Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate Shortage Update: What Patients Need to Know in 2026

The Trace Elements Shortage: Where Things Stand in 2026

If you've been trying to fill a prescription for Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate — commonly known as Tralement — and struggling to find it, you're not imagining things. Trace element injections used in parenteral nutrition have faced recurring supply challenges for over a decade, and 2026 continues to present difficulties for patients who depend on these essential minerals.

Here's what you need to know about the current state of the shortage, what it means for your costs, and what options you have.

Is Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate Still in Shortage?

As of early 2026, trace element injections remain on the ASHP (American Society of Health-System Pharmacists) Drug Shortages List. The shortage is categorized as ongoing, though supply has improved compared to the worst periods of 2013–2015 when older Multitrace products began disappearing from the market.

The current situation is best described as intermittent supply constraints rather than a complete outage. American Regent, the sole FDA-approved manufacturer of Tralement and Multrys, has been producing and shipping product, but not always at levels sufficient to meet full demand. Some home infusion pharmacies report periodic allocation limits from their wholesalers.

Why Is It Still Hard to Find?

The root causes haven't changed much from previous years:

• Single-source manufacturing: American Regent remains the only company producing FDA-approved multi-trace element injections. There are no competing FDA-approved alternatives from other manufacturers.
• Rising demand: The home parenteral nutrition patient population continues to grow, driven by conditions like short bowel syndrome, intestinal failure, and complex GI disorders.
• Discontinued legacy products: Multitrace-4 and Multitrace-5, which were marketed without FDA approval for decades, have been fully discontinued. The market has not fully adjusted.
• Manufacturing complexity: Sterile injectable production requires rigorous quality controls. Any production issue can ripple through the supply chain for weeks.

For a deeper dive into these causes, see our article on why Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate is so hard to find.

What Does It Cost in 2026?

Pricing for Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate varies significantly depending on where and how you access it:

• Institutional pricing: Hospitals and home infusion pharmacies typically pay $5–$25 per single-dose vial through wholesale and GPO contracts.
• Cash pricing: If purchased outside of insurance or normal supply channels, prices can range from $10–$50 per vial or higher during tight supply.
• Insurance coverage: For most patients on home parenteral nutrition, trace elements are covered under the medical benefit (not the pharmacy benefit). Medicare Part B covers PN and its additives for patients with permanent intestinal failure. Private insurance coverage varies but typically requires prior authorization for home PN.

Since patients on TPN need this product daily, even small per-vial price increases add up over time. For tips on managing costs, check our guide to saving money on this medication.

Are There New Options in 2026?

While no new FDA-approved multi-trace element products have entered the market since Multrys, there are some developments worth noting:

• 503B compounding pharmacies continue to offer compounded trace element solutions as an alternative during shortages. These are produced under FDA oversight and can be a viable bridge when commercial products are unavailable.
• Individual trace element injections remain available from multiple manufacturers, giving pharmacists flexibility to prepare PN with separate zinc, copper, selenium, and manganese vials.
• Advocacy efforts by organizations like ASPEN (American Society for Parenteral and Enteral Nutrition) and the Oley Foundation continue to push for supply chain improvements and encourage other manufacturers to enter the market.

How to Find It in Stock Right Now

If you need Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate today, here are your best steps:

1. Use Medfinder to search for current availability across pharmacies and suppliers.
2. Contact your home infusion pharmacy and ask about their current supply status and expected restocking dates.
3. Ask about alternatives — individual trace elements or 503B compounded solutions can fill the gap.
4. Talk to your nutrition support team about monitoring your trace element blood levels more frequently during shortage periods.

For a full walkthrough, read our article on how to find this medication in stock near you.

Final Thoughts

The Copper Sulfate/Manganese Sulfate/Selenious Acid/Zinc Sulfate shortage in 2026 is real but manageable with the right approach. Stay in close communication with your care team, use availability tools like Medfinder, and know that alternatives exist. Your health depends on these trace minerals — don't wait until you're completely out to start looking for a resupply.