When You Can't Get Fluticasone/Vilanterol, Here Are Your Options

If you've been prescribed Fluticasone/Vilanterol (brand name Breo Ellipta) and can't find it at your pharmacy, you may be wondering what other medications can do the same job. The answer: there are several good alternatives.

Before we get into those, let's make sure you understand what Fluticasone/Vilanterol does and how it works — that way you can have an informed conversation with your doctor about switching.

Important: Never switch medications on your own. Always talk to your doctor or prescriber before changing your treatment. These alternatives require a new prescription.

What Is Fluticasone/Vilanterol?

Fluticasone/Vilanterol is a combination inhaler prescribed for the maintenance treatment of asthma (in adults 18 and older) and COPD (chronic obstructive pulmonary disease, including chronic bronchitis and emphysema).

It comes in the Ellipta dry powder inhaler device and is taken as one puff once a day. It's available in two strengths:

• 100/25 mcg — for COPD or moderate asthma
• 200/25 mcg — for more severe asthma

For a deeper look, read our full guide: What Is Fluticasone/Vilanterol? Uses, Dosage, and What You Need to Know.

How Does Fluticasone/Vilanterol Work?

This inhaler works in two ways at the same time:

• Fluticasone Furoate (ICS) reduces inflammation in your airways. Inflammation is what makes your airways swollen, tight, and reactive. By calming this down, the corticosteroid component helps prevent asthma attacks and COPD flare-ups.
• Vilanterol (LABA) relaxes the smooth muscles around your airways. This opens them up so air can flow more freely. The effect lasts for about 24 hours, which is why you only need one puff per day.

This combination of an inhaled corticosteroid (ICS) and a long-acting beta2-agonist (LABA) is one of the most effective approaches for managing chronic airway diseases. Learn more in our post on how Fluticasone/Vilanterol works.

Alternative 1: Budesonide/Formoterol (Symbicort)

Symbicort is one of the most commonly prescribed ICS/LABA inhalers and is often the first alternative doctors consider when Breo Ellipta isn't available.

• Drug class: ICS/LABA combination
• How it works: Budesonide reduces inflammation; Formoterol relaxes airway muscles
• Dosing: Two puffs twice daily (compared to Breo's once-daily dosing)
• Device: Metered-dose inhaler (MDI) — different from the Ellipta dry powder device
• Approved for: Asthma (ages 6+) and COPD
• Cost: Around $300 to $400 without insurance; generics are available and may cost less

Key difference: Symbicort requires twice-daily dosing. Some patients find Breo's once-daily convenience easier to stick with. However, Symbicort is widely available and many insurance plans prefer it.

Alternative 2: Fluticasone/Salmeterol (Advair Diskus or Advair HFA)

Advair has been one of the most well-known asthma and COPD inhalers for decades. It's available in two forms:

• Advair Diskus — a dry powder inhaler (similar concept to Ellipta)
• Advair HFA — a metered-dose inhaler

Details:

• Drug class: ICS/LABA combination
• How it works: Fluticasone Propionate reduces inflammation; Salmeterol relaxes airway muscles
• Dosing: One puff twice daily
• Approved for: Asthma (ages 4+) and COPD
• Cost: Generic versions (Wixela Inhub, AirDuo) are available for $150 to $250 without insurance

Key difference: Advair requires twice-daily dosing and uses a different form of Fluticasone (propionate vs. furoate). Generic options make it significantly cheaper than Breo Ellipta.

Alternative 3: Mometasone/Formoterol (Dulera)

Dulera is another ICS/LABA option that some doctors prescribe when other inhalers aren't available or aren't covered by insurance.

• Drug class: ICS/LABA combination
• How it works: Mometasone reduces inflammation; Formoterol relaxes airway muscles
• Dosing: Two puffs twice daily
• Device: Metered-dose inhaler (MDI)
• Approved for: Asthma (ages 5+)
• Cost: Around $350 to $450 without insurance

Key difference: Dulera is approved for asthma but not for COPD. If you use Fluticasone/Vilanterol for COPD, Dulera may not be the right alternative for you.

Alternative 4: Budesonide/Glycopyrrolate/Formoterol (Breztri Aerosphere)

Breztri Aerosphere is a newer option — and it's actually a triple therapy inhaler. It adds an anticholinergic (Glycopyrrolate) to the ICS/LABA combination.

• Drug class: ICS/LAMA/LABA triple combination
• How it works: Budesonide reduces inflammation; Glycopyrrolate and Formoterol both open airways through different mechanisms
• Dosing: Two puffs twice daily
• Approved for: COPD only
• Cost: Around $400 to $550 without insurance

Key difference: This is more medication than Breo Ellipta provides. Your doctor may recommend it if you need additional bronchodilation beyond what an ICS/LABA alone can offer. It's only for COPD — not asthma.

How to Choose the Right Alternative

The best alternative depends on several factors:

• Your condition — Is it asthma, COPD, or both?
• Dosing preference — Can you manage twice-daily dosing, or do you need once-daily?
• Insurance coverage — Which inhalers are on your plan's formulary?
• Cost — Do you need a generic option to keep costs down?
• Device type — Are you comfortable with an MDI, or do you prefer a dry powder inhaler?

Your doctor and pharmacist can help you weigh these factors. Don't be afraid to ask about cost — it matters, and they can help you find the most affordable option.

Final Thoughts

Not being able to fill your Fluticasone/Vilanterol prescription is stressful, but you have real options. Symbicort, Advair, Dulera, and Breztri are all proven medications that work through similar mechanisms.

Before switching, try using Medfinder to check if Fluticasone/Vilanterol is available at another pharmacy near you. If it's truly unavailable, bring this list to your next doctor's appointment and ask which alternative is the best fit for your situation.

For more information, read our posts on how to find Fluticasone/Vilanterol in stock and how to save money on Fluticasone/Vilanterol.