Daliresp alternatives: What can I take instead of Daliresp?

Compare Daliresp alternatives | Incruse Ellipta | Anoro Ellipta | Trelegy Ellipta | Symbicort | Theophylline ER | Natural alternatives | How to switch meds

Daliresp is the brand name for roflumilast, a unique treatment option for chronic obstructive pulmonary disease (COPD). COPD, including both emphysema and chronic bronchitis forms, can impose a formidable disease burden on an individual. If you have COPD, symptoms of cough and shortness of breath can be pervasive. Exacerbations of the disease can lead to an increase in mucus production and breathing difficulty, at times necessitating oxygen supplementation and hospitalization. 

Daliresp is not a bronchodilator and should not be used for the treatment of sudden breathing problems. If your exacerbations are occurring frequently despite other treatment options, Daliresp may be considered. Daliresp therapy only involves taking a 500 mcg tablet once daily, after taking a 250 mcg starting dose for four weeks. 

If you are reluctant to start Daliresp or if you are already on Daliresp and curious about alternatives due to both common and serious side effects, read on to learn more about your options.

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What can I take in place of Daliresp?

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Other alternatives to Daliresp

• Yuperli (revefenacin)
• Lonhala Magnair (glycopyrrolate)
• Bevespi Aerosphere (formoterol-glycopyrrolate)
• Breztri Aerosphere (budesonide-formoterol-glycopyrrolate)
• Atrovent HFA (ipratropium)
• Proair HFA (albuterol)
• Ventolin HFA (albuterol)
• Albuterol nebulizer solution
• Ipratropium-albuterol nebulizer solution
• Perforomist (formoterol)
• Brovana (arformoterol) nebulizer solution
• Serevent Diskus (salmeterol)
• Prednisone

Top 5 Daliresp alternatives

1. Incruse Ellipta

Treatment of COPD starts with short-acting bronchodilators, either a beta agonist like Proair HFA, short-acting muscarinic antagonist like Atrovent HFA, or a combination of the two such as Combivent HFA. If you have more than infrequent symptoms, you are a candidate to add a long-acting agent, and long-acting muscarinic antagonists (LAMAs) are a popular choice. Incruse Ellipta can provide the convenience of a once-daily LAMA, via a dry powder inhaler. Dry powder inhalers require one quick inhalation to deliver the medication to the bronchial tubes and open the airways sustainably. Spiriva and Tudorza are other LAMA examples.

If you are considering Daliresp, you are probably already on Incruse Ellipta or another LAMA. If not, you should consider this option first. Daliresp is a phosphodiesterase 4 inhibitor (PDE 4) that reduces airway inflammation, which may explain why studies have found that it improves airflow and reduces COPD exacerbations. The fact that Daliresp is an oral medication may appeal to individuals who struggle to use inhalers. However, you should know that Daliresp is only approved by the Food and Drug Administration (FDA) for severe COPD. It is usually instituted when maximal inhaled therapies have failed.

RELATED: Incruse Ellipta vs. Spiriva

2. Anoro Ellipta

While LAMAs or long-acting beta agonists (LABAs) are first-line maintenance options for COPD sufferers experiencing worsening symptoms or exacerbations, combination inhaled products are next in line when LAMAs and LABAs are insufficient. Coupling a LAMA with a LABA puts both mechanisms to work for an additive bronchodilating effect. Anoro Ellipta does just that as a combination LAMA-LABA dry powder inhaler. Stiolto and Duaklir consist of this combination type too. Like many inhaled products, they all have the potential for throat irritation, and due to the LABA content, they can affect blood pressure and heart rate. Daliresp avoids these adverse effects but causes other side effects including diarrhea and dizziness.

RELATED: Anoro Ellipta alternatives

3. Trelegy Ellipta

If exacerbations or symptoms persist despite a LAMA-LABA, adding an inhaled corticosteroid (ICS) allows for the pairing of the steroid’s anti-inflammatory effect with the LAMA’s and LABA’s bronchodilating effects. Trelegy Ellipta packages these three drug types in one once-daily dry powder inhaler. Naturally, the potential for efficacy with three mechanisms working in your favor is exciting. Keep in mind though that more medicines bring more potential side effects too. ICS-containing inhalers entail a risk of thrush and, to a lesser extent, pneumonia. Having three component drugs also means Trelegy has a significant number of drug interactions. Daliresp may not be a better alternative in this regard; it has a long list of important drug interactions as well.

4. Symbicort

Symbicort combines two drug types, a LABA formoterol and an ICS budesonide. The inhaler provides another way to control COPD symptoms and prevent exacerbations. Its formoterol component has a fast onset of action, so Symbicort has an added advantage of providing quick and long-lasting bronchodilation. Some individuals find Symbicort’s traditional inhaler mechanism easier to use than a dry powder inhaler. The need to use it twice per day can be less attractive compared to some of the once-daily inhalers. Breo Ellipta is a once-daily LABA-ICS combination inhaler.

RELATED: Symbicort alternatives

5. Theophylline ER

If inhaler therapy has been maximized and found to be ineffective or intolerable due to side effects, you may be looking for other therapies. Symptoms like cough and shortness of breath may be too persistent or flare ups of the disease may be too frequent. At these points, discussing Daliresp is reasonable. Another idea could be theophylline. Theophylline ER is a once-daily pill that inhibits phosphodiesterase, but unlike Daliresp, it is a nonselective inhibitor of the enzyme, rather than a PDE 4 inhibitor. There is a fine line between the beneficial airway-opening effects of theophylline and its adverse effects such as headache, nausea, and diarrhea. Blood tests to monitor levels of theophylline are advisable to help avoid side effects from excessive dosing. Interactions with other drugs and being metabolized by the liver are two other characteristics of theophylline that limit its use. Significant liver disease (Child-Pugh class B or C) is a contraindication to Daliresp too.

Natural alternatives to Daliresp 

As you can see, pharmacologic treatment options for COPD abound. There is plenty that you can do in addition to taking prescription drugs. If you smoke, quitting could be your most impactful action. Lung function declines much quicker if you continue smoking. Your healthcare provider could discuss medications to help quit smoking, such as varenicline, NIcoderm CQ, and bupropion SR. 

A non-medicinal way to improve your quality of life and exercise capacity in the face of COPD is to do pulmonary rehabilitation. Repeated visits to a pulmonary rehab center can be quite helpful. The experts will guide you in exercise therapy and provide substantial education on lung disease. After concluding the course of rehab sessions, you will likely want to continue exercising. Yoga is an exercise option with proven success in COPD.

Nutrition should not be ignored. If you are overweight, weight loss may be helpful. If you have been losing weight with COPD, asking your healthcare professional about the reasons why and getting advice on calorie and protein intake would be worthwhile. Vitamin D gained attention when low levels were found to be associated with worse COPD outcomes, but to date, taking supplements such as vitamin D has not shown to benefit COPD patients in clinical trials.

How to switch to a Daliresp alternative

If you are considering stopping Daliresp, get medical advice from your prescribing doctor first. You want to make sure you do so for the right reasons. If you both agree that discontinuing Daliresp is the right decision, tapering off of it should not be necessary. However, you may also want to discuss whether substituting any of the alternatives is advisable. Depending on your insurance coverage, Daliresp may not be covered or require a higher copay. Using your SingleCare prescription saving card can save you up to 80% off on Daliresp at your local pharmacy.