Alternatives to Zilxi for Rosacea

If you've been prescribed Zilxi (Minocycline topical foam, 1.5%) but can't fill your prescription — whether because of cost, availability, or insurance issues — you have options. Several effective rosacea treatments are available, many of them with generic versions that are easier to find and much more affordable.

In this guide, we'll cover what Zilxi is, how it works, and the best alternative medications your dermatologist might recommend.

What Is Zilxi?

Zilxi is the first and only topical minocycline foam approved by the FDA for treating inflammatory lesions of rosacea in adults. It was developed by Journey Medical Corporation (formerly Foamix Pharmaceuticals) and became available in 2020.

It comes as a 1.5% foam in a pressurized canister that you apply once daily to the pimples and bumps on your face caused by rosacea. Unlike many other rosacea treatments, Zilxi uses minocycline — a tetracycline antibiotic — delivered directly to the skin rather than taken by mouth.

For a deeper dive into the medication, see our full guide: What is Zilxi? Uses, dosage, and what you need to know.

How Does Zilxi Work?

Zilxi works through two main mechanisms:

• Anti-inflammatory action — Minocycline reduces the inflammation that causes the red, swollen bumps characteristic of rosacea
• Antibacterial effects — It inhibits the growth of bacteria on the skin that may contribute to rosacea flare-ups

Because it's applied as a foam directly to the skin, Zilxi delivers the medication right where it's needed while minimizing the systemic side effects that come with taking oral antibiotics. Learn more about how Zilxi works.

Why You Might Need an Alternative

There are several common reasons patients look for alternatives to Zilxi:

• Cost — Without insurance, Zilxi costs $400-$600 per canister. Even with insurance, copays can be high.
• Availability — As a brand-name specialty product with no generic, many pharmacies don't stock it.
• Insurance denial — Many plans require prior authorization and step therapy, requiring you to try other treatments first.
• Side effects — Some patients may not tolerate Zilxi well.

Whatever the reason, the good news is that there are several well-studied alternatives.

Best Alternatives to Zilxi

1. Metronidazole (MetroGel, MetroCream, Noritate)

What it is: A topical antibiotic and anti-inflammatory that has been a first-line treatment for rosacea for decades.

How it works: Metronidazole reduces inflammation and fights certain microorganisms on the skin. It's available as a gel, cream, and lotion.

Why consider it:

• Available as a generic, making it significantly cheaper (often $20-$50 with a coupon)
• Widely stocked at virtually all pharmacies
• Long track record of safety and effectiveness
• Usually covered by insurance without prior authorization

Typical use: Applied once or twice daily to affected areas.

2. Ivermectin (Soolantra)

What it is: A topical anti-parasitic cream approved for the inflammatory bumps of rosacea.

How it works: Ivermectin targets Demodex mites, which are found in higher numbers on the skin of people with rosacea. It also has anti-inflammatory properties.

Why consider it:

• Applied only once daily
• Some studies show it may be more effective than Metronidazole for papulopustular rosacea
• Generic versions are becoming available, reducing costs
• Well-tolerated with minimal side effects

Typical use: Apply a pea-sized amount to each area of the face once daily.

3. Azelaic Acid (Finacea, Azelex)

What it is: A topical gel or foam that treats the bumps and pimples of rosacea.

How it works: Azelaic acid reduces inflammation, kills bacteria, and helps normalize skin cell turnover. It has the added benefit of helping with redness and uneven skin tone.

Why consider it:

• Available as a generic (azelaic acid 15% gel)
• Can help with both bumps and redness
• Generally well-tolerated
• Affordable — generic versions often cost $30-$80 with a coupon

Typical use: Applied twice daily to affected areas.

4. Doxycycline (Oracea)

What it is: A low-dose oral tetracycline antibiotic used for moderate-to-severe rosacea.

How it works: At the sub-antimicrobial dose used in Oracea (40 mg modified-release), Doxycycline works as an anti-inflammatory rather than an antibiotic. This means it reduces bumps and redness without contributing to antibiotic resistance.

Why consider it:

• Good option for patients with more widespread or severe rosacea
• Generic Doxycycline is very affordable (often under $20)
• Can be combined with topical treatments for better results
• Well-studied with decades of clinical data

Typical use: Taken by mouth once daily, usually with food.

How to Choose the Right Alternative

The best alternative for you depends on several factors:

• Severity of your rosacea — Mild cases may respond well to topical Metronidazole or Azelaic Acid alone. More severe cases might benefit from Doxycycline.
• Your skin type — Some products may cause more irritation on sensitive skin.
• Cost and insurance coverage — Generic options are almost always cheaper and easier to get covered.
• Other medications you take — Check our guide on Zilxi drug interactions for information about tetracycline interactions that may also apply to Doxycycline.

Always discuss any medication changes with your dermatologist before switching treatments.

Final Thoughts

Zilxi is an innovative treatment for rosacea, but it's not the only option. If you can't find it, can't afford it, or your insurance won't cover it, alternatives like Metronidazole, Ivermectin, Azelaic Acid, and Doxycycline are all proven treatments that may work just as well for your skin.

If you'd prefer to keep trying to find Zilxi, use Medfinder to check pharmacy availability near you, and see our tips on how to find Zilxi in stock.

For help with the cost, read our guide to saving money on Zilxi in 2026.