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

Dhivy (carbidopa/levodopa 25 mg/100 mg, functionally scored tablets; Avion Pharmaceuticals) has emerged as a clinically useful formulation for Parkinson's disease patients who benefit from precise, incremental dose adjustment. FDA-approved in November 2021 and commercially available since February 2022, it is the only carbidopa/levodopa tablet with three functional score lines that allow reliable splitting into exact quarter-dose segments (6.25 mg carbidopa/25 mg levodopa per segment).

As prescribers managing Parkinson's disease patients, you may be fielding questions about Dhivy availability — and patients on the broader carbidopa/levodopa market may be encountering supply issues, particularly with extended-release formulations. This briefing provides a clear clinical picture of the 2026 supply situation and practical guidance for maintaining treatment continuity.

Current Supply Status: Dhivy and the Broader CD/LD Landscape

Dhivy (immediate-release 25/100 mg) is not currently listed on the FDA or ASHP drug shortage databases. Avion Pharmaceuticals continues to manufacture and distribute the product. However, patients may experience variable availability based on regional stocking patterns and individual pharmacy inventory decisions.

The broader carbidopa/levodopa market landscape in 2026 is as follows:

• IR tablets (10/100, 25/100, 25/250 mg): Relatively stable. Multiple generic manufacturers (Teva, Amneal, Sun Pharma, and others) active. Spot shortages at individual pharmacies but overall supply adequate. Dhivy falls in this category.
• ER/CR tablets: Active ASHP shortage as of early 2026. Accord Healthcare discontinued the 25/100 mg ER strength; only the 50/200 mg ER remains from Accord. Availability varies by NDC, manufacturer, and geographic region.
• ODT formulations: Effectively discontinued. Both Viatris (2021) and Sun Pharma (December 2022) exited this market. No active ODT manufacturers currently supplying U.S. market.
• Brand ER capsules (Rytary, Crexont): Available but requiring prior authorization. Crexont (FDA-approved 2024) is expanding market access; Rytary remains a mainstay for patients with motor fluctuations.

2026 FDA Safety Update: Vitamin B6 Deficiency Warning

In March 2026, the FDA issued a MedWatch safety communication and required updated labeling for all carbidopa/levodopa products — including Dhivy — regarding the risk of vitamin B6 (pyridoxine) deficiency. Long-term carbidopa/levodopa use can deplete B6 levels, and postmarketing reports have documented B6 deficiency-related seizures that were refractory to standard antiepileptic therapy and resolved only after B6 administration.

Clinical recommendations from the updated labeling include evaluating vitamin B6 levels prior to initiating carbidopa/levodopa therapy and monitoring for signs of B6 deficiency during treatment. Higher doses of carbidopa/levodopa increase the risk of B6 depletion. Advise patients to discuss B6 supplementation with you, particularly those on high doses or long-term therapy.

Clinical Implications of Dhivy's Unique Design

Dhivy's functional four-segment design enables titration in 6.25/25 mg carbidopa/levodopa increments — the smallest precisely deliverable oral dose currently on the U.S. market. Clinical situations where this may be particularly valuable:

• Early-stage PD: Patients who require the lowest effective levodopa dose to control mild symptoms while minimizing peak-dose dyskinesia risk.
• Motor fluctuations: "Brittle" patients navigating narrow therapeutic windows who benefit from smaller, more frequent doses (e.g., 6.25/25 mg every 1–2 hours) rather than larger, less frequent doses.
• Swallowing difficulties: The scoring also facilitates splitting for patients who have trouble swallowing full tablets — a not-uncommon challenge in PD given dysphagia.
• Initial titration: Patients starting carbidopa/levodopa for the first time who can benefit from slow, granular dose escalation to minimize early side effects like nausea.

Prescribing Guidance for Patients Who Can't Find Dhivy

If a patient reports that their pharmacy doesn't have Dhivy, consider these options:

1. Bridge with generic IR tablets. Generic carbidopa/levodopa 25/100 mg tablets contain the same active ingredients and can serve as a short-term bridge. Note that precise quarter-dose splitting (6.25/25 mg) is not reliably achievable with standard tablets. Counsel patients accordingly.
2. Direct patients to a specialty pharmacy. Specialty pharmacies, particularly those affiliated with academic neurology centers, may stock Dhivy more consistently and can manage mail-order supply.
3. Consider Rytary or Crexont if ER formulation is appropriate. For patients with motor fluctuations where ER dosing is clinically indicated, Rytary or Crexont may be appropriate. Both require prior authorization. Use the official conversion tables for dose calculation.
4. Authorize early refills when appropriate. If a patient is at risk of running out due to supply issues, early refill authorization can prevent dangerous treatment gaps.

Patient Safety: The Risks of Treatment Gaps

Carbidopa/levodopa supply disruptions represent a patient safety concern. Abrupt discontinuation of carbidopa/levodopa can precipitate a neuroleptic malignant syndrome (NMS)-like reaction — potentially life-threatening — characterized by high fever, severe muscle rigidity, autonomic instability, and altered consciousness. Even dose reductions can significantly impact quality of life, mobility, and fall risk.

Counsel patients to begin their refill search 10–14 days before their current supply runs out, and to contact your office immediately if they anticipate a treatment gap — not after they've run out.

Tools for Helping Your Patients Access Dhivy

• medfinder for Providers (medfinder.com/providers): Your patients can use medfinder to have pharmacies in their area contacted to check Dhivy availability, reducing the time burden of locating their medication.
• Avion Pharmaceuticals support line: 1-888-612-8466 — can direct patients to pharmacies and provide access to savings programs.
• ASHP Drug Shortage Resource Center: ashp.org/drug-shortages — tracks current shortage status for specific carbidopa/levodopa NDCs.
• Parkinson's Foundation Helpline: 1-800-4PD-INFO — can assist patients with medication access.
• NeedyMeds and RxAssist: Patient assistance program databases for uninsured or underinsured patients who cannot afford Dhivy's brand-name pricing.

Summary for Prescribers

Dhivy is not in official shortage, but pharmacy-level availability varies. The broader carbidopa/levodopa ER market remains in active shortage. Patients on long-term therapy need B6 monitoring per the new 2026 FDA labeling update. Proactive counseling about refill timing, use of pharmacy-finding tools, and bridge prescription planning can prevent dangerous treatment gaps for your Parkinson's patients. For practical workflow guidance, see our companion article on how to help your patients find Dhivy in stock.