Trelegy vs. Spiriva: Differences and similarities explained

In this article:

• Key differences
• Conditions treated
• Is Spiriva better than Trelegy?
• Insurance coverage and cost comparison
• Side effects
• Drug interactions
• Trelegy and Spiriva Drug warnings
• Can you take Trelegy and Spiriva together?

In this article

• Key differences
• Conditions treated
• Is Spiriva better than Trelegy?
• Insurance coverage and cost comparison
• Side effects
• Drug interactions
• Trelegy and Spiriva Drug warnings
• Can you take Trelegy and Spiriva together?

Trelegy and Spiriva are two popular medications prescribed for chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. Trelegy and Spiriva work as maintenance treatments to control and prevent COPD symptoms such as shortness of breath, chronic cough, and wheezing. They need to be taken daily for maximum effectiveness. Although th’re 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 help reduce inflammation and relax the smooth muscles in the lungs to improve breathing. It’s taken as one inhalation or puff once daily. 

Spiriva contains tiotropium, an anticholinergic. It is available as Spiriva Respimat (soft mist inhaler) and Spiriva HandiHaler (dry powder inhaler). Tiotropium works by relaxing the airway muscles and helping keep them open. It’s taken as two puffs once daily.

`Trelegy is generally a more complete option since it combines three medications in one inhaler, which can be especially helpful for those needing more than one treatment to manage symptoms. Spiriva, on the other hand, focuses solely on bronchodilation or opening up the airways, making it a simpler option for those who don’t need the added ingredients. The Spiriva HandiHaler is also available as a generic, which may be more accessible for some. 

Compare Trelegy vs. Spiriva key differences
Difference	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 both used to treat COPD. In addition to COPD, Trelegy is approved by the Food and Drug Administration (FDA) for the maintenance treatment of asthma in adults. 

On the other hand, the FDA-approved uses of Spiriva vary depending on the dosage form. For example, Spiriva HandiHaler is approved for the maintenance treatment of COPD in adults. While Spiriva Respimat is also approved for COPD in adults, it may be prescribed to treat asthma in adults and children 6 years and older. 

Neither Trelegy nor Spiriva is used to relieve acute bronchospasm or sudden breathing problems. Instead, a short-acting rescue inhaler like Ventolin (albuterol) is 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. Taking them consistently may help reduce the risk of hospital visits due to breathing problems and improve a person’s overall quality of life.

However, Spiriva is typically used for less severe forms of COPD in people 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 found that people with COPD who switched from one or two inhalers to a single triple inhaler like Trelegy had fewer flare-ups and improved lung function. Researchers also found that older adults and those who had more frequent flare-ups or asthma-like symptoms experienced the most benefit from switching. 

What’s best for one person might not be best for someone else. Only a healthcare provider can recommend the most effective medication based on factors like other medical conditions and interactions with other medications.

COPD Coupons & Resources

Trelegy vs. Spiriva: Insurance coverage and cost comparison

Insurance plans and Medicare Part D may cover Trelegy Ellipta and Spiriva, but actual coverage and out-of-pocket costs can vary by plan. It’s important to check with specific insurance plans to see if these inhalers are on their formulary or preferred drug list.

Without insurance or coupons, Trelegy’s average retail price for a 30-day supply is $918, depending on the pharmacy and location. The average retail price of Spiriva HandiHaler is $668, and the average retail price of Spiriva Respimat is $97. A generic version of Spiriva HandiHaler, tiotropium bromide, may be available at a lower cost than the brand-name drug.  

Patients may be able to save with a SingleCare prescription discount card. Using this card can help people access up to 80% in savings and can be used at various pharmacies across the country.  

Compare Trelegy vs. Spiriva cost & coverage
Coverage details	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	$918	$675	$62
SingleCare cost	$534	$266	$62

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing in ZIP code 23666 as of Dec. 11, 2025. The listed price without insurance references the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available.

Trelegy vs. Spiriva side effects

Both drugs share similar side effects, such as upper respiratory and urinary tract infections. In addition, both medications can cause headaches, sore throat, and cough. Other side effects are possible, although their severity and frequency of occurrence can vary.  

Spiriva may be more likely to cause chest pain and dry mouth than Trelegy. However, Trelegy has been found to cause back pain as a potential side effect, which is not one that’s listed on Spiriva’s drug label.

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

Compare Trelegy vs. Spiriva side effects
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. However, both Trelegy and Spiriva can interact with other anticholinergic drugs, increasing the risk of certain side effects like dry mouth, blurred vision, and constipation. 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 interact with Trelegy. Combining Trelegy with these medications may cause cardiovascular side effects like increased heart rate and blood pressure, or side effects related to corticosteroids, such as swelling, weight gain, and mood changes.
• Monoamine oxidase inhibitors and tricyclic antidepressants: These types of antidepressants can increase the effects of vilanterol on the heart. Combining these medications with Trelegy should only be done with guidance from a healthcare provider.
• Beta blockers: These medications are prescribed to treat heart conditions or high blood pressure, but they can also reduce how well Trelegy works to open the airways. In severe cases, taking a beta blocker with Trelegy may lead to serious breathing problems.
• Certain diuretics: Known as “water pills,” these get rid of extra fluid but can also lower potassium levels. Since taking these drugs with Trelegy can increase the risk of an irregular heartbeat, it may be recommended to check potassium levels before using them together. 

Tell a 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
Atrovent (ipratropium) Ditropan (oxybutynin) Cogentin (benztropine)	Anticholinergic	Yes	Yes
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

Consult a healthcare professional for other possible drug interactions.

Trelegy and Spiriva drug warnings

Both Trelegy and Spiriva can worsen certain health conditions like narrow-angle glaucoma and urinary retention (trouble urinating). People with existing glaucoma, an enlarged prostate, or bladder-neck problems may need to use these medications carefully and seek medical help if they experience eye pain, vision changes, or difficulty urinating. 

In rare cases, these inhalers may cause paradoxical bronchospasm, a condition in which breathing or wheezing worsens after using the medication. If this happens, the inhaler may need to be stopped and replaced with a different treatment. 

Additional warnings for Trelegy

Since Trelegy combines three different medications, it has additional warnings that don’t apply to Spiriva. A potential side effect of Trelegy is 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.

COPD patients taking Trelegy may also have an increased risk of pneumonia. It’s important to watch for fever, chills, cough, or shortness of breath while using it. In addition, the steroid in Trelegy can weaken the immune system, which could lead to or worsen fungal, bacterial, viral, or parasitic infections.

Trelegy can affect how the adrenal glands work, especially in those switching from oral steroids too quickly. A healthcare provider may recommend slowly tapering off the old medication to prevent adrenal problems. Using too much Trelegy can also lead to adrenal suppression or hypercorticism (too much steroid hormone in the body).

Other risks include heart rhythm problems, high blood pressure, decreased bone density, and electrolyte imbalances like low potassium. People with conditions like seizures, thyroid problems, or diabetes may need to use Trelegy with caution.

Can you take Trelegy and Spiriva together?

Taking Trelegy and Spiriva together isn’t generally recommended because both medications contain an anticholinergic ingredient. Trelegy includes umeclidinium, while Spiriva contains tiotropium. Using these together can increase the risk of side effects such as dry mouth, constipation, blurred vision, and trouble urinating. A healthcare provider may be more likely to recommend adding a different inhaler or switching completely to Trelegy if Spiriva isn’t working well enough to control symptoms.