When You Can't Get Carac, You Still Have Options

If your pharmacist told you Carac is out of stock or unavailable — and you've already tried the tips in our guide on how to find Carac in stock near you — it may be time to talk to your dermatologist about an alternative treatment.

The good news is that Carac is not the only medication used to treat actinic keratosis. Several other prescription options are available, and your doctor can help you decide which one is the best fit for your skin, your treatment goals, and your budget.

What Is Carac and What Does It Treat?

Carac is a brand-name cream containing Fluorouracil 0.5%, a topical chemotherapy agent. It's FDA-approved to treat actinic keratoses (AKs) — rough, scaly patches on the skin caused by long-term sun exposure. These patches are considered precancerous because, if left untreated, some can develop into squamous cell carcinoma.

Carac is applied once daily for up to four weeks. Many patients and dermatologists prefer it because the lower 0.5% concentration tends to cause less skin irritation than higher-strength Fluorouracil products. For a deeper look at the medication, visit our post on what Carac is and how it's used.

How Does Carac Work?

Fluorouracil is a pyrimidine analog — a type of antimetabolite that interferes with DNA and RNA synthesis in rapidly dividing cells. When applied to the skin, it selectively targets the abnormal cells in actinic keratoses, causing them to become inflamed, crust over, and eventually slough off. Healthy skin cells, which divide more slowly, are mostly spared.

The treatment process can look alarming — redness, crusting, and peeling are expected and actually indicate the medication is working. For a complete explanation, read our post on how Carac works.

Alternative Treatments for Actinic Keratosis

If you can't get Carac, here are the most commonly prescribed alternatives. Each works differently and has its own pros, cons, and treatment timeline.

1. Generic Fluorouracil 5% Cream (Efudex)

Efudex contains the same active ingredient as Carac — Fluorouracil — but at a higher concentration of 5%. It's one of the most widely prescribed treatments for actinic keratoses and has been used for decades.

• How it's used: Applied twice daily for 2 to 4 weeks
• Pros: Widely available as a generic, much more affordable (generic Fluorouracil 5% can cost as little as $30 to $150 without insurance), proven track record
• Cons: Higher concentration often causes more intense redness, irritation, pain, and crusting than Carac 0.5%
• Best for: Patients who need a cost-effective option or can't find Carac

Generic Fluorouracil 5% is stocked at most pharmacies and rarely faces supply issues.

2. Imiquimod (Aldara, Zyclara)

Imiquimod works completely differently from Fluorouracil. Instead of directly killing abnormal cells, it stimulates your immune system to attack them. It's available as Aldara (5%) and Zyclara (3.75%).

• How it's used: Aldara is typically applied 2 times per week for 16 weeks. Zyclara is applied once daily for two 2-week treatment cycles with a 2-week break in between.
• Pros: Different mechanism of action, well-studied, available as a generic
• Cons: Longer treatment duration, can cause flu-like symptoms in some patients, local skin reactions
• Cost: Generic Imiquimod costs roughly $50 to $300 depending on the pharmacy and formulation
• Best for: Patients who don't tolerate Fluorouracil well or who have widespread actinic keratoses

3. Diclofenac Sodium 3% Gel (Solaraze)

Solaraze contains Diclofenac, a topical nonsteroidal anti-inflammatory drug (NSAID). It's one of the gentlest topical treatments for actinic keratosis.

• How it's used: Applied twice daily for 60 to 90 days
• Pros: Much less irritating than Fluorouracil or Imiquimod, generally well tolerated
• Cons: Very long treatment duration (2-3 months), may be less effective for thicker lesions
• Cost: Generic Diclofenac 3% gel costs approximately $40 to $200
• Best for: Patients with mild actinic keratoses who prefer a gentler treatment

4. Tirbanibulin (Klisyri)

Klisyri is one of the newest FDA-approved treatments for actinic keratosis, approved in 2020. It works by inhibiting tubulin polymerization and a signaling pathway called Src kinase, leading to cell death in abnormal cells.

• How it's used: Applied once daily for just 5 consecutive days
• Pros: Shortest treatment duration of any topical AK treatment, good efficacy
• Cons: Brand-name only (no generic yet), can be expensive, local skin reactions during treatment
• Cost: Approximately $700 to $1,000+ without insurance
• Best for: Patients who want the shortest possible treatment course

Non-Medication Alternatives

In addition to topical medications, your dermatologist may recommend procedural treatments for actinic keratosis:

• Cryotherapy (freezing): The most common in-office treatment. Liquid nitrogen is applied to individual lesions to freeze and destroy them. Quick, effective for small numbers of AKs.
• Photodynamic therapy (PDT): A photosensitizing agent is applied to the skin, then activated with a special light. Effective for widespread AKs, though it can cause significant redness and discomfort.
• Chemical peels: Medical-grade peels can treat superficial AKs over a broader area.
• Curettage: Scraping of thicker lesions, sometimes combined with electrodesiccation.

How to Choose the Right Alternative

The best alternative depends on several factors:

• Number and location of lesions: Widespread AKs may benefit from field treatment (Fluorouracil, Imiquimod, or PDT). Isolated spots may respond well to cryotherapy.
• Your tolerance for side effects: Solaraze is gentlest; Fluorouracil 5% is most intense.
• Treatment duration preference: Klisyri (5 days) vs. Solaraze (60-90 days)
• Cost and insurance coverage: Generic Fluorouracil 5% is the most affordable option by far.
• Your doctor's recommendation: Always discuss alternatives with your dermatologist before switching medications.

Final Thoughts

Not being able to fill your Carac prescription is frustrating, but it doesn't mean you have to go without treatment. Several effective alternatives exist, ranging from other topical creams to in-office procedures. Talk to your dermatologist about which option makes the most sense for you.

In the meantime, you can still search for Carac availability on Medfinder.com — supply changes regularly, and it may become available near you soon. And for more information about the current supply situation, read our Carac shortage update for 2026.