Daptomycin Shortage: A Provider Briefing for 2026

Daptomycin — marketed as Cubicin and Cubicin RF by Merck, with multiple generic versions available — remains one of the most important antibiotics in the infectious disease arsenal. Its unique mechanism of action against gram-positive organisms, including MRSA and VRE, makes it an essential option when Vancomycin is ineffective, poorly tolerated, or contraindicated.

However, supply disruptions have affected Daptomycin availability intermittently over the past several years. This briefing provides prescribers and clinical pharmacists with an up-to-date overview of the shortage landscape, prescribing considerations, alternative strategies, and tools to help your patients access this medication in 2026.

Shortage Timeline and Current Status

Daptomycin has appeared on the ASHP and FDA drug shortage databases periodically, with supply disruptions tied to specific manufacturers rather than a market-wide collapse. Key timeline points:

• 2018-2020: Brand-name Cubicin patent expiration led to entry of generic competitors. Initial generic supply was limited, contributing to periodic shortages.
• 2021-2023: Supply chain disruptions during and after the COVID-19 pandemic affected multiple injectable antibiotic manufacturers, including some Daptomycin producers.
• 2024: The all-time high of 323 active drug shortages (Q1 2024 per ASHP) included several injectable antibiotics. Daptomycin was intermittently affected.
• 2025-2026: Supply has stabilized somewhat with additional generic manufacturers entering the market and the expansion of premixed IV formulations. However, intermittent backorders continue to affect specific NDCs and manufacturers.

As of early 2026, the shortage is best characterized as regional and formulation-specific rather than a complete market disruption. Some pharmacies report adequate stock while others experience delays, particularly for lyophilized powder vials from certain manufacturers.

Prescribing Implications

The intermittent nature of Daptomycin supply disruptions has several implications for clinical practice:

Outpatient Parenteral Antibiotic Therapy (OPAT)

Daptomycin is a preferred OPAT agent due to its once-daily dosing and generally favorable safety profile compared to Vancomycin (which requires therapeutic drug monitoring). When Daptomycin is unavailable for OPAT, the impact on discharge planning can be significant:

• Patients may face extended hospital stays awaiting medication availability
• Home infusion pharmacies may need to source from alternative distributors
• Switching to Vancomycin for OPAT adds monitoring burden (trough levels, renal function) and twice-daily dosing

Culture-Directed Therapy

When Daptomycin is the optimal agent based on culture and sensitivity data — particularly for VRE bacteremia where options are severely limited — supply disruptions create genuine clinical dilemmas. In these cases:

• Contact your institution's antimicrobial stewardship team early
• Work with pharmacy to explore all available formulations (vials and premixed bags)
• Consider Linezolid as an alternative for VRE, recognizing the different side effect profile (myelosuppression, serotonin syndrome risk)

Dose Optimization

Standard dosing is 4 mg/kg IV once daily for cSSSI and 6 mg/kg IV once daily for bacteremia/endocarditis. Off-label higher doses (8-12 mg/kg) used in complex infections consume more drug per patient. During supply constraints, antimicrobial stewardship programs should review whether dose optimization or de-escalation is appropriate for individual patients.

Availability Picture: Brand vs. Generic vs. Premixed

Understanding the available product landscape helps in sourcing:

• Cubicin RF (brand): Merck's ready-to-use formulation. Generally more consistently available but at premium pricing.
• Generic lyophilized powder (350 mg, 500 mg vials): Multiple manufacturers. Availability varies by manufacturer — some NDCs may be on backorder while others are stocked.
• Generic premixed IV solutions (350 mg/50 mL, 500 mg/50 mL, 700 mg/100 mL in 0.9% NaCl): Expanding availability. These may offer an alternative pathway when vials are scarce.

When ordering through your pharmacy, specify that you're flexible on manufacturer and formulation type to maximize the chance of successful procurement.

Cost and Access Considerations

Cost remains a relevant factor, particularly for patients transitioning to outpatient therapy:

• Generic Daptomycin 500 mg vial: AWP approximately $29-$50
• Brand Cubicin RF: Significantly higher, often several hundred dollars per vial
• Full treatment course: $400-$2,000+ for generic; substantially more for brand

For uninsured or underinsured patients, the Merck Patient Assistance Program (merckhelps.com) may provide brand Cubicin at no cost. Prescription Hope offers Cubicin access for approximately $70/month for qualifying patients.

Most insurance plans cover Daptomycin as a specialty medication, though prior authorization is common. Medicare Part B covers it when administered in outpatient settings.

Tools and Resources for Providers

Several resources can help you and your patients navigate Daptomycin availability:

• Medfinder for Providers — Search for Daptomycin availability across pharmacies, including specialty and home infusion services
• ASHP Drug Shortages Database — Real-time shortage tracking and estimated resolution dates
• FDA Drug Shortage Database — Official shortage notifications and manufacturer updates
• Your institution's antimicrobial stewardship program — Can help coordinate sourcing and recommend alternatives

For a patient-facing resource you can share, see our Daptomycin shortage update for patients and our guide on finding Daptomycin in stock.

Alternative Agents: A Quick Reference

When Daptomycin is unavailable, consider these alternatives based on infection type:

• MRSA bacteremia/endocarditis: Vancomycin (first-line alternative); consider Dalbavancin for selected cases
• VRE bacteremia: Linezolid (most common alternative); Tigecycline in select cases
• Complicated skin infections: Vancomycin, Linezolid, Oritavancin (single-dose option), Telavancin
• Bone and joint infections: Vancomycin, Linezolid (with monitoring for prolonged courses)

For detailed alternative comparisons, see our clinical guide on alternatives to Daptomycin.

Looking Ahead

The long-term outlook for Daptomycin supply is cautiously optimistic. Additional generic manufacturers continue to enter the market, and premixed formulations offer supply chain redundancy. However, the broader trend of injectable antibiotic shortages — driven by low profit margins, manufacturing complexity, and consolidation of sterile injectable production — means intermittent disruptions should be anticipated as part of clinical planning.

Antimicrobial stewardship programs should maintain updated shortage protocols that include:

• Pre-approved alternative algorithms for common Daptomycin indications
• Automatic pharmacy alerts when supply falls below threshold levels
• Patient communication templates for treatment changes due to shortages

Final Thoughts

Daptomycin supply disruptions require proactive management at both the institutional and individual patient level. By staying informed through ASHP and FDA databases, leveraging tools like Medfinder for Providers, and maintaining familiarity with alternative agents, prescribers can minimize the clinical impact of these shortages on their patients.

For additional provider resources, see our guide on how to help your patients find Daptomycin in stock and our provider guide to saving patients money on Daptomycin.