lungs. It does this through a combination of fluticasone, a corticosteroid that reduces inflammation, and salmeterol, a long-acting beta agonist (LABA) that relaxes muscles in the airways to improve breathing. These components collectively help to prevent symptoms such as wheezing, shortness of breath, and ongoing cough from occurring. Asthma is characterized by chronic inflammation and narrowing of the airways which can lead to difficulty breathing. Therefore, by reducing inflammation and relaxing lung muscles with Wixela's dual-action formula, patients can manage their condition more effectively.
On the other hand, Dulera also combines two medications – mometasone furoate (an anti-inflammatory steroid), and formoterol fumarate (a LABA). Like Wixela’s ingredients these work together in reducing inflammation within your respiratory tract and relaxing your lung muscles allowing for better airflow thus making it easier for you to breathe if you have asthma or COPD.
What is Dulera?
Dulera is a brand name for a combination drug that includes mometasone, an inhaled corticosteroid (ICS), and formoterol, a long-acting beta2-adrenergic agonist (LABA). This combination works together to reduce inflammation in the airways and relax the muscles around them. It thus helps to control symptoms of asthma and improve lung function. Unlike Wixela, which is another ICS/LABA combo but with different active ingredients (fluticasone propionate and salmeterol xinafoate), Dulera's distinct mechanism of action does not involve blocking other molecules or neurotransmitters directly.
The FDA first approved Dulera in 2010. Since it doesn't operate like SSRI antidepressants such as Prozac by inhibiting reuptake, it doesn’t cause sedation or affect weight gain or sexual function - common side effects associated with SSRIs. The effects of Dulera on reducing inflammation and relaxing airway muscles can be particularly beneficial for managing persistent asthma when typical short-term relief medications are not sufficient.
What conditions is Dulera approved to treat?
Dulera has been approved by the FDA for the treatment of:
- Asthma in patients 12 years of age and older
- Chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
It is important to note that Dulera should not be used as a rescue inhaler or for people whose asthma is well controlled on low or medium dose inhaled corticosteroids.
How does Dulera help with these illnesses?
Dulera is a combination medication containing formoterol and mometasone. Formoterol, a long-acting beta agonist (LABA), works by opening the airways in the lungs to facilitate easier breathing. Mometasone, on the other hand, is an inhaled corticosteroid that reduces inflammation within these airways. Dulera's dual-action mechanism helps manage asthma symptoms more effectively for certain patients compared to medications like Wixela which only contain one type of active ingredient. This makes it particularly beneficial for managing chronic obstructive pulmonary disease (COPD) or severe asthma cases where one medication may not be sufficient. It's important to note, however, that Dulera should not be used as a "rescue" inhaler during an acute asthma attack – instead it should be used daily as part of an ongoing treatment regimen.
How effective are both Wixela and Dulera?
Both Wixela Inhub and Dulera have established histories of success in managing symptoms of asthma and COPD, and they were both approved by the FDA within a few years of each other. Since they act on different receptors (beta-2 adrenergic receptor for Wixela vs corticosteroid receptor for Dulera), they may be prescribed under different circumstances.
The effectiveness of Wixela and Dulera in managing respiratory conditions was directly studied in several clinical trials; the two drugs exhibited similar efficacy in controlling symptoms as well as promising safety profiles. In these studies, there weren't significant differences between the patients receiving either drug to measure efficacy in treating respiratory conditions. A 2010 clinical trial compared fluticasone propionate/salmeterol (Wixela) against mometasone furoate/formoterol (Dulera) which showed that individuals on fluticasone propionate/salmeterol experienced fewer incidences of pneumonia.
A 2008 review reported that fluticasone propionate/salmeterol effectively reduces exacerbations from the first week onwards, has a favorable side effect profile over many other inhalers, and is well-tolerated even among elderly populations with COPD or asthma. Further, it became one of the most widely used combination inhaler therapies globally due to its consistent performance. The dose showing optimal efficacy varies depending on individual patient characteristics but generally ranges from 100/50 μg to 500/50 μg twice daily.
A study conducted in 2016 indicated that mometasone furoate/formoterol seems more effective than placebo at reducing flare-ups and improving lung function when used continuously over time, although it's typically considered only after monotherapies or other first-line treatments fail to control symptoms adequately enough. Research shows that combining an ICS such as mometasone with a LABA like formoterol can significantly improve lung function compared to ICS alone; however, data supporting its superiority over other combinations is lacking. Nonetheless, due to its unique pharmacology involving simultaneous bronchodilation and inflammation reduction effects without major systemic absorption-related adverse events make this combination treatment option particularly useful for those unresponsive or intolerant to single-entity medications.
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At what dose is Wixela typically prescribed?
Inhaled dosages of Wixela range between 100-250 mcg twice daily for adults, depending on the severity of symptoms and response to treatment. Children from age of 4 years can be started on a dosage of 50-100 mcg twice daily. If there is no adequate response after a week, your doctor may consider increasing the dose. However, it's crucial not to exceed the maximum recommended dosage which is 500/50mcg twice per day in any case. Similarly, Dulera should be administered as two inhalations twice daily by the orally inhaled route only. In patients aged 12 years and older who are not adequately responsive to low dose treatments or have severe asthma symptoms, they might need higher doses such as Dulera (200/5) micrograms but this should be under strict medical supervision.
At what dose is Dulera typically prescribed?
Dulera treatment is generally initiated with the strength of 100 mcg/5 mcg (mometasone/formoterol), taken as two inhalations twice daily, morning and evening. It can then be increased to a dosage of 200 mcg/5 mcg if necessary for adequate symptom control. The maximum recommended dose is 800 mcg per day divided into four doses, which may be considered if there's no significant improvement in symptoms after several weeks at the lower strength. Do bear in mind that Dulera should not be used more than twice daily or beyond the prescribed dose.
What are the most common side effects for Wixela?
Common side effects of Wixela Inhub and Dulera might include:
- Headache
- Sore throat
- Sinusitis (inflammation of the sinus cavities in the head)
- Upper respiratory tract infection
- Nasal congestion
- Back pain and muscle soreness
- Nausea, vomiting or diarrhea
- Tremors or nervousness
- Dry mouth or hoarseness/voice changes
- Coughing, wheezing or chest tightness immediately after using these inhalers
Please note that while these medications have similar uses, everyone's reaction to medication is different. If you experience any severe discomfort, it's crucial to contact your healthcare provider promptly.
Are there any potential serious side effects for Wixela?
In rare instances, Wixela can result in serious side effects such as:
- Allergic reactions, including rash, hives, itching, swelling of the face or throat, difficulty breathing
- Signs of infection: fever; chills; feeling tired; flu-like symptoms
- Eye problems including glaucoma and cataracts: blurred vision or other changes in vision
- Increased heart rate or abnormal heartbeat patterns
- Feeling nervousness or restlessness on a regular basis
- High blood sugar level - frequent urination, increased thirst and hunger
- Decreased levels of potassium in your blood - muscle weakness or spasms
On the other hand Dulera may cause similar side effects but also includes:
- Symptoms like asthma becoming worse over time
- Lower bone mineral density which can lead to osteoporosis over time.
It's important to note that these are potential side effects and not everyone who takes these medications will experience them. If you have any concerns about taking either of these medications it would be best to consult with your healthcare provider.
What are the most common side effects for Dulera?
When taking Dulera, a patient may experience the following side effects:
- Dry mouth or throat irritation
- Nasal congestion or sinusitis
- Headache or dizziness
- Nausea and possible vomiting
- Trouble sleeping (insomnia)
- Sweating and feeling nervousness
- Increased heart rate
- Muscle pain or cramps While significant weight loss is not typically associated with Dulera, it's important to monitor any changes in body weight. Rash can also be a rare but serious side effect. Always consult your healthcare provider if you notice these symptoms while using Dulera.
Are there any potential serious side effects for Dulera?
While Dulera is typically a safe medication to use for managing asthma, there can be serious side effects in certain cases. Such symptoms might include:
- Indications of an allergic reaction including hives, itching or skin rash, fever, swollen glands, difficulty breathing or swallowing
- Unexpected weight gain in your face and body
- Tremors or nervousness
- Changes in vision such as blurriness or seeing halos around lights
- An irregular heartbeat that's faster than usual
- Feelings of extreme restlessness and agitation leading to uncontrolled actions
Should any of these occur while using Dulera, it's crucial you seek immediate medical attention.
Contraindications for Wixela and Dulera?
Both Wixela and Dulera, like most inhaled corticosteroids and bronchodilators, may cause a worsening of symptoms in some people. If you experience an increase in shortness of breath, wheezing or sudden breathing problems immediately after using these medications, please seek immediate medical attention.
Neither Wixela nor Dulera should be taken if you are taking or have recently been taking monoamine oxidase inhibitors (MAOIs) or tricyclic antidepressants; the combination can lead to potential cardiac complications such as abnormal heart rhythm. Always inform your physician which medications you are currently taking; MAOIs will require a period of about 2 weeks to clear from your system before starting treatment with Wixela or Dulera to prevent dangerous interactions.
How much do Wixela and Dulera cost?
For the brand name versions of these drugs:
- The price of one inhaler of Wixela Inhub (100 mcg/50 mcg) averages around $125, which works out to approximately $4.20/day based on a typical usage pattern.
- The price of Dulera (100mcg/5mcg) is about $340 per inhaler, working out to approximately $11.30/day.
Thus, if you are using standard doses for each drug, then brand-name Wixela is less expensive on a per-day treatment basis than Dulera. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic version of Wixela Inhub and Dulera(mometasone/formoterol), costs can vary significantly:
- Generic mometasone/formoterol combinations are available with prices ranging from $125 to more than $200 depending on formulation and dosage strength.
- Currently, there's no exact generic equivalent for Dulera because it uses a unique combination and delivery method.
It's important to discuss with your healthcare provider about what medication options may work best for your condition while taking into account potential costs involved.
Popularity of Wixela and Dulera
Wixela Inhub and Dulera are both widely prescribed inhaled medications used to control the symptoms of asthma.
In 2020, Wixela Inhub was estimated to have been prescribed to about 2.1 million people in the US. This accounted for just over 10% of inhaler prescriptions in the US that year. As a generic version of Advair Diskus, availability and use of Wixela Inhub has seen a steady increase since its approval by the FDA in 2019.
On the other hand, Dulera was prescribed to an estimated 600,000 patients in the USA during the same period. With its unique combination formulation containing mometasone furoate and formoterol fumarate dihydrate, it accounts for approximately 3% of overall inhaler prescriptions used for managing persistent asthma symptoms. The prevalence of Dulera has remained relatively stable over recent years despite newer entrants into this category.
Conclusion
Both Wixela (generic form of Advair) and Dulera are well-established medications used in treating asthma and COPD. They have been proven to be more effective than placebo treatments through numerous clinical studies and meta-analyses. In some cases, the inhalers may be combined, but this is subject to careful consideration by a physician as they can also interact adversely with each other. Due to their different mechanisms of action, with Wixela containing fluticasone (a corticosteroid) and salmeterol (a long-acting beta agonist), while Dulera contains mometasone (another corticosteroid) and formoterol (also a long-acting beta agonist), they tend to be prescribed under different circumstances.
Wixela has an advantage over Dulera due its availability in generic form; it represents significant cost savings especially for patients who must pay out of pocket. However, both Wixela and Dulera might require an adjustment period where effects may not become noticeable immediately.
The side effect profile is similar between these two drugs; both being generally well-tolerated but can cause mouth or throat pain, hoarseness or changes in voice, muscle cramps or spasms among others. For both drugs, patients must closely observe their symptoms particularly when starting treatment or adjusting dosage levels since unmanaged asthma/COPD could worsen rapidly leading to hospitalization if not addressed promptly.
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Refrences
- Barnes, P. J. (2002, January). Scientific rationale for inhaled combination therapy with long-acting β<sub>2</sub>-agonists and corticosteroids. European Respiratory Journal. European Respiratory Society (ERS).http://doi.org/10.1183/09031936.02.00283202