What to Do When You Can't Get Eohilia

If you've been prescribed Eohilia (Budesonide oral suspension) for eosinophilic esophagitis (EoE) but can't fill your prescription — whether due to insurance denials, cost, or availability — you're not out of options. There are several alternative treatments your doctor may consider.

This post covers the most common alternatives to Eohilia, how they compare, and what to discuss with your healthcare provider. Remember: never switch or stop medications without talking to your doctor first.

Alternative #1: Compounded Budesonide Slurry

Before Eohilia was FDA-approved in 2024, the most common treatment for EoE was a compounded budesonide slurry. This involves mixing budesonide (from a nebulizer solution) with a thickening agent like sucralose (Splenda) or honey to create a viscous liquid that coats the esophagus.

Pros:

• Significantly cheaper than Eohilia — often $30 to $100 per month depending on the pharmacy
• Widely available through compounding pharmacies
• Years of clinical experience supporting its effectiveness
• Many gastroenterologists are very familiar with prescribing it

Cons:

• Not FDA-approved for EoE (off-label use)
• Dosing and preparation can vary between pharmacies
• Some insurance plans don't cover compounded medications
• Quality may vary between compounding pharmacies

Alternative #2: Swallowed Fluticasone Propionate

Another common off-label option is fluticasone propionate, typically from a metered-dose inhaler (MDI). Instead of inhaling the medication, patients puff it into their mouth and swallow it without using a spacer.

Pros:

• Relatively affordable — generic fluticasone inhalers can cost $30 to $80 with a coupon
• Available at most retail pharmacies
• Well-studied for EoE treatment

Cons:

• Not FDA-approved for EoE
• Technique matters — patients need to learn how to swallow the medication properly
• May not coat the esophagus as effectively as a liquid suspension

Alternative #3: Dupixent (Dupilumab)

Dupixent is the other FDA-approved treatment for EoE. It's a biologic medication that works differently from Eohilia — it blocks interleukin-4 and interleukin-13, which are proteins that drive the allergic inflammation in EoE.

Pros:

• FDA-approved for EoE (in patients 1 year and older weighing at least 15 kg)
• Different mechanism of action — may work for patients who don't respond to steroids
• Also treats other conditions like eczema, asthma, and nasal polyps

Cons:

• Very expensive — around $3,700 per month without insurance
• Requires injections (subcutaneous, every 1 to 2 weeks)
• May cause injection site reactions and eye problems
• Also requires prior authorization from most insurers

Alternative #4: Proton Pump Inhibitors (PPIs)

Proton pump inhibitors like omeprazole (Prilosec), pantoprazole (Protonix), and esomeprazole (Nexium) are often the first treatment tried for EoE. Research has shown that a significant portion of EoE patients — possibly up to one-third — respond well to PPI therapy.

Pros:

• Widely available and very affordable — $4 to $30 per month for generics
• Available over the counter (omeprazole, esomeprazole)
• Good safety profile for short to medium-term use
• Usually the first treatment doctors try, so no step therapy barriers

Cons:

• Don't work for all EoE patients
• Long-term use has been associated with some concerns (bone density, kidney issues, nutrient absorption)
• May mask symptoms without fully resolving esophageal inflammation

Alternative #5: Dietary Elimination Therapy

For some patients, EoE is driven by food allergens. Elimination diets — particularly the six-food elimination diet (removing dairy, wheat, eggs, soy, nuts, and seafood) — have shown effectiveness in reducing esophageal eosinophils.

Pros:

• No medication side effects
• Can identify specific food triggers
• May provide long-term management strategy

Cons:

• Very restrictive and difficult to follow
• Requires multiple endoscopies to monitor progress
• Not practical for everyone

How to Choose the Right Alternative

The best alternative to Eohilia depends on your specific situation:

• If cost is the main issue: Compounded budesonide slurry or swallowed fluticasone are the most affordable options
• If you've tried steroids without success: Dupixent offers a completely different approach
• If you haven't tried anything yet: Your doctor may start with a PPI trial
• If you prefer non-drug options: Dietary elimination therapy may be worth discussing

Talk to your gastroenterologist about which option makes the most sense for you. And don't give up on getting Eohilia if it's been prescribed — check out our guide on how to find Eohilia in stock or use MedFinder to check availability in your area.

If cost is a barrier, read our post on how to save money on Eohilia.