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

Provider Briefing: Cyclosporine Supply in 2026

Cyclosporine remains a critical medication across transplant medicine, rheumatology, dermatology, nephrology, and ophthalmology. Over the past two years, supply disruptions — including a permanent manufacturer discontinuation and product recalls — have created challenges for prescribers and patients alike. This briefing provides the current state of Cyclosporine availability, prescribing implications, and tools to support patient access.

Shortage Timeline

Key events affecting Cyclosporine supply:

• January 2024: The manufacturer of Cyclosporine Injection (50 mg/mL) permanently discontinued the product, as reported to the FDA. This eliminated the only commercially available IV Cyclosporine formulation in the U.S.
• 2024: Novartis issued a voluntary U.S. nationwide recall of two lots of Sandimmune oral solution (100 mg/mL) due to crystallization. Affected lots: FX001500 and FX001582 (both with 09/2024 expiration). No adverse events were reported, but the recall reduced oral solution inventory at pharmacies nationwide.
• 2024-2025: Intermittent supply disruptions reported for certain generic Cyclosporine modified capsule manufacturers, likely related to raw material sourcing and GMP compliance challenges.
• 2026: Oral modified capsules (Neoral, Gengraf, generics) are generally available. Sandimmune oral solution supply has stabilized. The injectable formulation remains permanently discontinued.

Prescribing Implications

IV-to-Oral Conversion

With the discontinuation of Cyclosporine Injection, providers in transplant and acute care settings must plan for oral-only administration. For patients who cannot tolerate oral medication, consider:

• Nasogastric (NG) tube administration of oral solution or opened capsule contents (per institutional protocols)
• Conversion to alternative IV immunosuppressants (e.g., Tacrolimus injection, which remains available)
• Consultation with clinical pharmacy for equivalent dosing — IV Cyclosporine had approximately 3:1 oral-to-IV dose conversion ratio

Formulation Non-Interchangeability

A recurring issue in the context of shortages: Cyclosporine modified (Neoral, Gengraf) and non-modified (Sandimmune) formulations are NOT bioequivalent and must not be interchanged without careful dose adjustment and monitoring. Modified formulations have more predictable and higher bioavailability. Switching formulation types requires re-establishing trough levels.

Narrow Therapeutic Index Considerations

Cyclosporine is classified as a narrow therapeutic index (NTI) drug. When switching between generic manufacturers within the modified formulation category, trough level monitoring is advisable — even though FDA-approved generics are bioequivalent by regulatory standards. In practice, transplant patients may experience clinically meaningful variability. For detailed pharmacology, providers can review our article on how Cyclosporine works.

Current Availability Picture

FormulationStatus (March 2026)NotesModified oral capsules (Neoral, Gengraf, generics)Generally availableIntermittent shortages with some generic manufacturers; check multiple sourcesNon-modified oral capsules (Sandimmune)Available but limitedFewer prescribers use this formulation; narrower distributionOral solution 100 mg/mLAvailablePost-recall supply has stabilized; verify lot numbersInjection 50 mg/mLPermanently discontinuedNo commercial manufacturer; consider compounding or alternative agentsOphthalmic (Restasis, Cequa, Vevye)AvailableNo current shortage; multiple formulations and manufacturers

Cost and Access Considerations

Cost remains a significant access barrier for some patients:

• Generic modified capsules (100 mg, 30 ct): Retail cash price ~$243; $43-$80 with discount cards (GoodRx, SingleCare)
• Brand Neoral (100 mg, 30 ct): ~$390 cash price
• Novartis $0 Co-Pay Card: Available for commercially insured patients via saveonmyprescription.com — covers Neoral and Sandimmune
• Patient Assistance: Novartis Patient Assistance Foundation (pap.novartis.com) provides free medication to eligible uninsured/underinsured patients
• Insurance: Generic oral Cyclosporine is typically covered on Tier 2/3 formularies. Brand may require prior authorization.

Direct patients with cost concerns to our guide on saving money on Cyclosporine, or review our provider-specific resource on helping patients save on Cyclosporine.

Tools and Resources for Providers

Medfinder for Providers

Medfinder offers real-time pharmacy inventory search that can be used by clinical staff to quickly identify pharmacies with Cyclosporine in stock near a patient's location. This is particularly useful for:

• Discharge planning for transplant patients
• Directing patients to pharmacies with confirmed stock
• Identifying alternative pickup locations when a patient's usual pharmacy is out

Alternative Agents

When Cyclosporine is unavailable, consider these alternatives based on indication:

• Transplant: Tacrolimus (Prograf) — the most direct substitute; well-established conversion protocols exist
• Rheumatoid arthritis: Methotrexate (first-line), biologics (Adalimumab, Etanercept), or Tofacitinib
• Psoriasis: Methotrexate, Apremilast (Otezla), or biologics (Secukinumab, Guselkumab)
• Nephrotic syndrome: Tacrolimus, Rituximab (off-label for refractory cases)
• GVHD: Tacrolimus, Sirolimus, Ruxolitinib (Jakafi)

For a patient-facing overview of alternatives, see our article on alternatives to Cyclosporine.

Looking Ahead

The Cyclosporine supply situation has improved relative to the acute disruptions of 2024, but structural vulnerabilities remain:

• The injectable form has no replacement on the horizon from major manufacturers
• Generic competition for oral Cyclosporine is limited by NTI classification complexity
• Global supply chain pressures continue to affect immunosuppressant production

Proactive prescribing strategies — including early refill protocols, establishing relationships with specialty pharmacies, and having documented alternative regimens for each patient — remain the best defense against supply disruptions.

Final Thoughts

Cyclosporine supply challenges require prescriber awareness and proactive patient management. Ensure your transplant, autoimmune, and dermatology patients know about real-time stock checking tools like Medfinder, and maintain documented backup plans for each Cyclosporine-dependent patient. For additional provider resources, see our guide on how to help patients find Cyclosporine in stock.