What Is Carac?

Carac is a prescription topical cream containing 0.5% Fluorouracil, used to treat actinic keratoses (AKs) — rough, scaly patches of skin caused by years of sun exposure. Actinic keratoses are considered precancerous because they can develop into squamous cell skin cancer if left untreated.

Carac belongs to a class of drugs called topical antineoplastics (specifically, pyrimidine analogs). It works by stopping the growth of abnormal skin cells. You can learn more about the science behind it in our guide on how Carac works.

Brand Name vs. Generic

Fluorouracil is the generic (active ingredient) name. It's available under several brand names:

• Carac — 0.5% cream (30g tube), made by Bausch Health
• Efudex — 5% cream (25g, 40g) and 2%/5% solution
• Tolak — 4% cream (40g tube)
• Fluoroplex — 1% cream (discontinued)

Carac is unique because it has the lowest concentration of Fluorouracil (0.5%) among available formulations, applied just once daily. This can mean fewer side effects compared to higher-concentration products, though some skin irritation is still expected.

What Is Carac Used For?

Carac is FDA-approved to treat actinic keratoses on the face, including the forehead, temples, cheeks, and nose. Actinic keratoses typically appear as:

• Rough, dry, or scaly patches of skin
• Flat to slightly raised bumps on the skin's surface
• Pink, red, or brown colored patches
• Patches that may itch, burn, or feel tender

These patches are most common on areas that get the most sun exposure: the face, scalp, ears, forearms, and backs of the hands. They're especially common in people over 40 who have fair skin and a history of significant sun exposure.

Off-Label Uses

While Carac is specifically approved for actinic keratoses, Fluorouracil in other formulations is sometimes used off-label for:

• Common warts
• Bowen's disease (squamous cell carcinoma in situ)
• Actinic cheilitis (precancerous changes on the lips)
• Superficial basal cell carcinoma (Efudex 5% only)

How to Use Carac

Using Carac correctly is important for getting the best results while minimizing side effects. Here's how to apply it:

1. Wash your hands and clean the affected area with a gentle cleanser. Pat dry.
2. Apply a thin layer of Carac cream to the affected areas using your fingertip.
3. Avoid the eyes, nose, and mouth. If the cream accidentally gets in your eyes, flush with water immediately.
4. Do not cover the treated area with bandages or occlusive dressings unless your doctor specifically tells you to.
5. Wash your hands thoroughly after applying.

Dosage

• Carac 0.5% cream: Apply once daily to affected areas for up to 4 weeks.
• Your doctor will tell you exactly how long to use it based on your specific condition.
• Do not use more than directed — applying extra cream won't speed up results but will increase side effects.

Sun Protection

Fluorouracil makes your skin more sensitive to sunlight. While using Carac:

• Apply broad-spectrum sunscreen (SPF 30+) daily
• Wear protective clothing and a hat
• Avoid prolonged sun exposure and tanning beds

Who Should Not Use Carac?

Carac is not safe for everyone. Do not use Carac if you:

• Are pregnant or may become pregnant — Carac is Pregnancy Category X. Fluorouracil can cause miscarriage or serious birth defects.
• Are breastfeeding — Use is not recommended during breastfeeding.
• Have a known allergy to Fluorouracil or any ingredient in Carac.
• Have DPD deficiency — Dihydropyrimidine dehydrogenase (DPD) deficiency can cause dangerous toxicity with Fluorouracil, though this is primarily a concern with systemic (injectable) use.

Be sure to tell your doctor about all medications you're taking, including over-the-counter drugs and supplements. Check our guide on Carac drug interactions for more details.

How Much Does Carac Cost?

Carac is one of the more expensive topical medications:

• Carac 0.5% cream (30g): $800–$1,500+ without insurance
• Generic Fluorouracil 5% (40g): $30–$150 without insurance
• Efudex 5% (40g): $600–$1,200
• Tolak 4% (40g): $700–$1,400

Insurance Coverage

Generic Fluorouracil 5% is widely covered by most insurance plans with low copays ($10–$50). Brand-name Carac often requires prior authorization, and some insurers may require you to try the generic 5% version first (step therapy).

Ways to Save

There are several ways to reduce your out-of-pocket cost for Carac:

• Bausch Health patient savings card — Eligible patients may pay as little as $0–$25 copay.
• Discount cards — GoodRx, SingleCare, and RxSaver offer coupons for generic Fluorouracil.
• Patient assistance programs — Bausch Health offers a patient assistance program for uninsured or underinsured patients.

For a complete breakdown of savings options, see our guide on how to save money on Carac.

Final Thoughts

Carac is an effective topical treatment for actinic keratoses that offers the convenience of once-daily application at a lower Fluorouracil concentration. While it can cause skin irritation during treatment, this is typically a sign the medication is working.

The biggest challenges with Carac are its high cost and limited availability. If you have a prescription and need help finding it, use Medfinder to check pharmacy availability near you. And if you need to find a doctor who can prescribe Carac, start with a dermatologist in your area.