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

As a prescriber managing patients with glaucoma or ocular hypertension, you may have noticed an uptick in calls about brinzolamide (Azopt) availability. Patients are reporting difficulty finding their prescription at local pharmacies — and they're turning to their ophthalmologists and optometrists for guidance. This article gives you the clinical and logistical context you need to support your patients through these supply disruptions.

Current Supply Status (2026)

Brinzolamide ophthalmic suspension 1% is not currently listed on the FDA Drug Shortage Database as of 2026. However, localized and regional availability issues are being reported. Generic brinzolamide — which entered the market in 2021 — is produced by a limited number of manufacturers (Sandoz, Bausch & Lomb, Teva), and any disruption at one facility can create regional shortfalls. Brand-name Azopt (Alcon) remains available but may be cost-prohibitive for uninsured or underinsured patients without appropriate prior authorizations.

Why Ophthalmic Drugs Are Particularly Vulnerable to Supply Issues

Sterile ophthalmic suspensions face unique manufacturing challenges that make supply chains less resilient than oral solid dosage forms:

Cleanroom manufacturing. Sterile eye drops require ISO-classified cleanrooms and rigorous aseptic processing — facilities that are capital-intensive and cannot be quickly scaled or replaced.

Quality testing lead times. Each batch of sterile ophthalmics must pass sterility, particulate, and stability testing before release, adding significant time between production and distribution.

Regulatory sensitivity. FDA 483 observations or warning letters at a manufacturing site can trigger production holds that reduce available supply for months.

Clinical Considerations When Brinzolamide Is Unavailable

When patients cannot access brinzolamide, the clinical priority is maintaining IOP control. Here is a framework for managing this situation:

Substitution Within Class: Dorzolamide

Dorzolamide 2% ophthalmic solution (Trusopt generic) is the most clinically similar substitute. Both agents inhibit carbonic anhydrase II with comparable IOP-lowering efficacy (approximately 15-20% reduction or 4-5 mmHg in clinical studies). Key differences:

Dorzolamide causes more ocular stinging (12% vs. 3% for brinzolamide) due to its lower pH, but is less likely to cause blurred vision

Both are sulfonamides — contraindicated in patients with sulfonamide hypersensitivity

Both carry the same renal clearance caution (avoid in CrCl < 30 mL/min)

Generic dorzolamide is significantly less expensive ($15-$30 vs. $53-$90 for generic brinzolamide with coupons)

Fixed-Combination Options

If brinzolamide is being used as adjunctive therapy alongside another agent, transitioning to a fixed combination can simplify dosing while maintaining efficacy:

Cosopt (dorzolamide/timolol) or generic equivalent — BID dosing; appropriate for patients without beta-blocker contraindications

Simbrinza (brinzolamide/brimonidine) — TID dosing; beta-blocker-free option; may be available when standalone brinzolamide is not

Class Switch: Prostaglandin Analogs or Other Agents

For patients on brinzolamide monotherapy or when switching classes is clinically appropriate:

Prostaglandin analogs (latanoprost, bimatoprost, travoprost) — first-line for most patients; once-daily dosing; greater IOP reduction (25-32%) but different mechanism; inexpensive generics available

Beta-blockers (timolol) — cost-effective second-line; avoid in asthma, COPD, bradycardia

Alpha-2 agonists (brimonidine) — appropriate when beta-blockers are contraindicated; BID-TID dosing; risk of allergic conjunctivitis

Documentation and Practice Management Recommendations

Document patient-reported supply difficulties in the chart for continuity of care

Keep manufacturer samples of brinzolamide or dorzolamide on hand for bridge therapy

Preauthorize brand substitution in advance so refills can proceed without delay

Consider recommending mail-order pharmacies for patients on long-term brinzolamide therapy to reduce supply disruption risk

Schedule a follow-up IOP check within 4-6 weeks when a patient transitions to a new agent

How medfinder Can Support Your Patients

medfinder is a service that calls pharmacies on behalf of patients to locate which ones have a specific medication in stock. When patients cannot find brinzolamide, referring them to medfinder.com/providers can reduce the burden on your front desk staff and help patients resolve supply issues faster without multiple follow-up calls to your office.

Read our detailed provider guide: How to help your patients find brinzolamide in stock.