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

Provider Briefing: Cyclopentolate Shortage in 2026

The Cyclopentolate Hydrochloride ophthalmic solution shortage has entered its third year, and the impact on clinical practice continues. For ophthalmologists, optometrists, and pediatric eye care specialists, the inconsistent availability of this essential cycloplegic agent creates real challenges for patient flow, exam accuracy, and operational planning.

This briefing covers the current state of the shortage, the clinical implications for your practice, alternative agents, and tools that can help you and your patients navigate the situation.

Shortage Timeline

The Cyclopentolate shortage has evolved through several phases:

• 2023: Akorn, Inc. — one of the largest U.S. generic ophthalmic drug manufacturers — filed for Chapter 11 bankruptcy and ultimately ceased operations. Akorn produced a substantial share of generic Cyclopentolate HCl ophthalmic solution. Their exit immediately reduced available supply.
• 2023-2024: Cyclopentolate was added to both the FDA Drug Shortages database and the ASHP Current Drug Shortages list. Bausch Health reduced output without providing a public explanation. Regional stock-outs became common.
• 2025: Alcon (Cyclogyl brand) and Sandoz maintained partial production, but overall supply remained below pre-2023 levels. The combination product Cyclomydril (Cyclopentolate 0.2%/Phenylephrine 1%) was also listed as in shortage.
• 2026 (current): The shortage persists. Both standalone Cyclopentolate HCl and Cyclomydril remain on shortage lists. Supply is inconsistent — some regions report adequate stock while others experience recurring outages.

Prescribing Implications

The shortage affects clinical practice in several key areas:

Cycloplegic Refraction Accuracy

Cyclopentolate 1% has long been the preferred agent for cycloplegic refraction, particularly in pediatric patients. Its balance of adequate cycloplegia, reasonable onset time (15-30 minutes), and manageable duration (~24 hours) made it the standard of care for most routine and pediatric refractions.

When substituting with Tropicamide, clinicians should be aware of its weaker cycloplegic effect. While recent studies — including a 2023 randomized clinical trial published in the American Journal of Ophthalmology — found Tropicamide to be a reliable substitute for non-strabismic children, it may under-correct hyperopia in patients with significant accommodative excess.

Pediatric Considerations

Pediatric ophthalmology practices are disproportionately affected by this shortage. Key considerations include:

• For suspected accommodative esotropia or high hyperopia, Cyclopentolate or Atropine remains preferred over Tropicamide.
• Atropine 1% provides complete cycloplegia but requires instillation 1-3 days before the exam, which adds logistical complexity.
• Infants require only 0.5% Cyclopentolate — ensure this specific concentration is available or consider Atropine if it is not.

Office Supply Management

Many practices have had to revise their supply chain strategies:

• Maintaining relationships with multiple distributors rather than relying on a single source
• Ordering ahead by 2-4 weeks instead of just-in-time purchasing
• Tracking lot numbers and expiration dates more carefully as stock may sit longer
• Considering compounding pharmacies for backup supply

Current Availability Picture

As of early 2026, the availability landscape is as follows:

• Alcon (Cyclogyl): Available in 0.5%, 1%, and 2% concentrations. Distribution has been maintained but may be allocated or limited in some regions.
• Sandoz: Generic Cyclopentolate HCl available. Intermittent stock at wholesalers.
• Bausch Health: Supply status unclear; the company has not provided detailed public updates on restoration timeline.
• Akorn: All presentations permanently discontinued.
• Compounding pharmacies: Some, such as Pine Pharmaceuticals, offer combination products (TPC Drops: Tropicamide/Phenylephrine/Cyclopentolate) as alternatives.

Cost and Access Considerations

For practices that bill Cyclopentolate as a pass-through or for patients filling retail prescriptions:

• Generic Cyclopentolate 1% (2 mL): Average retail ~$30; as low as $9-$12 with discount cards
• Brand Cyclogyl 1% (15 mL): $50-$75 retail without insurance
• Insurance: Generally covered; typically administered in-office and billed as part of the examination
• Patient savings: Direct patients to discount card platforms (GoodRx, SingleCare) if they need retail prescriptions

For practices purchasing in bulk, pricing may vary significantly based on distributor relationships and allocation status.

Tools and Resources for Your Practice

Several resources can help you manage through the shortage:

• Medfinder for Providers: Check real-time pharmacy availability for Cyclopentolate and its alternatives. Useful for directing patients to pharmacies with stock and for monitoring supply trends in your area.
• ASHP Drug Shortage Database: Track official shortage status and manufacturer updates at ashp.org.
• FDA Drug Shortages Page: Official federal database with manufacturer-reported information.
• Compounding pharmacy partnerships: Establish relationships with ophthalmic compounding pharmacies as a backup supply source.

Alternative Agents: Clinical Comparison

When Cyclopentolate is unavailable, the following agents can be considered:

• Tropicamide (0.5% or 1%): Onset 15-30 min, duration 4-8 hrs. Adequate for routine mydriasis and acceptable for cycloplegic refraction in many patients. Weaker cycloplegia than Cyclopentolate — may underestimate hyperopia by 0.25-0.50D in some pediatric populations.
• Atropine Sulfate (0.5% or 1%): Onset 30-60 min, duration 7-14 days. Gold standard for complete cycloplegia. Best for strabismus evaluations and suspected accommodative esotropia. Requires advance instillation (typically by parents at home 1-3 days prior).
• Homatropine (2% or 5%): Onset 30-60 min, duration 1-3 days. Intermediate option. Less commonly stocked but useful for uveitis management.
• Phenylephrine (2.5% or 10%): Mydriatic only — no cycloplegia. Use as an adjunct with Tropicamide for enhanced dilation. Avoid 10% concentration in patients with cardiovascular risk factors.

For more detail on alternatives, see our clinical guide: Alternatives to Cyclopentolate.

Looking Ahead

The ophthalmic drug supply chain remains fragile. With only a handful of manufacturers producing sterile ophthalmic solutions, any single-point disruption can have outsized effects. The FDA has signaled interest in improving the resilience of the generic sterile drug supply chain, but meaningful changes will take time.

In the interim, practices should:

• Diversify their supply sources
• Maintain protocols for alternative cycloplegic agents
• Educate staff on substitution guidelines
• Communicate proactively with patients about potential delays or alternative drops

Final Thoughts

The Cyclopentolate shortage is a supply-side problem, not a demand-side one. The medication remains essential for quality eye care, and the clinical alternatives — while adequate — are not always equivalent. Staying informed about the shortage status, maintaining flexible clinical protocols, and leveraging tools like Medfinder for Providers will help your practice continue delivering excellent patient care.

Related resources:

• How to help your patients find Cyclopentolate in stock
• How to help patients save money on Cyclopentolate
• Cyclopentolate drug interactions