When Cromolyn Isn't Available, What Are Your Options?

Cromolyn Sodium (brand name Gastrocrom) has been in an active FDA shortage since 2023, leaving many patients scrambling for options. If you depend on Cromolyn for mastocytosis, mast cell activation syndrome (MCAS), or other mast cell conditions, you may be wondering: what else can I take?

The answer depends on your specific condition, symptoms, and medical history. Never switch or stop medications without talking to your doctor first. But it helps to know what alternatives exist so you can have an informed conversation with your prescriber.

What Is Cromolyn and How Does It Work?

Cromolyn Sodium is a mast cell stabilizer. It works by preventing mast cells from releasing inflammatory chemicals like histamine and leukotrienes. This makes it different from antihistamines, which only block histamine after it's already been released.

Because Cromolyn stops the problem at its source, many patients with mast cell disorders consider it a cornerstone of their treatment. It's taken as an oral solution (100 mg/5 mL ampules) four times a day, 30 minutes before meals and at bedtime.

For a complete overview, see What Is Cromolyn? Uses, Dosage, and What You Need to Know.

Alternative 1: Ketotifen

Ketotifen is the most commonly discussed alternative to Cromolyn for mast cell disorders. It is both a mast cell stabilizer and an H1 antihistamine, giving it a dual mechanism of action.

How it's used:

• Oral capsules (compounded) — typically 1 mg to 2 mg twice daily
• Eye drops (Zaditor) — available over the counter for allergic conjunctivitis

Key facts:

• Ketotifen is not commercially available as an oral medication in the United States. It must be obtained through a compounding pharmacy.
• It has a more established track record in other countries (available OTC in Canada and Europe).
• Common side effects include drowsiness, weight gain, and dry mouth.
• Compounded oral Ketotifen typically costs $50 to $150 per month depending on the pharmacy.

Many MCAS specialists consider Ketotifen a first-line alternative when Cromolyn is unavailable. Talk to your doctor about whether it's appropriate for your situation.

Alternative 2: Nedocromil

Nedocromil (brand name Tilade for the inhaled form, Alocril for eye drops) is another mast cell stabilizer with a mechanism similar to Cromolyn. It prevents mast cell degranulation and blocks the release of inflammatory mediators.

Key facts:

• Nedocromil is primarily available as an inhaled or ophthalmic medication — not as an oral solution.
• It is most useful for patients who used Cromolyn for respiratory or eye-related symptoms.
• Availability is limited, and the inhaled form (Tilade) has been discontinued in the U.S.
• The ophthalmic form (Alocril) may still be available by prescription.

Because Nedocromil is not available in an oral form, it is not a direct substitute for patients taking Gastrocrom for mastocytosis or MCAS GI symptoms.

Alternative 3: H1 and H2 Antihistamine Combination

While antihistamines don't stabilize mast cells the way Cromolyn does, a combination of H1 and H2 blockers is a standard part of mast cell disorder management — and may help bridge the gap during a shortage.

Common H1 antihistamines:

• Cetirizine (Zyrtec) — 10 mg daily, OTC
• Fexofenadine (Allegra) — 180 mg daily, OTC
• Hydroxyzine — 25 to 50 mg up to 3 times daily, prescription (also helps with anxiety and itching)

Common H2 antihistamines:

• Famotidine (Pepcid) — 20 to 40 mg twice daily, OTC

Many mast cell patients already take these alongside Cromolyn. If you're unable to access Cromolyn, your doctor may increase your antihistamine doses or add one you're not currently taking.

Alternative 4: Compounded Cromolyn Sodium

If the commercial Cromolyn oral solution is unavailable, some compounding pharmacies can prepare Cromolyn Sodium in capsule form (typically 100 mg or 200 mg) using bulk powder. This bypasses the commercial supply chain and may be available even during the shortage.

Key facts:

• Cost: approximately $200 to $250 for a 60- to 90-day supply
• You'll need a prescription that specifies compounding is acceptable
• Not all compounding pharmacies carry Cromolyn powder, so call ahead
• Some patients report slight differences in absorption compared to the liquid

This is technically the same medication in a different form — making it the closest possible substitute.

A Note on Switching Medications

Mast cell disorders are complex, and what works for one patient may not work for another. Before switching from Cromolyn to any alternative:

• Talk to your prescriber — they know your medical history and current symptom profile
• Don't stop Cromolyn abruptly if you still have some supply. Stopping suddenly can trigger symptom flares.
• Keep a symptom diary when starting a new medication so you and your doctor can evaluate how well it's working.

For help finding a specialist who can guide your treatment, see How to Find a Doctor Who Can Prescribe Cromolyn Near You.

Final Thoughts

The Cromolyn shortage has been incredibly frustrating for patients who depend on this medication. While no alternative is a perfect 1:1 replacement, options like Ketotifen, antihistamine combinations, and compounded Cromolyn can help manage your symptoms while supply remains limited.

Before trying anything new, always consult your healthcare provider. And if you're still looking for Cromolyn itself, try Medfinder to check real-time pharmacy availability in your area. Read more: How to Find Cromolyn in Stock Near You.