When Epsolay Isn't an Option

Epsolay is an effective treatment for the bumps and blemishes of rosacea, but it isn't always easy to get. Whether your pharmacy doesn't stock it, your insurance won't cover it, or the cost is too high, you may need to explore other options.

The good news is that Epsolay isn't the only treatment available for inflammatory rosacea. Several other FDA-approved medications can help manage your symptoms. In this guide, we'll walk you through the best alternatives — what they are, how they work, and what to expect.

Before switching medications, always talk to your dermatologist. They can recommend the best option based on your specific type of rosacea and skin sensitivity.

What Is Epsolay and How Does It Work?

Epsolay is a prescription topical cream containing 5% microencapsulated Benzoyl Peroxide (E-BPO). It was approved by the FDA in April 2022 specifically for treating inflammatory lesions of rosacea in adults.

Benzoyl Peroxide is an oxidizing agent that kills bacteria and removes dead skin cells. What makes Epsolay different from regular Benzoyl Peroxide is its microencapsulation technology. The active ingredient is released slowly over time, which means less irritation — a big deal for rosacea-prone skin that's naturally more sensitive.

You apply Epsolay once daily as a pea-sized amount to each area of the face. It comes in a 30-gram pump bottle that costs between $545 and $1,034 without insurance. For a complete breakdown, see our guide on Epsolay uses, dosage, and what you need to know.

Why You Might Need an Alternative

There are several common reasons patients look for Epsolay alternatives:

• Availability: Epsolay can be hard to find at local pharmacies
• Cost: Without savings programs, it can cost over $500 per month
• Insurance denials: Many plans require prior authorization or step therapy
• Side effects: Some patients experience too much dryness, stinging, or irritation
• Treatment response: Not every medication works for every patient

Alternative 1: Metronidazole Cream or Gel

Brand names: MetroGel, MetroCream, Noritate
Available generically: Yes
Typical cost: $15-$50 for generic with a coupon card

Metronidazole is one of the most commonly prescribed treatments for rosacea and has been used for decades. It's available in 0.75% cream, gel, and lotion formulations, as well as a 1% gel (Noritate).

How it works: Metronidazole has anti-inflammatory and antimicrobial properties. The exact mechanism in rosacea isn't fully understood, but it effectively reduces the number and redness of inflammatory bumps.

How to use it: Applied once or twice daily to affected areas of the face.

Pros:

• Available as an affordable generic
• Well-studied with a long track record
• Usually well-tolerated with mild side effects
• Widely stocked at most pharmacies

Cons:

• May take 3-4 weeks to see full improvement
• Some patients find it less effective than newer options
• Can cause mild stinging or dryness

Alternative 2: Soolantra (Ivermectin 1% Cream)

Brand name: Soolantra
Available generically: Limited generic availability
Typical cost: $400-$700 without insurance; coupons may lower this significantly

Soolantra is a topical cream containing 1% Ivermectin, an antiparasitic medication. It was approved by the FDA for rosacea in 2014 and has become one of the most popular prescription options.

How it works: Ivermectin reduces inflammation and kills Demodex mites — tiny organisms that live on the skin and are found in higher numbers in people with rosacea. By targeting both inflammation and mites, Soolantra addresses two possible contributors to rosacea flares.

How to use it: Applied once daily as a pea-sized amount to each area of the face.

Pros:

• Effective for moderate to severe papulopustular rosacea
• Once-daily application like Epsolay
• Generally well-tolerated
• Addresses Demodex mites, which may be a root cause for some patients

Cons:

• Brand-name cost is high without a coupon or savings card
• Some patients experience skin burning or irritation initially
• May not be as effective for redness (erythema) alone

Alternative 3: Azelaic Acid (Finacea)

Brand name: Finacea (15% gel or foam)
Available generically: Yes (generic Azelaic Acid gel available)
Typical cost: $30-$80 for generic with a coupon card

Azelaic Acid is a naturally occurring acid with anti-inflammatory and antimicrobial properties. It's been used to treat rosacea for many years and is available in both branded and generic formulations.

How it works: Azelaic Acid reduces swelling and redness by calming the skin's inflammatory response. It also has mild antimicrobial effects that help clear pustules and papules.

How to use it: Applied twice daily to the affected areas of the face.

Pros:

• Affordable generic options available
• Can also help with mild hyperpigmentation
• Safe for long-term use
• Available at most pharmacies

Cons:

• Requires twice-daily application (vs. once daily for Epsolay)
• May cause tingling, stinging, or burning when first applied
• Some patients find it takes longer to see results

Alternative 4: Zilxi (Minocycline 1.5% Foam)

Brand name: Zilxi
Available generically: No
Typical cost: $400-$700 without insurance

Zilxi is a topical minocycline foam approved by the FDA in 2020 for inflammatory lesions of rosacea. It's one of the newer treatment options available.

How it works: Minocycline is a tetracycline antibiotic with anti-inflammatory properties. The topical foam formulation delivers it directly to the skin, reducing the risk of systemic side effects associated with oral minocycline.

How to use it: Applied once daily to affected areas of the face.

Pros:

• Once-daily application
• Topical delivery avoids common oral antibiotic side effects
• May work for patients who haven't responded to other topicals

Cons:

• No generic available, so cost is high
• May cause yellow/orange foam residue
• Some patients experience application site irritation

How to Choose the Right Alternative

The best alternative depends on your individual situation:

• Looking for the most affordable option? Generic Metronidazole or Azelaic Acid gel are typically the most budget-friendly choices.
• Want once-daily convenience? Soolantra and Zilxi both require just one daily application, like Epsolay.
• Dealing with sensitive skin? Talk to your dermatologist about which option is gentlest for your skin type.
• Insurance requiring step therapy? Many plans will cover Metronidazole or Azelaic Acid without prior authorization, making them easier to access as a first step.

Your dermatologist can help you weigh these factors. To find a dermatologist who treats rosacea, check our provider guide.

Final Thoughts

If you can't fill your Epsolay prescription, don't lose hope. Several proven alternatives can effectively manage rosacea symptoms. Talk to your dermatologist about switching to Metronidazole, Soolantra, Azelaic Acid, or Zilxi — and be sure to discuss cost, insurance coverage, and what to expect during the transition.

In the meantime, you can still try to find Epsolay in stock using Medfinder. Sometimes the medication becomes available at nearby pharmacies you haven't checked yet.

For details about potential Epsolay side effects or drug interactions, check out our other guides.