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

Provider Briefing: Cyclopentolate Shortage Status in 2026

Cyclopentolate Hydrochloride ophthalmic solution — the cornerstone of cycloplegic refraction and a standard mydriatic for comprehensive eye exams — remains in shortage as of early 2026. This briefing provides an updated picture of the shortage for ophthalmologists, optometrists, and other prescribers, including the current supply landscape, prescribing implications, and clinical resources.

For patient-facing information on this shortage, see: Cyclopentolate Shortage Update: What Patients Need to Know in 2026.

Shortage Timeline

Understanding the full timeline provides context for the current supply picture:

• November 9, 2020: FDA first lists Cyclopentolate Ophthalmic Solution as in shortage. Multiple manufacturers report supply constraints linked to production issues and increased demand pressures.
• 2021: The shortage impacts pediatric ophthalmology practices disproportionately. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) raises concerns. Providers begin implementing conservation strategies.
• 2022: Supply fluctuates. Practices report intermittent availability. Some regions experience complete stock-outs while others maintain adequate supply.
• February 2023: Akorn Pharmaceuticals ceases all operations following Chapter 7 bankruptcy liquidation. Akorn was a significant supplier of generic Cyclopentolate (available in 0.5%, 1%, and 2% concentrations) and numerous other ophthalmic generics. The closure represented a critical inflection point in the shortage.
• 2023-2024: The post-Akorn supply gap places additional burden on Alcon (Cyclogyl brand, 0.5%, 1%, and 2%), Sandoz (generic 1%), and Bausch Health (generic 1%). Production increases are implemented but cannot fully compensate for the lost capacity.
• 2025-2026: Supply stabilizes somewhat as remaining manufacturers optimize production. The FDA continues to list the drug as in shortage. ASHP reports some products available while others remain on backorder. The Cyclopentolate/Phenylephrine combination (Cyclomydril) has also experienced concurrent shortage periods.

Prescribing Implications

The prolonged shortage has meaningful clinical implications for eye care providers:

Cycloplegic Refraction in Pediatric Patients

Cyclopentolate has long been the cycloplegic agent of choice recommended by both the American Optometric Association (AOA) and the American Academy of Ophthalmology (AAO) for pediatric refraction. The shortage has forced providers to re-evaluate protocols:

• Tropicamide 1% has emerged as a more viable cycloplegic than previously recognized. A 2023 randomized clinical trial published in the American Journal of Ophthalmology found that Tropicamide may be an acceptable substitute for Cyclopentolate in cycloplegic refraction for pediatric patients with brown irides, though clinical judgment remains essential.
• Atropine 1% provides superior cycloplegia but with a duration of 7-14 days, making it less practical for routine refraction. It remains the recommended alternative when maximum cycloplegia is essential (young children, heavily pigmented irides, suspected accommodative esotropia).
• Homatropine 2% or 5% offers intermediate cycloplegia (duration 1-3 days) but is less commonly stocked and has also experienced periodic supply constraints.

Concentration Availability

When your usual concentration is unavailable, consider:

• The 1% solution is the most commonly produced and may have better availability than 0.5% or 2%.
• Adjusting the number of drops or instillation protocol rather than the concentration may be clinically appropriate in some cases.
• The 2% solution, when available, can be used at reduced drop count in patients who typically receive the 1% solution.

In-Office Inventory Management

Practices should consider:

• Maintaining relationships with multiple suppliers and distributors
• Ordering in larger quantities when available (while being mindful of expiration dates)
• Tracking lot numbers and expiration dates carefully to minimize waste
• Establishing protocols for when to use alternatives and when to defer exams

Current Availability Picture

As of early 2026, the following manufacturers are actively supplying Cyclopentolate to the U.S. market:

• Alcon: Cyclogyl (brand) — 0.5%, 1%, 2% in 2 mL, 5 mL, and 15 mL bottles. Availability varies by concentration and size.
• Sandoz: Generic Cyclopentolate HCl — primarily 1% in 2 mL and 15 mL bottles. Has increased production capacity.
• Bausch Health: Generic Cyclopentolate HCl — 1% in 15 mL bottles. Intermittent availability.

The Cyclopentolate/Phenylephrine combination (Cyclomydril, Alcon) is available in 0.2%/1% in 2 mL and 5 mL bottles, though it has its own separate shortage listing.

Cost and Access Considerations

For patients who receive Cyclopentolate as a take-home prescription (less common) rather than in-office administration:

• Generic pricing: $12-$35 with discount cards (SingleCare, GoodRx); $25-$60 at retail
• Brand Cyclogyl: $100-$200+ at retail
• Insurance: Generally covered as a medical benefit when administered in-office. Take-home prescriptions may require pharmacy benefits, and coverage varies by plan.
• Compounding: Compounding pharmacies can prepare Cyclopentolate ophthalmic solutions when commercial products are unavailable, typically at $20-$50 depending on concentration and volume.

Direct patients who are struggling with cost to: How to Save Money on Cyclopentolate in 2026.

Tools and Resources for Providers

Several resources can help your practice navigate the ongoing shortage:

• Medfinder for Providers — Track real-time availability of Cyclopentolate and other shortage medications. Help your patients find pharmacies with stock.
• FDA Drug Shortage Database — Monitor official shortage status and manufacturer updates at accessdata.fda.gov.
• ASHP Drug Shortage Resource Center — Detailed shortage reports including affected NDCs, manufacturer status, and estimated resupply dates at ashp.org.
• AAPOS and AAO Clinical Guidelines — Updated recommendations on alternative cycloplegic protocols during shortage periods.

For clinical guidance on helping patients locate this medication, read: How to Help Your Patients Find Cyclopentolate in Stock: A Provider's Guide.

Looking Ahead

The Cyclopentolate shortage reflects broader vulnerabilities in the ophthalmic pharmaceutical supply chain. With a limited number of manufacturers, specialized production requirements, and low profit margins, ophthalmic generics remain at risk for supply disruptions.

Encouraging developments include:

• Sandoz's expanded production capacity
• Growing clinical evidence supporting Tropicamide as a cycloplegic alternative in appropriate patient populations
• Increased attention from professional organizations and advocacy for policies that address generic drug shortages

However, providers should plan for continued intermittent supply through at least the remainder of 2026. Maintaining flexible refraction protocols and building relationships with multiple suppliers remains the most effective strategy.

Final Thoughts

The Cyclopentolate shortage is now in its sixth year. While supply has improved from its nadir in 2023, the situation remains fluid. Providers who stay informed about the current landscape, maintain flexible clinical protocols, and leverage tools like Medfinder for Providers will be best positioned to continue delivering quality care to their patients despite these ongoing constraints.

For drug interaction considerations related to alternative agents, see: Cyclopentolate Drug Interactions: What to Avoid.