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Drug vs. Drug

Trelegy vs. Spiriva: Differences, similarities & side effects

Learn why your healthcare provider may prescribe Trelegy or Spiriva for COPD
Gerardo Sison medical writer headshot
By | Sep. 10, 2024
Two inhalers with "vs." between them: Trelegy vs. Spiriva

Key takeaways

  • Trelegy and Spiriva are maintenance treatments for COPD, taken daily to control symptoms like shortness of breath and chronic cough. 

  • Trelegy combines three medications (fluticasone furoate, umeclidinium, and vilanterol), while Spiriva contains tiotropium as a simpler bronchodilator. 

  • Trelegy may be more suitable for severe COPD, while Spiriva may be prescribed for milder cases. 

  • Consult a healthcare provider to determine the best treatment, as both drugs have potential side effects and drug interactions.

In this article:

Trelegy and Spiriva are two popular medications prescribed for chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. Individuals with COPD might experience shortness of breath, chronic cough, wheezing, and chest tightness.

Trelegy and Spiriva are maintenance treatments that help control and prevent COPD symptoms. Therefore, they need to be taken daily for maximum effectiveness. Although they are used for similar purposes, they differ in active ingredients, dosages, drug interactions, and more.  

Trelegy vs. Spiriva: Key differences

Trelegy Ellipta is a combination dry powder inhaler that includes fluticasone furoate, umeclidinium, and vilanterol. These ingredients work together as a corticosteroid, anticholinergic, and long-acting beta agonist (LABA), respectively. Together, they reduce inflammation, help open airways, and relax muscles to ease breathing.

Spiriva contains tiotropium, an anticholinergic. It is available as Spiriva Respimat (soft mist inhaler) and Spiriva HandiHaler (dry powder inhaler). Tiotropium works by relaxing airway muscles and helping keep them open.

Trelegy is generally more comprehensive as it combines three medications in one inhaler, which can be especially beneficial for those needing multiple therapies. Spiriva, on the other hand, focuses solely on bronchodilation, making it a simpler option for those who may not need the additional components provided by Trelegy.

Compare Trelegy vs. Spiriva key differences
Trelegy Spiriva
Drug class Inhaled corticosteroid/anticholinergic/long-acting beta agonist Anticholinergic
Brand/generic status Brand Brand and generic available (for Spiriva HandiHaler)
What is the generic name? Fluticasone furoate/umeclidinium/vilanterol Tiotropium bromide
What form(s) does the drug come in? Trelegy Ellipta (inhalation powder) Spiriva HandiHaler (inhalation powder)

Spiriva Respimat (inhalation spray)
What is the standard dosage? 1 inhalation by mouth once daily 2 inhalations by mouth once daily
How long is the typical treatment? Long-term Long-term
Who typically uses the medication? Adults Adults

Trelegy vs. Spiriva: Conditions treated

Trelegy Ellipta and Spiriva are used to treat lung diseases, but they have different specific uses and benefits. Trelegy is approved by the Food and Drug Administration (FDA) for the maintenance treatment of COPD and asthma in adults. The FDA-approved uses of Spiriva vary depending on the dosage form.

Spiriva HandiHaler is approved for the maintenance treatment of COPD in adults. However, Spiriva Respimat has an added approved use. In addition to COPD, Spiriva Respimat can also be used to treat asthma in adults and children 6 years and older. 

Neither Trelegy nor Spiriva are prescribed to relieve acute bronchospasms or sudden breathing difficulties. A short-acting rescue inhaler like Ventolin (albuterol) is typically recommended for the immediate relief of an acute COPD or asthma attack.

Compare Trelegy vs. Spiriva conditions treated
Condition Trelegy Spiriva
COPD Yes Yes (HandiHaler and Respimat)
Asthma Yes Yes (Respimat)

Is Spiriva better than Trelegy?

Trelegy and Spiriva are effective medications that help improve lung function and reduce exacerbations or flare-ups. As a result, these medications may help reduce the risk of hospital visits due to breathing problems and improve an affected individual’s quality of life.

However, Spiriva is typically used for less severe forms of COPD in individuals who may only need a single inhaler to manage their symptoms. COPD can progress, and in people with more severe disease, Trelegy may be a better option since it combines three medications in one inhaler. Still, limited studies directly compare Trelegy and Spiriva.

One study compared Trelegy to two different dual inhaler treatments. One dual inhaler combined fluticasone and vilanterol, while the other combined umeclidinium and vilanterol. Trelegy reduced COPD flare-ups to an average of 0.9 times per year, while the average number of flare-ups for the other treatments were 1.1 and 1.2 times per year. Trelegy also lowered hospital visits due to severe flare-ups to 0.1 times per year compared with 0.2 times per year with one of the dual treatments.

What’s best for you, though, might not be best for someone else. Only a healthcare provider can determine the most effective medication for their patient, considering factors like medical conditions, history, and interactions with other medications.

Trelegy vs. Spiriva: Insurance coverage and cost comparison

Insurance plans and Medicare Part D typically cover both Trelegy Ellipta and Spiriva, although the coverage specifics can vary by plan. This means most patients can expect some level of financial assistance if they have insurance.

Without insurance or coupons, Trelegy’s average retail price for a 30-day supply is $879, depending on the pharmacy and location. The average retail price of Spirava HandiHaler is $679, and the average retail price of Spiriva Respimat is $709. A generic version of Spiriva HandiHaler, tiotropium bromide, is available and may be cheaper than the brand-name alternative.  

Patients may be able to save on prescription drugs with a SingleCare prescription discount card. The card provides access to digital coupons that can be used at pharmacies across the country for significant savings.  

Compare Trelegy vs. Spiriva cost & coverage
Trelegy Spiriva HandiHaler Spiriva Respimat
Typically covered by insurance? Yes Yes Yes
Typically covered by Medicare Part D? Yes Yes Yes
Quantity 1 box 1 box 1 box
Average retail cost* $879 $689 $709
SingleCare cost* $504 $191  $433  
*Cost at time of publication. Costs vary by pharmacy.

Trelegy vs. Spiriva side effects

Both drugs share similar side effects, such as upper respiratory and urinary tract infections. However, Spiriva may have a higher risk of these infections than Trelegy. In addition, both medications can cause headaches, sore throat, and cough.

Spiriva may be more likely to cause chest pain and dry mouth than Trelegy. However, Trelegy has been noted to cause back pain, which is not explicitly listed on Spiriva’s drug label side effects.

Both drugs can cause serious side effects, including allergic reactions, especially in those with a hypersensitivity to milk proteins. Seek immediate medical attention for symptoms of a serious allergic reaction, such as rash, swelling of the face or throat, and trouble breathing. For a complete list of side effects to be aware of, consult your healthcare provider.

Compare Trelegy vs. Spiriva side effects
Trelegy Spiriva
Side effect Applicable? Frequency Applicable? Frequency
Headache Yes 5% Yes 6%
Chest pain No – Yes 7%
Sore throat Yes 15% Yes 9%
Upper respiratory tract infection Yes 7% Yes 41%
Urinary tract infection Yes 2% Yes 7%
Dry mouth No – Yes 16%
Constipation Yes >1% Yes 4%
Back pain Yes 2% No –
Cough Yes 1% Yes 3%
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your healthcare provider to learn more.
Source: DailyMed (Trelegy), DailyMed (Spiriva)

Trelegy and Spiriva drug interactions

Trelegy interacts with more drugs than Spiriva does. However, both Trelegy and Spiriva can interact with other anticholinergic drugs, increasing the risk of anticholinergic side effects. Therefore, it’s recommended to avoid using Trelegy and Spiriva with other anticholinergic-containing medications. 

In addition, Trelegy can interact with the following medications: 

  • Strong cytochrome P450 3A4 inhibitors: Certain antifungals, antibiotics, and antivirals, among other medications, can interfere with Trelegy. Combining Trelegy with these medications may cause side effects related to corticosteroids and the heart, so it’s important to use them together cautiously.
  • Monoamine oxidase inhibitors and tricyclic antidepressants: These types of antidepressants can amplify the effects of vilanterol, a component of Trelegy, on the heart. Extreme caution is advised when using these together.
  • Beta blockers: These medications, often used for heart conditions, can block the lung-opening effects of Trelegy. This drug interaction can lead to severe breathing problems if not monitored appropriately.
  • Certain diuretics: Known as “water pills,” these can change your heart’s rhythm and lower potassium levels, especially when used with Trelegy. Careful monitoring is required if these are taken together.

Tell your healthcare provider about all medications you take, including prescription drugs, over-the-counter medicine, and herbal supplements, before starting a new medication. 

Compare Trelegy vs. Spiriva drug interactions
Drug Drug class Trelegy Spiriva
Nizoral (ketoconazole)

Sporanox (itraconazole)

Diflucan (fluconazole)

 Antifungal Yes No
Biaxin (clarithromycin)

Ery-Tab (erythromycin)

Zithromax (azithromycin)

 Antibiotic Yes No
Norvir (ritonavir)

Crixivan (indinavir)

Reyataz (atazanavir)

 Antiviral Yes No
Nardil (phenelzine)

Parnate (tranylcypromine)

Marplan (isocarboxazid)

 Monoamine oxidase inhibitor Yes No
Elavil (amitriptyline)

Tofranil (imipramine)

Pamelor (nortriptyline)

 Tricyclic antidepressant Yes No
Inderal (propranolol)

Toprol-XL (metoprolol)

Tenormin (atenolol)

 Beta blocker Yes No
Lasix (furosemide)

Microzide (hydrochlorothiazide)

Demadex (torsemide)

 Non–potassium-sparing diuretic Yes No
Atrovent (ipratropium)

Ditropan (oxybutynin)

Cogentin (benztropine)

 Anticholinergic Yes Yes
Consult a healthcare professional for other possible drug interactions.

Trelegy and Spiriva Drug warnings

For both Trelegy and Spiriva, there’s a risk of worsening narrow-angle glaucoma and urinary retention. Patients with narrow-angle glaucoma should use these medications cautiously and consult a healthcare provider immediately if symptoms occur. Similarly, those with prostatic hyperplasia or bladder-neck problems should watch for signs of urinary retention and seek medical advice if needed. 

Both drugs also carry a risk of paradoxical bronchospasm, a condition where breathing or wheezing worsens after using the medication. If this occurs, the medication may need to be discontinued and replaced with a different treatment. 

Additional warnings for Trelegy

Trelegy, being a combination of multiple medications, has additional warnings that are not associated with Spiriva. There is an increased risk of serious asthma-related events with LABA monotherapy, so Trelegy should not be used to initiate treatment in acutely deteriorating COPD or asthma patients, nor should it be used to treat acute symptoms. Combining Trelegy with other LABA-containing therapies increases the risk of overdose, so such combinations should be avoided.

Trelegy users may also experience thrush or Candida albicans infections in the mouth and throat. To reduce this risk, it’s important to rinse the mouth with water (without swallowing) after inhalation. 

In addition, COPD patients taking Trelegy may have an increased risk of pneumonia and should be monitored for signs and symptoms. The medication can worsen existing infections like fungal, bacterial, viral, and parasitic infections, potentially leading to more serious or even fatal outcomes. 

There are also risks linked to adrenal function with Trelegy. When transferring from systemic steroids to Trelegy, it’s important to be weaned slowly to avoid impaired adrenal function. Hypercorticism and adrenal suppression can occur at very high dosages or even at regular dosages in some individuals. 

Other risks include heart issues, increased blood pressure, lower bone density, and electrolyte imbalances like low potassium and high blood sugar. If you have conditions like seizures, thyroid issues, diabetes, or ketoacidosis, use Trelegy with caution.

Can you take Trelegy and Spiriva together?

Taking Trelegy and Spiriva together is generally not recommended because both medications contain an anticholinergic component. Trelegy includes umeclidinium, an anticholinergic, while Spiriva contains tiotropium, another anticholinergic. Using them together can increase the risk of side effects such as dry mouth, constipation, and urinary retention. Always consult your healthcare provider before combining any medications to ensure they are safe and effective for your specific condition.