Generic Symbicort (Budesonide/Formoterol)

What is generic Symbicort?

Generic Symbicort is any inhaler with the same two medicines as Symbicort: budesonide, an inhaled steroid that calms airway inflammation, and formoterol, a long-acting bronchodilator. In the US, the FDA approved the first generic, Breyna, in March 2022 (FDA list of 2022 first generics). Cipla's Foracort range from India contains the same active ingredients and is made and licensed in India.

Brand-name Symbicort can cost several hundred dollars a month in the US without insurance. For a detailed head-to-head, read our Foracort vs Symbicort comparison.

Is Foracort the same as Symbicort?

Both treat asthma and chronic obstructive pulmonary disease (COPD) with the same active ingredients, but they differ in maker, devices and approval.

AstraZeneca also makes the dry-powder Symbicort Turbuhaler, which is sold outside the US.

Which Foracort strength matches Symbicort?

The numbers are counted differently. The US Symbicort label gives the dose delivered from the mouthpiece: each puff meters 181/5.1 mcg at the valve but delivers 160/4.5 mcg (Symbicort label on DailyMed). Many products sold outside the US are named by the metered dose instead; the Symbicort Turbuhaler labeled 200/6, for example, delivers 160/4.5 mcg per dose (budesonide/formoterol review on PMC).

Following the same naming, Foracort 100/6 is usually treated as the nearest match to Symbicort 80/4.5, and Foracort 200/6 to Symbicort 160/4.5. Foracort 400/6 and Forte 400/12 have no single-puff US match. Foracort is a different device, so these are close matches, not identical doses; ask your doctor to confirm the strength and puffs before switching.

Which budesonide/formoterol products are available here?

Prices can change. Shipping to the USA is a flat $30, free on orders of $199 or more; product pages state delivery in about 6–15 days, and customs can add delays.

How do you choose a strength and device?

• Start from your prescription. From US Symbicort 80/4.5, the usual counterpart is a 100/6 Foracort product; from 160/4.5, a 200/6 product or the Symbicort Turbohaler.
• High strengths are for maintenance. Foracort 400/6 and Forte 400/12 carry much more budesonide per dose. They are not used as relievers; that approach uses low-dose budesonide/formoterol. Use them only if your doctor prescribes that dose.
• Aerosol inhaler: closest to the US device; a spacer helps if timing is hard.
• Dry powder (Turbuhaler, Rotacaps): breath-activated, but you must breathe in quickly and deeply. Rotacaps go into a capsule inhaler such as Cipla's Rotahaler or Revolizer.
• Respules: vials for a nebulizer, for people who cannot use a handheld inhaler well. Symbicort has no nebulizer form, so the dose must come from your doctor.

Our guide to types of asthma inhalers explains how preventers and relievers fit together, and the asthma category lists other preventers.

Can budesonide/formoterol be used as a reliever?

Formoterol starts working within minutes, so some people with asthma use one budesonide/formoterol inhaler both daily and for extra puffs when symptoms flare. This is single maintenance and reliever therapy (SMART, or MART). GINA notes it is approved in many countries with low-dose budesonide/formoterol, and that it should not be used by people whose combination inhaler contains a different long-acting bronchodilator, such as salmeterol (GINA reliever recommendations).

The US Symbicort label does not include reliever use, so SMART is only for people whose doctor has given them a written plan with the daily dose and a maximum number of extra puffs. Never start it on your own. Otherwise, keep a rescue inhaler such as albuterol (salbutamol) with you; see our Asthalin vs Ventolin guide.

How do you use a budesonide/formoterol inhaler?

1. Aerosol: shake for about 5 seconds before each use, and prime a new inhaler, or one unused for over 7 days, as the leaflet directs. Never breathe out into a Turbuhaler or capsule inhaler.
2. Breathe out fully, away from the mouthpiece.
3. Seal your lips around it. With an aerosol, press the canister as you start a slow, deep breath; with a Turbuhaler or Rotacaps, breathe in quickly and deeply.
4. Hold your breath for about 10 seconds, then breathe out slowly.
5. Rinse your mouth with water and spit it out after every dose to lower the risk of oral thrush and hoarseness.

Take doses about 12 hours apart and keep using it even when you feel well.

What are the side effects?

Common side effects on the US label include cold-like symptoms, headache, sore throat, sinusitis, back pain, stomach discomfort and oral thrush. Some people also notice shaking, nervousness or muscle spasms. Inhaled steroids can raise the risk of pneumonia in COPD, and with long-term use doctors watch for thinning bones, glaucoma, cataracts and slower growth in children.

Get urgent help if wheezing worsens right after a dose, if your face or throat swells, or if you have chest pain or a racing heartbeat.

Who should not use it?

• Anyone allergic to budesonide, formoterol or another ingredient.
• Anyone having a severe asthma attack or COPD flare: it is not an emergency treatment.
• Do not combine it with another long-acting bronchodilator, such as salmeterol.
• Tell your doctor about heart problems, high blood pressure, seizures, thyroid disease, diabetes, liver disease, osteoporosis, glaucoma or cataracts, infections including tuberculosis, and pregnancy or breastfeeding.

Strong CYP3A4 inhibitors such as ritonavir, ketoconazole, itraconazole and clarithromycin can raise budesonide levels. Beta-blockers can block the effect of formoterol and may tighten the airways in people with asthma. MAO inhibitors, tricyclic antidepressants and potassium-lowering diuretics also need caution.

Frequently asked questions

Is Foracort a generic Symbicort?

It has the same active ingredients, budesonide and formoterol, and is made and licensed in India by Cipla. In the US, the first approved generic of Symbicort was Breyna, approved in 2022.

Which product matches Symbicort 160/4.5?

Foracort 200/6, as an inhaler or Rotacaps, is the usual counterpart, and our Symbicort Turbohaler is labeled 160/4.5. Confirm the strength and number of puffs with your doctor.

Can children use budesonide/formoterol?

The US label covers asthma from age 6, with the 80/4.5 strength for ages 6 to 11; safety and effectiveness under 6 have not been established. A child's strength and device should be chosen by their doctor.

How long does one pack last?

A 120-puff inhaler lasts 30 days at two puffs twice a day. Rotacaps and Respules come in packs of 30, 60 or 90; a 60-pack covers 30 days at one dose twice a day.

This article gives general information and does not replace advice from your doctor or pharmacist. Budesonide/formoterol is a prescription medicine; do not start, stop or change an inhaler without medical advice, and get emergency care during a severe asthma attack.