Symbicort and Foracort are combination inhalers for asthma and COPD that contain the same two medicines: budesonide, an inhaled corticosteroid that calms airway inflammation, and formoterol, a long-acting bronchodilator that keeps the airways open. Symbicort is AstraZeneca’s brand. Foracort is made in India by Cipla. Brand-name Symbicort can cost several hundred dollars a month in the US without insurance, so many people look at alternatives. Here is how the two compare, and what to check with your doctor before switching.
Foracort vs Symbicort at a glance
| Foracort | Symbicort | |
|---|---|---|
| Active ingredients | Budesonide + formoterol | Budesonide + formoterol |
| Maker | Cipla, India | AstraZeneca |
| Devices | Aerosol inhaler, Rotacaps (dry-powder capsules for a Rotahaler), Respules for nebulizers | Aerosol inhaler in the US; Turbuhaler dry-powder device in most other countries |
| Strengths (budesonide/formoterol) | 100/6, 200/6 and 400/6 mcg per puff or capsule | US: 80/4.5 and 160/4.5 mcg per puff |
| Usual adult dose | 1–2 puffs or 1 capsule twice a day, as prescribed | 2 puffs twice a day |
| Used for | Asthma and COPD | Asthma (ages 6+) and COPD |
Why the strengths look different
The numbers on the two labels are counted in different ways. US Symbicort states the amount delivered from the mouthpiece, while Foracort, like most products sold outside the US, states the amount metered by the valve or capsule. As a rough guide, Foracort 100/6 corresponds to Symbicort 80/4.5, and Foracort 200/6 to Symbicort 160/4.5. Foracort 400/6 has no direct US match; in the US, a higher budesonide dose is usually reached by taking two puffs of the 160/4.5 inhaler.
These are close equivalents, not proof that two different devices deliver identical doses to your lungs. Ask your doctor to confirm the strength and number of puffs if you change from one product to the other.
How the two medicines work together
Budesonide reduces the swelling and mucus that make airways twitchy, which prevents attacks over time. It is not felt immediately; the benefit builds over one to two weeks of regular use. Formoterol relaxes the muscle around the airways for about 12 hours and, unlike salmeterol, starts working within a few minutes. That fast start is what allows budesonide/formoterol to be used in a special way called SMART.
SMART: one inhaler as preventer and reliever
With single maintenance and reliever therapy (SMART, sometimes called MART), you take budesonide/formoterol every day and also use extra puffs of the same inhaler when symptoms flare, instead of a separate albuterol inhaler. Each reliever puff then delivers a little more steroid exactly when inflammation is rising. International GINA guidelines and the 2020 US asthma guideline update support this approach for many people with moderate to severe asthma, including children from age 4 in the US guidance.
In the US, using Symbicort as a reliever is off-label, and the approach only works with a written plan from your doctor that sets the daily dose and a maximum number of puffs per day (12 inhalations of 4.5 mcg formoterol for adults and teens in the US guideline). Never start reliever use on your own. If you are not on a SMART plan, keep your albuterol reliever with you; see our guide to asthma inhaler types for how relievers and preventers fit together.
Is there a generic Symbicort in the US?
Yes. The FDA approved the first generic, Breyna, in 2022, and authorized generic versions are also sold. Prices still vary widely by pharmacy and insurance plan. Foracort is made and licensed under Indian regulations.
For every budesonide/formoterol option we carry, with strengths and prices side by side, see our generic Symbicort page.
Choosing a Foracort device
- Foracort Inhaler (100, 200 or 400): a pressurized aerosol like the US Symbicort. Use it with a spacer if your timing is not perfect.
- Foracort Rotacaps: powder capsules loaded into a Rotahaler device. No hand-breath coordination needed, but you must be able to inhale quickly and deeply.
- Foracort Respules: single-dose vials for a nebulizer, mainly for young children and people who cannot use an inhaler.
If you prefer AstraZeneca’s original product, the Symbicort Turbuhaler is the dry-powder version sold outside the US.
How to use a budesonide/formoterol aerosol inhaler
- Shake the inhaler and remove the cap. Prime a new inhaler, or one unused for a week, by spraying into the air as the leaflet directs.
- Breathe out fully, away from the mouthpiece.
- Close your lips around the mouthpiece, press the canister as you begin a slow, deep breath in.
- Hold your breath for about 10 seconds, then breathe out slowly.
- Wait 30 seconds before a second puff.
- Rinse your mouth with water and spit it out after every dose to reduce the risk of thrush and a hoarse voice.
Side effects and precautions
The most common side effects are hoarseness, sore throat, oral thrush (white patches in the mouth), headache, tremor and a fast heartbeat. Mouth rinsing prevents most throat problems. With long-term high doses of inhaled steroid, doctors watch for thinning bones, cataracts, glaucoma, slower growth in children and, in people with COPD, a higher risk of pneumonia.
- Tell your doctor about heart rhythm problems, high blood pressure, an overactive thyroid, diabetes or low potassium, which formoterol can affect.
- Strong CYP3A4 inhibitors such as ritonavir, cobicistat, ketoconazole and itraconazole can raise budesonide levels enough to cause steroid side effects throughout the body.
- Beta-blockers, including some eye drops, can block formoterol and worsen breathing.
- Do not use another long-acting bronchodilator (such as salmeterol) at the same time.
Seek urgent care if breathing gets worse right after a dose, or if your usual reliever dose stops helping.
Frequently asked questions
Is Foracort the same as Symbicort?
It contains the same two active ingredients, but it comes from a different maker, in different devices and strengths.
Which Foracort strength matches Symbicort 160/4.5?
Foracort 200/6 is the closest match. Confirm the dose and number of puffs with your doctor before switching.
Can I use Foracort for COPD?
Budesonide/formoterol is widely used as maintenance treatment for COPD. It is not meant to replace a rescue inhaler unless your doctor has given you a plan that says so.
How long does an inhaler last?
A 120-puff inhaler lasts 30 days at 2 puffs twice a day. Count your doses if the inhaler has no counter, and store it below 86°F (30°C).
This article gives general information and does not replace advice from your doctor or asthma nurse. Do not stop or change a preventer inhaler without medical advice.
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