Atropine Shortage: A Provider Briefing for 2026

Atropine Sulfate — one of the most essential medications in emergency medicine, anesthesiology, and ophthalmology — continues to face supply constraints in 2026. This briefing provides healthcare providers and prescribers with the current state of the shortage, its clinical implications, and actionable strategies to ensure patient care is not compromised.

Shortage Timeline: How We Got Here

The Atropine shortage has been an evolving situation with roots going back more than a decade:

• 2012-2018: Intermittent shortages of Atropine Sulfate Injection reported to the FDA and ASHP, primarily related to manufacturing quality issues and production delays at sterile injectable facilities
• 2014: Alcon discontinued Isopto Atropine ophthalmic solution. Akorn received FDA approval for generic Atropine Sulfate 1% ophthalmic solution, partially filling the gap
• 2020-2022: COVID-19 disrupted pharmaceutical supply chains globally, affecting raw material sourcing and manufacturing timelines for many injectable products including Atropine
• 2023: Medefil launched FDA-approved prefilled Atropine Sulfate Injection syringes to address emergency syringe shortages, adding a new domestic supplier
• Mid-2025: Pfizer discontinued Atropine Abboject LifeShield prefilled syringes, removing a major supply source from the market
• 2026 (current): Atropine Sulfate Injection remains on FDA and ASHP shortage lists. Somerset/Civica prefilled syringes are on back order with resupply dates extending to late 2026-2028

Prescribing Implications

The shortage has different implications depending on clinical setting and indication:

Emergency and Critical Care

Atropine is the first-line treatment for symptomatic bradycardia per ACLS guidelines and remains essential for organophosphate/nerve agent poisoning. In the emergency department and ICU, there is no clinically equivalent substitute for many of Atropine's emergency indications.

Providers should:

• Verify institutional Atropine stock levels regularly
• Coordinate with pharmacy to establish allocation protocols
• Consider Glycopyrrolate as an adjunct for antisialagogue needs to conserve Atropine for cardiac and toxicologic emergencies
• Ensure crash carts and code carts are checked for Atropine availability and expiration

Anesthesiology and Perioperative Care

Atropine is commonly used as a premedication to reduce secretions and as a vagolytic agent. In this setting, Glycopyrrolate (Robinul) is a well-established alternative:

• Five times more potent as an antisialagogue
• Does not cross the blood-brain barrier — fewer CNS effects
• Less likely to produce tachycardia
• Available in injectable and oral forms

Switching to Glycopyrrolate for routine perioperative antisialagogue use can help preserve Atropine supply for emergency indications.

Ophthalmology

Atropine 1% remains the gold standard for cycloplegia and is the preferred agent for amblyopia treatment in children. For routine cycloplegic refraction, Cyclopentolate is an acceptable alternative with a shorter duration of action (4-24 hours vs. 1-2 weeks).

For myopia control, low-dose Atropine (0.01%-0.05%) is increasingly prescribed. These concentrations are typically compounded and are not directly affected by the manufactured product shortage, though active ingredient availability may occasionally be constrained. Specialty compounding pharmacies such as Imprimis Pharmaceuticals can be valuable resources.

Palliative Care

Atropine sublingual drops are sometimes used for death rattle in end-of-life care. Alternatives include Glycopyrrolate (0.2 mg IV/SC) and Scopolamine (transdermal patch or 0.4 mg IV/SC), both of which have demonstrated comparable efficacy in clinical studies.

Current Availability Picture

As of early 2026:

• Available: Fresenius Kabi (injection vials), Hikma (injection vials), Medefil (prefilled syringes)
• Discontinued: Pfizer Abboject LifeShield syringes
• Back ordered: Somerset/Civica prefilled syringes (estimated resupply: late 2026-2028)
• Ophthalmic: Generic Atropine Sulfate 1% ophthalmic solution from multiple generic manufacturers — generally available but may experience intermittent spot shortages

Providers can check real-time pharmacy-level availability using Medfinder for Providers.

Cost and Access Considerations

For patients filling Atropine prescriptions at retail pharmacies:

• Atropine ophthalmic solution 1% (5 mL): $54 retail, $21+ with coupon
• Atropine Sulfate injection vials: $37-$318+ depending on concentration and volume
• AtroPen auto-injectors: $300-$800+ per unit
• Compounded low-dose ophthalmic drops: $30-$75 per bottle

Atropine is a generic medication and is generally covered by insurance without prior authorization for standard formulations. AtroPen may require prior authorization due to its high cost. Patients without insurance can benefit from coupon programs through GoodRx and SingleCare, which can reduce costs by up to 60-80%.

For additional cost-saving strategies, direct patients to our patient savings guide for Atropine.

Tools and Resources for Providers

• Medfinder for Providers: Real-time pharmacy availability tracking to help patients locate Atropine in stock
• ASHP Drug Shortage Resource Center: Updated shortage details and therapeutic alternatives
• FDA Drug Shortage Database: Official shortage status and manufacturer information
• Compounding pharmacies: For low-dose ophthalmic Atropine and other custom formulations

For a step-by-step workflow on helping patients access Atropine during the shortage, see our provider's guide to finding Atropine for patients.

Looking Ahead

The Atropine shortage is unlikely to resolve completely in the near term. With only a small number of domestic manufacturers and ongoing supply chain fragility for sterile injectables, intermittent shortages may persist through 2026 and beyond.

However, several factors point toward gradual improvement:

• Medefil's continued expansion of prefilled syringe production
• Potential new entrants into the generic injectable market
• FDA initiatives to address drug shortage root causes through manufacturing quality improvements
• Growing compounding pharmacy infrastructure for ophthalmic formulations

Providers should stay informed about supply changes and maintain flexible prescribing strategies to adapt to availability fluctuations.

Final Thoughts

Atropine remains an irreplaceable medication for several critical indications. The ongoing shortage requires providers to stay proactive: conserve supply for the highest-priority uses, leverage alternatives where appropriate, and use tools like Medfinder to help patients navigate availability challenges.

For related clinical resources, see our guides on Atropine drug interactions, Atropine side effects, and helping patients save on Atropine.