Dexamethasone/Tobramycin Shortage: What Providers and Prescribers Need to Know in 2026

Drug shortages continue to challenge clinical workflows across specialties, and ophthalmic medications are no exception. This briefing covers the current availability status of Dexamethasone/Tobramycin (TobraDex, TobraDex ST), prescribing considerations, therapeutic alternatives, and tools to help your patients access their medication.

Current Shortage Status

As of early 2026, Dexamethasone/Tobramycin ophthalmic is not listed on the FDA or ASHP drug shortage databases. Both generic Tobramycin/Dexamethasone suspension and brand-name TobraDex products are being manufactured and distributed through normal channels.

However, clinicians and patients continue to report intermittent pharmacy-level stock-outs. These are primarily driven by supply chain dynamics rather than a true manufacturing shortage — pharmacy inventory practices, limited generic manufacturers in the sterile ophthalmic space, and variable distributor allocation all contribute to localized unavailability.

Supply Chain Timeline

• 2020–2022: Broader pharmaceutical supply chain disruptions impacted many sterile products. Ophthalmic manufacturing faced particular challenges due to cleanroom requirements and quality control demands.
• 2023–2024: The overall active drug shortage count reached an all-time high of 323 in Q1 2024 per ASHP data. While Dexamethasone/Tobramycin was not directly affected, the broader shortage environment created supply chain strain across ophthalmic products.
• 2025–2026: Supply has stabilized for the ophthalmic Dexamethasone/Tobramycin combination. Generic availability remains good, though brand TobraDex ST inventory can be inconsistent at some retail pharmacies. Note that injectable Tobramycin has faced separate shortage issues that do not directly affect the ophthalmic product.

Prescribing Implications

When prescribing Dexamethasone/Tobramycin, consider the following strategies to minimize patient access issues:

1. Prescribe generically. Write for "Tobramycin/Dexamethasone 0.3%/0.1% ophthalmic suspension" rather than brand-name TobraDex. The generic is more widely stocked and significantly less expensive ($28–$55 with discount card vs. $200–$350 for brand).
2. Allow substitution. Ensure your prescription permits generic substitution to give pharmacists flexibility.
3. Consider the ointment. For appropriate clinical scenarios (e.g., nighttime use, patients who struggle with drops), the Dexamethasone/Tobramycin ointment may be more readily available than the suspension at certain pharmacies.
4. Have a backup plan. Discuss with the patient that if the combination product is unavailable, separate Tobramycin and Dexamethasone eye drops are both widely available and can be used concurrently with a 5–10 minute interval between instillation.

Availability Picture by Formulation

• Generic Tobramycin/Dexamethasone 0.3%/0.1% suspension: Most readily available. Multiple generic manufacturers. Most likely to be in stock or easily ordered.
• TobraDex (brand suspension): Available but not stocked at all retail pharmacies due to cost and lower demand.
• TobraDex ST (0.05%/0.3%): Less commonly stocked. No generic equivalent. Patients may need to special-order through their pharmacy.
• TobraDex ointment: Available but less commonly prescribed. Most pharmacies will need to order it.

Cost and Access Considerations

Cost is a significant driver of patient adherence with this medication. The price differential between generic and brand is substantial:

• Generic suspension: $28–$55 (with discount card)
• Brand TobraDex suspension: $200–$350 cash price
• TobraDex ointment: $290–$385 cash price

Most insurance formularies cover the generic as a preferred product (Tier 1–2). Brand TobraDex may require prior authorization or step therapy through generic. For uninsured patients, manufacturer programs through Novartis (copay.novartispharma.com) and Novartis Patient Assistance NOW (patientassistancenow.com) may provide access.

Tools and Resources for Your Practice

Several tools can streamline the process of helping patients find their medication:

• Medfinder for Providers — A free tool that helps locate pharmacies with specific medications in stock. You or your staff can search on behalf of patients before sending prescriptions.
• FDA Drug Shortage Database — Monitor for any formal shortage announcements at accessdata.fda.gov.
• ASHP Drug Shortage Resource Center — Provides clinical guidance and alternative recommendations during shortages.
• Discount card programs — Direct patients to GoodRx, SingleCare, or other programs that can reduce generic pricing to under $30.

Therapeutic Alternatives

If Dexamethasone/Tobramycin is unavailable, the following alternatives may be clinically appropriate depending on the indication:

• Zylet (Tobramycin 0.3%/Loteprednol 0.5%) — Same antibiotic, softer steroid. Lower risk of IOP elevation. Preferred for patients with glaucoma risk or longer treatment courses.
• Maxitrol (Neomycin/Polymyxin B/Dexamethasone) — Same steroid, broader antibiotic spectrum. Note the higher Neomycin allergy rate (~8–10% contact sensitization).
• Pred-G (Prednisolone/Gentamicin) — Alternative aminoglycoside-steroid combination. Different steroid (Prednisolone) and antibiotic (Gentamicin).
• Separate components — Prescribe Tobramycin 0.3% drops and Dexamethasone 0.1% drops individually. Both are widely available. Instruct patients to space instillation by 5–10 minutes.

Looking Ahead

The sterile ophthalmic product segment continues to face consolidation among generic manufacturers, which could impact future supply stability. While Dexamethasone/Tobramycin supply appears adequate for 2026, providers should stay alert to broader trends in ophthalmic drug manufacturing and maintain familiarity with therapeutic alternatives.

Final Thoughts

Dexamethasone/Tobramycin remains accessible in 2026, but proactive prescribing practices — writing for generic, allowing substitution, and having alternatives ready — can prevent treatment delays for your patients. Medfinder for Providers can help your practice verify pharmacy stock before sending prescriptions. For workflow integration tips, see our provider's guide to helping patients find Dexamethasone/Tobramycin in stock.