Can't Get Opzelura? Here Are Your Options

If you've been prescribed Opzelura (Ruxolitinib cream) and can't fill your prescription — whether because of availability issues, insurance denials, or cost — you're probably wondering what alternatives exist. The good news is that there are several other treatment options for both atopic dermatitis and vitiligo that your dermatologist may consider.

In this article, we'll cover what Opzelura is, how it works, and walk through the best alternative medications so you can have an informed conversation with your doctor.

Before exploring alternatives, you may want to try Medfinder to see if a pharmacy near you has Opzelura in stock. You can also read our guide on how to find Opzelura in stock for more tips.

What Is Opzelura and How Does It Work?

Opzelura is a topical cream containing Ruxolitinib, a Janus kinase (JAK) inhibitor. It's the first and only topical JAK inhibitor approved by the FDA. It works by blocking JAK1 and JAK2 enzymes in the skin, which reduces the inflammatory signals that cause itching and redness in atopic dermatitis and the immune attack on melanocytes (pigment-producing cells) in vitiligo.

Opzelura is applied as a thin layer twice daily to affected skin areas. It comes in 60-gram and 100-gram tubes as a 1.5% cream.

For a deeper dive, see our article on how Opzelura works.

Alternative 1: Eucrisa (Crisaborole)

What It Is

Eucrisa is a topical ointment containing Crisaborole, a phosphodiesterase 4 (PDE4) inhibitor. It's FDA-approved for mild to moderate atopic dermatitis in patients 3 months of age and older.

How It Works

Eucrisa works by inhibiting the PDE4 enzyme, which plays a role in inflammation. By blocking this enzyme, it reduces the production of inflammatory chemicals in the skin, helping to relieve itching and redness.

Key Differences from Opzelura

• Eucrisa is approved for younger patients (3 months+) compared to Opzelura (2 years+ for eczema)
• It works through a different mechanism (PDE4 vs. JAK inhibition)
• Eucrisa is only approved for atopic dermatitis, not vitiligo
• Some patients experience a stinging or burning sensation at the application site with Eucrisa
• It does not carry the same boxed warning as Opzelura

Cost

Eucrisa costs approximately $700 to $900 per tube without insurance, which is lower than Opzelura but still expensive. Manufacturer coupons may be available.

Alternative 2: Protopic (Tacrolimus Ointment)

What It Is

Protopic is a topical calcineurin inhibitor available in 0.03% and 0.1% strengths. It's FDA-approved for moderate to severe atopic dermatitis in adults and children 2 years and older.

How It Works

Tacrolimus suppresses the immune system locally in the skin by inhibiting calcineurin, a protein involved in T-cell activation. This reduces inflammation, itching, and redness associated with eczema.

Key Differences from Opzelura

• Protopic has been available much longer and has a well-established safety profile
• It's available in generic form (Tacrolimus ointment), making it significantly more affordable
• Protopic carries its own boxed warning about a potential risk of lymphoma and skin cancer
• It's approved for moderate to severe eczema, while Opzelura is for mild to moderate
• Protopic is not FDA-approved for vitiligo, though it is sometimes used off-label for this purpose

Cost

Generic Tacrolimus ointment can cost as little as $30 to $80 with a coupon, making it one of the most affordable alternatives to Opzelura.

Alternative 3: Elidel (Pimecrolimus Cream)

What It Is

Elidel is another topical calcineurin inhibitor, available as a 1% cream. It's FDA-approved for mild to moderate atopic dermatitis in patients 2 years of age and older.

How It Works

Like Tacrolimus, Pimecrolimus works by suppressing the local immune response in the skin. It inhibits calcineurin to reduce T-cell activation and inflammation.

Key Differences from Opzelura

• Elidel targets the same severity level as Opzelura (mild to moderate atopic dermatitis)
• It is available in generic form (Pimecrolimus cream), which is much more affordable
• Elidel has a similar boxed warning to Protopic regarding potential lymphoma risk
• It is not approved for vitiligo
• The cream formulation is similar to Opzelura, which some patients prefer over ointments

Cost

Generic Pimecrolimus cream costs approximately $50 to $150 with a coupon, making it a budget-friendly option.

Alternative 4: Dupixent (Dupilumab)

What It Is

Dupixent is an injectable biologic medication (a monoclonal antibody) that targets interleukin-4 (IL-4) and interleukin-13 (IL-13). It's FDA-approved for moderate to severe atopic dermatitis in adults and children 6 months and older.

How It Works

Dupixent works by blocking IL-4 and IL-13, two key proteins that drive the type 2 inflammation responsible for atopic dermatitis. Unlike topical treatments, Dupixent is given as an injection (usually every two weeks) and works systemically throughout the body.

Key Differences from Opzelura

• Dupixent is for moderate to severe eczema — it's a step up in treatment intensity
• It's an injection, not a topical cream
• Dupixent does not carry a boxed warning
• It's typically prescribed after topical treatments have failed
• Dupixent is not approved for vitiligo

Cost

Dupixent costs approximately $3,000 to $3,500 per month without insurance, but the manufacturer (Sanofi/Regeneron) offers a copay card that can reduce costs significantly for eligible patients.

What About Vitiligo Alternatives?

If you were prescribed Opzelura specifically for vitiligo, your options are more limited since Opzelura is the first FDA-approved pharmacologic treatment for this condition. However, your dermatologist may consider:

• Topical corticosteroids: Sometimes used to help with repigmentation, especially on the body (not face)
• Tacrolimus ointment (off-label): Used off-label for vitiligo, particularly on facial areas
• Phototherapy (narrowband UVB): Light therapy that stimulates melanocytes to produce pigment
• Combination therapy: Using phototherapy alongside topical treatments for better results

Final Thoughts

While Opzelura is a groundbreaking treatment — especially for vitiligo — it's not your only option if you can't fill your prescription. Talk to your dermatologist about which alternative makes the most sense for your condition, severity, and budget.

And don't give up on finding Opzelura itself. Use Medfinder to check pharmacy availability, and read our guide to saving money on Opzelura if cost is the main barrier.