Betaxolol shortage: What providers and prescribers need to know in 2026

Betaxolol Shortage: What Providers and Prescribers Need to Know in 2026

The ongoing Betaxolol shortage is creating challenges for providers across multiple specialties. Patients are presenting with unfilled prescriptions, and the timeline for full supply restoration remains uncertain. This guide provides a clinical overview of the current situation and evidence-based guidance for managing affected patients.

Current Shortage Overview

Affected Formulations

ProductStatusDetailsKerlone (brand oral tablets)Permanently discontinuedDiscontinued in U.S. market; no plans for returnBetaxolol generic tablets (10 mg, 20 mg)Limited supplyEpic Pharma discontinued production; few manufacturers remainBetoptic S (0.25% ophthalmic suspension)Permanently discontinuedNovartis discontinued globally in 2024Betaxolol 0.5% ophthalmic solution (generic)Limited supplyAvailable from select manufacturers; intermittent shortages

Root Causes

The Betaxolol shortage reflects a broader pattern affecting older, low-volume generic medications. Key contributing factors include:

• Sequential manufacturer exits reducing the supplier base
• Low market volume making production economically unattractive
• Limited active pharmaceutical ingredient (API) suppliers
• No new ANDA filings incentivized by current market conditions

Clinical Considerations for Patient Transitions

Oral Betaxolol (Hypertension)

Betaxolol is a selective beta-1 adrenergic blocker with high lipophilicity and a long half-life (~14-22 hours), allowing once-daily dosing. When transitioning patients to alternatives, consider the following:

Recommended Alternatives

• Bisoprolol (Zebeta): Most pharmacologically similar. High beta-1 selectivity, once-daily dosing, well-established in hypertension and heart failure (CIBIS-II). Generic widely available. Typical dose: 2.5-10 mg once daily.
• Metoprolol succinate (Toprol XL): Extended-release formulation allows once-daily dosing. Most widely prescribed selective beta-blocker. Typical dose: 25-200 mg once daily.
• Atenolol (Tenormin): Selective beta-1 blocker, once-daily dosing, hydrophilic (fewer CNS effects). Extremely affordable. Typical dose: 25-100 mg once daily.
• Nebivolol (Bystolic): Third-generation beta-blocker with vasodilatory properties. Consider for patients with fatigue or erectile dysfunction on other beta-blockers. Brand only; higher cost.

Dose Conversion Guidance

There are no universally accepted dose-equivalence tables for beta-blockers. However, the following approximate conversions from Betaxolol 20 mg daily can guide clinical decision-making:

• Bisoprolol: 5-10 mg daily
• Metoprolol succinate: 50-100 mg daily
• Atenolol: 50-100 mg daily

Critical reminder: Betaxolol should be tapered over 1-2 weeks before discontinuation. Abrupt withdrawal may precipitate rebound tachycardia, hypertensive crisis, or myocardial ischemia—particularly in patients with underlying coronary artery disease.

Ophthalmic Betaxolol (Glaucoma / Ocular Hypertension)

Betaxolol's beta-1 selectivity gave it a distinct clinical niche: patients with concurrent reactive airway disease (asthma, COPD) who needed a topical beta-blocker for intraocular pressure (IOP) reduction. The loss of this option requires careful alternative selection.

Recommended Ophthalmic Alternatives

• Timolol (Timoptic, Timoptic-XE): Most commonly used ophthalmic beta-blocker. Non-selective; use with caution in patients with bronchospastic disease. Gel-forming solution allows once-daily dosing.
• Latanoprost (Xalatan) / Travoprost / Bimatoprost: Prostaglandin analogs are first-line for most glaucoma patients. Once-daily dosing at bedtime. Safe for patients with respiratory disease. Generic latanoprost is affordable.
• Brimonidine (Alphagan P): Alpha-2 agonist. No beta-blocker-related cardiovascular or respiratory effects. Useful for patients who cannot tolerate beta-blockers.
• Dorzolamide/Timolol (Cosopt): Fixed-dose combination for patients needing additional IOP reduction.

For patients previously on Betaxolol due to respiratory concerns: Avoid switching to Timolol. Prostaglandin analogs (Latanoprost) or Brimonidine are preferred alternatives that avoid bronchospastic risk.

Patient Communication

Patients affected by the Betaxolol shortage may experience anxiety about medication changes. Consider these communication strategies:

• Proactively reach out to patients on Betaxolol before they run out
• Explain that effective alternatives are available and widely used
• Provide written instructions for the taper schedule and new medication start
• Schedule follow-up to assess response to the new medication

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Tools for Your Practice

MedFinder for Providers can help you and your staff quickly identify pharmacies with Betaxolol in stock, reducing patient callbacks and phone tag. You can also direct patients to MedFinder to search on their own.

For more on helping patients navigate availability issues, see our guide on how to help your patients find Betaxolol in stock.

Reporting and Monitoring

• Report shortages to the FDA Drug Shortage Program
• Monitor the ASHP drug shortage resource for updates
• Consider flagging Betaxolol patients in your EHR for proactive outreach

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Summary

The Betaxolol shortage requires proactive patient management. For oral use, Bisoprolol and Metoprolol succinate are the strongest alternatives. For ophthalmic use, the choice depends on the patient's respiratory status—Timolol for those without airway disease, and prostaglandin analogs or Brimonidine for those with asthma or COPD. Early communication and scheduled transitions will minimize treatment gaps and patient anxiety.