When You Can't Get Winlevi, What Are Your Options?

If you've been prescribed Winlevi (Clascoterone) cream for acne and can't fill your prescription — whether because of availability issues, insurance denials, or the high cash price — you're not stuck. There are several effective alternatives your dermatologist can consider.

That said, it's important to understand that Winlevi works differently from other acne treatments, so a direct substitute doesn't exist. Let's look at what makes Winlevi unique and which alternatives come closest.

What Is Winlevi and How Does It Work?

Winlevi is a topical androgen receptor inhibitor — the first and only one approved by the FDA for acne. It contains Clascoterone 1% and works by blocking androgen receptors in the skin.

Androgens like testosterone and dihydrotestosterone (DHT) increase sebum (oil) production in your skin's sebaceous glands. Excess sebum is one of the main drivers of acne. By blocking androgen receptors locally, Winlevi reduces oil production and the inflammation that follows — all without entering your bloodstream in significant amounts.

This mechanism makes it particularly useful for hormonal acne and for patients who haven't responded well to traditional topical treatments.

Alternatives to Winlevi for Acne

While no other topical medication works exactly like Winlevi, these alternatives target acne through different but effective mechanisms:

1. Tretinoin (Retin-A)

What it is: A topical retinoid that increases skin cell turnover and prevents clogged pores.

How it compares: Tretinoin is one of the most widely prescribed acne treatments and has decades of evidence behind it. Unlike Winlevi, it doesn't address the hormonal component of acne directly. It works by promoting the shedding of dead skin cells and reducing the formation of comedones (clogged pores).

Cost: Generic Tretinoin is significantly cheaper than Winlevi, typically costing $20 to $80 with a discount card.

Best for: Comedonal acne (blackheads and whiteheads), anti-aging benefits, patients who need an affordable first-line treatment.

2. Adapalene (Differin)

What it is: Another topical retinoid, available both over-the-counter (0.1%) and by prescription (0.3%).

How it compares: Adapalene is generally better tolerated than Tretinoin and is available OTC, making it very accessible. Like Tretinoin, it works on cell turnover rather than hormonal pathways. It's a good option if you're looking for something you can start right away without a prescription.

Cost: OTC Adapalene 0.1% (Differin) costs about $12 to $30. Prescription strength is more but still far less than Winlevi.

Best for: Mild to moderate acne, patients who want OTC access, those who find Tretinoin too irritating.

3. Spironolactone (Oral)

What it is: An oral antiandrogen medication used off-label for hormonal acne in women.

How it compares: Spironolactone is the closest alternative to Winlevi in terms of mechanism — both target androgen activity. However, Spironolactone works systemically (throughout the body) rather than locally on the skin. This means it can be very effective for hormonal acne but comes with more potential side effects, including dizziness, breast tenderness, and the need to monitor potassium levels. It is not recommended for men due to feminizing effects.

Cost: Generic Spironolactone is very affordable, typically $4 to $20 per month.

Best for: Women with hormonal acne, especially those with acne along the jawline and chin.

4. Dapsone Gel (Aczone)

What it is: A topical anti-inflammatory and antimicrobial gel for acne.

How it compares: Dapsone gel works through anti-inflammatory mechanisms rather than targeting androgens or cell turnover. It's particularly effective for inflammatory acne and is well tolerated. A generic version (Dapsone gel 7.5%) is now available, making it more affordable than it used to be.

Cost: Generic Dapsone gel costs roughly $50 to $150 depending on the pharmacy and discount programs used.

Best for: Inflammatory acne, patients who can't tolerate retinoids, women with adult acne.

A Quick Comparison

Here's how these alternatives stack up against Winlevi:

• Winlevi: Topical androgen blocker, ~$560-$846/tube, brand only, prescription required
• Tretinoin: Topical retinoid, ~$20-$80 generic, prescription required
• Adapalene: Topical retinoid, ~$12-$30 OTC, no prescription needed for 0.1%
• Spironolactone: Oral antiandrogen, ~$4-$20/month generic, prescription required, women only
• Dapsone gel: Topical anti-inflammatory, ~$50-$150 generic, prescription required

Final Thoughts

Winlevi is a unique medication with no exact topical equivalent. If you can't access it right now, talk to your dermatologist about which alternative makes the most sense for your specific type of acne. Many patients do well with retinoids, and women with hormonal acne may find Spironolactone just as effective.

If your goal is still to get Winlevi, check out our guides on how to find Winlevi in stock and how to save money on Winlevi. You can also use Medfinder to check real-time pharmacy availability near you.