Pulmicort Flexhaler alternatives: What you can use instead

In this article:

• What can you use instead of Pulmicort Flexhaler?
• Reasons for considering an alternative
• Can Symbicort replace Pulmicort Flexhaler?
• Pulmicort availability
• How to switch to an alternative
• Cost
• FAQs

In this article

• What can you use instead of Pulmicort Flexhaler?
• Reasons for considering an alternative
• Can Symbicort replace Pulmicort Flexhaler?
• Pulmicort availability
• How to switch to an alternative
• Cost
• FAQs

Pulmicort Flexhaler (budesonide aerosol powder) is an inhaled corticosteroid used for the daily maintenance treatment of asthma in adults and children 6 and older. Though it’s been available since 2007, recently some patients have found it hard to find. There’s no approved generic version, its availability may vary by pharmacy, and some strengths of the product have been discontinued. As a result, some may explore some Pulmicort Flexhaler alternatives. This article discusses the main alternatives healthcare providers may consider, how they compare to Pulmicort Flexhaler, and what you should discuss with your healthcare provider about switching.

What can you use instead of Pulmicort Flexhaler?

There are several choices when it comes to the maintenance treatment of asthma. Pulmicort Flexhaler contains an inhaled corticosteroid (ICS), budesonide. Alternative ICS inhalers include:

• Fluticasone propionate Diskus or HFA (brand name Flovent Diskus or Flovent HFA, discontinued)
• Qvar RediHaler (beclomethasone)
• Asmanex Twisthaler or Asmanex HFA (mometasone)
• Alvesco (ciclesonide)
• Arnuity Ellipta (fluticasone furoate)

Pulmicort Respules (budesonide) is a product with the same active ingredient as Pulmicort Flexhaler, but it’s a prescription liquid medication used with a nebulizer machine instead of an inhaler.

Healthcare providers may consider combination inhalers for some patients based on what they need for symptom control. “The most important factors I consider when selecting a replacement for Pulmicort are what type of disease the patient has, whether they currently experience adequate control over their symptoms, their inhaler technique, their age, and their health insurance coverage,” shares Michael DeShields, MD, medical director at Discovery Institute New Jersey.

Combination inhalers combine ICS ingredients with one or more other types of drugs to open the airways. Examples include Advair Diskus or Advair HFA (fluticasone/salmeterol), Airsupra (albuterol/budesonide), and Symbicort (budesonide/formoterol). Combination inhalers may be used to treat chronic obstructive pulmonary disease (COPD) as well as asthma.

Pulmicort Flexhaler alternatives for asthma compared
Medication	Device type	Age approved	Dosing	Key notes
Fluticasone Diskus or HFA	Dry powder disk/metered-dose inhaler	Approved for children as young as 4	Varies	Generic ICS
Qvar RediHaler (beclomethasone)	Metered-dose inhaler	Approved for children as young as 4	Twice daily	Common alternative inhaled corticosteroid
Asmanex Twisthaler (mometasone)	Dry powder inhaler or spray	Approved for children as young as 4	One to two times daily	Once daily dosing option
Alvesco (ciclesonide)	Metered-dose inhaler	Approved for adolescents as young as 12	Twice daily	Alternative inhaled steroid
Arnuity Ellipta (fluticasone)	Ellipta dry powder inhaler	Approved for children as young as 5	Once daily	Once daily dosing option
Generic budesonide (nebulizer/ Pulmicort Respules)	Nebulizer solution	Approved for children as young as 12 months	Twice daily	Generic option, but for nebulizer use, not the Flexhaler device
Advair Diskus or HFA (fluticasone salmeterol)	Dry powder disk/metered-dose inhaler	Approved for children as young as 4	Twice daily	ICS plus long-acting beta2-adrenergic agonist (LABA) for better maintenance control of asthma
Airsupra (albuterol/budesonide)	Metered-dose inhaler	Approved for adults 18 and older	As needed	Used as-needed to prevent asthma attacks, not maintenance treatment
Symbicort (budesonide/formoterol)	Metered-dose inhaler	Approved for children as young as 6	Twice daily	ICS plus LABA for better maintenance control of asthma

Why might you need a Pulmicort Flexhaler alternative?

There are many reasons why someone may need an alternative to their Pulmicort Flexhaler prescription. These may include:

• Pharmacy shortages of Pulmicort Flexhalers
• Your prescribed 90 mcg per actuation strength of Pulmicort Flexhaler was discontinued
• Your insurance plan no longer covers Pulmicort Flexhaler in its formulary
• The cost of your prescription is too high
• Pulmicort Flexhaler does not effectively help your symptoms.
• You prefer using other inhalers

Some patients may be allergic to the inactive ingredients in Pulmicort Flexhaler, warns Dr. DeShields. “The Pulmicort Flexhaler includes trace amounts of milk protein along with lactose and therefore should not be used by patients who have a severe milk-protein allergy,” he says.

In any case, it’s worth speaking to your healthcare provider to understand your treatment options if Pulmicort Flexhaler isn’t accessible or effective for you.

Can Symbicort replace Pulmicort Flexhaler?

Though some patients may switch from Pulmicort Flexhaler to Symbicort, these two inhalers aren’t exactly the same. “Substitution between alternate products will not be directly equivalent to one product,” says James Lyons, MD, clinical advisor at Epiphany Wellness. The two inhalers contain the same ICS, budesonide, but Symbicort is budesonide combined with formoterol, a LABA medication. “Therefore, it serves a different function therapeutically,” he says. The two medications in Symbicort work together to decrease inflammation and open up the airways in people with asthma and COPD, while Pulmicort Flexhaler only treats asthma.

Symbicort is recommended for people with asthma only when ICS-only inhalers don’t control their symptoms adequately. Switching could depend on the severity of your asthma symptoms and treatment goals. Contact your healthcare provider to discuss whether Symbicort or another inhaler could be an appropriate alternative.

Why is Pulmicort Flexhaler hard to find?

While inhaled budesonide can be found in combination inhalers and in nebulizer form, Pulmicort Flexhaler is the only product with inhaled budesonide as a metered-dose inhaler. It doesn’t have a generic version yet, and its manufacturer AstraZeneca discontinued the 90 mcg version of the inhaler in 2011.

The national drug code (NDC) for Pulmicort Flexhaler also changed in 2025, which resulted in a change of coverage from several pharmacy programs and formularies. The new labelers for the drug, Rubicon Holdings, does not participate in the Medicaid Drug Rebate Program (MDRP), so many state Medicaid formularies no longer pay for Pulmicort Flexhaler.

The availability of the remaining 180 mcg Pulmicort Flexhaler varies by pharmacy and region. Call ahead to ask your pharmacist about availability before you try to pick up your prescription. If your regular pharmacy is out of stock or doesn’t carry Pulmicort Flexhaler, talk to your healthcare provider about appropriate alternatives right away so you can minimize the time without a preventive inhaler.

How to switch from Pulmicort Flexhaler to an alternative

Switching from Pulmicort Flexhaler to an alternative should always be done under the supervision of your healthcare provider. Dosing for each alternative inhaler is different from Pulmicort Flexhaler. Some require multiple actuations, multiple times a day, while others may only require one dose per day. Your healthcare provider can advise on the best options, strength, and dosing schedule based on your symptom severity and treatment goals.

You can also work with your pharmacist and insurance provider to confirm coverage for the new medication before your last dose of Pulmicort Flexhaler so you can continue controlling your asthma symptoms.

It’s important to know that every inhaler requires its own technique to use properly. Not having proper inhaler technique is one of the most common reasons why inhaled medications don’t work as well to control symptoms. “With inhalers, I often tell patients that the medication is just half of the prescription, the device is the other half,” says Dr. Lyons. “The dry powder inhaler, such as Pulmicort Flexhaler, relies on the patient to breathe forcibly and properly, so if there is someone who has trouble with the technique each time they use it, then they will receive less than the intended amount of medication,” he says.

If you’re thinking of switching, talk to your healthcare provider about possible alternatives and the proper technique to use your newly prescribed inhaler effectively.

How much does Pulmicort Flexhaler cost?

The average price of a Pulmicort Flexhaler is $273 for 1, 90 mcg/act (60 inhalations) inhaler without insurance. The actual cost you pay can vary by pharmacy, quantity, and whether you’re using any discounts or insurance benefits to help pay for your prescription.

The cost of Pulmicort Flexhaler can be as low as $130 for 1, 90 mcg/act (60 inhalation) inhaler with a SingleCare discount. It’s free to get a SingleCare Prescription Discount Card, and you can use it at many retail pharmacies like Walgreens, Walmart, and CVS Pharmacy.

Expert takeaway

“It is important to breathe well. Prescriptions need to be filled at the pharmacy and if one inhaler does not control wheezing or shortness of breath, patients should let their physician know so a more appropriate medicine can be prescribed,” says Leslie Greenberg MD, Associate Program Director at University of Nevada Reno Family Medicine Residency Program and member of the SingleCare Medical Review Board.

Bottom line

Alternatives to Pulmicort Flexhaler include Fluticasone Diskus or HFA, Qvar RediHaler, Alvesco, and Asmanex Twisthaler. Pulmicort Respules is a liquid version of Pulmicort but it’s a nebulized version, not a Flexhaler. If inhaled corticosteroids alone don’t control your symptoms, your healthcare provider may suggest combination inhalers like Symbicort or Advair Diskus.

Because the availability of Pulmicort Flexhaler can be variable, patients looking to switch maintenance inhalers should start by consulting with their healthcare provider and their pharmacist. It’s important not to stop your current medications abruptly and to learn proper technique with your new inhaler for best results. When picking up your inhaler, ask the pharmacist to demonstrate its use.

Frequently asked questions

Is there a generic version of Pulmicort Flexhaler?

No, a generic version of Pulmicort Flexhaler isn’t available yet.

Can you use a rescue inhaler instead of Pulmicort Flexhaler?

No, Pulmicort Flexhaler is a maintenance treatment for asthma and shouldn’t be substituted with a rescue inhaler, which contains another type of medication. Talk to your healthcare provider if you are low on your inhaler prescription or if you notice a worsening of your asthma symptoms. Consider having your physician prescribe a rescue inhaler so that it can be used when needed.

Can a pharmacist substitute another inhaler?

“A pharmacist typically will not be able to merely exchange a patient’s therapeutic regimen without receiving an appropriate prescription or authorization to do so under applicable state regulations,” says Dr. DeShields. Talk to your healthcare provider for an alternative prescription appropriate for you.

Can you switch from Pulmicort to Flovent?

Flovent is a brand-name ICS that’s been discontinued, but its generic version, fluticasone Diskus or HFA is available. Talk to your healthcare provider to see if it’s appropriate to switch from Pulmicort to a fluticasone inhaler.