Diazepam Shortage: A Provider Briefing for 2026

The Diazepam supply situation continues to affect clinical practice in 2026. Whether you prescribe Diazepam for anxiety disorders, muscle spasticity, seizure management, or alcohol withdrawal protocols, the ongoing shortage of certain formulations requires awareness and proactive management.

This article provides a clinical overview of the current Diazepam shortage, its implications for prescribing, available alternatives, and tools that can help you and your patients navigate availability challenges.

Shortage Timeline

The Diazepam shortage has evolved over several years:

• 2020: Diazepam injection first appeared on the ASHP drug shortage list. Manufacturing disruptions at key facilities, including Pfizer's injectable line, reduced available supply of the 5 mg/mL formulation.
• Late 2021: Diazepam oral solution (5 mg/5 mL) was placed on allocation by its primary manufacturer, further limiting availability for patients who require liquid formulations (pediatric patients, dysphagia, titration).
• 2022–2024: Intermittent improvements in injectable supply, but sustained allocation on oral solution. Oral tablets remained generally available from multiple generic manufacturers including Teva, Mylan, and others.
• 2025: Oral solution remained on allocation. Injectable shortages persisted with Fresenius Kabi and Pfizer as the primary suppliers experiencing production constraints.
• Early 2026 (current): Fresenius Kabi has Diazepam 5 mg/mL 2 mL syringes on back order with estimated release mid-February 2026. Pfizer has Carpuject syringes in limited supply with weekly releases. Oral solution remains on allocation. Oral tablets are available from generic manufacturers.

Prescribing Implications

The shortage primarily affects injectable and liquid formulations, which has distinct implications depending on your clinical setting:

Emergency and Inpatient Settings

The injectable Diazepam shortage directly impacts protocols for status epilepticus and acute alcohol withdrawal in emergency departments and inpatient units. Key considerations:

• Status epilepticus: IV Lorazepam (Ativan) has become the more common first-line agent in many protocols and may be more readily available than IV Diazepam. If your institution's protocol specifies Diazepam, coordinate with pharmacy to confirm stock or update protocols as appropriate.
• Alcohol withdrawal: Oral Diazepam tablets can substitute for injectable forms in patients who can take oral medications. For patients who cannot take oral medications, IV Lorazepam or IV Phenobarbital may serve as alternatives. Chlordiazepoxide (Librium) remains a widely used oral option for alcohol withdrawal protocols.
• Procedural sedation: Midazolam (Versed) is a common alternative when Diazepam injection is unavailable.

Outpatient Settings

For outpatient prescribers (psychiatry, neurology, primary care), the shortage is less acute since oral tablets remain available. However:

• Patients requiring oral solution (e.g., pediatric patients, patients with swallowing difficulties) may face difficulty filling prescriptions. Consider whether tablets can be crushed or whether an alternative formulation is appropriate.
• Some pharmacies may have limited stock of specific tablet strengths. Advise patients to fill prescriptions promptly and to use tools like Medfinder for Providers to check availability before patients leave the office.
• For seizure rescue therapy, Valtoco (Diazepam nasal spray) offers a non-rectal alternative to Diastat that patients and caregivers generally prefer. Available in 5 mg, 7.5 mg, and 10 mg doses.

Current Availability Picture

A summary of formulation-specific availability as of February 2026:

• Oral tablets (2 mg, 5 mg, 10 mg): Available. Multiple generic manufacturers. Patients may occasionally encounter stock-outs at individual pharmacies but can generally find supply at nearby locations.
• Oral solution (5 mg/5 mL) and concentrate (5 mg/mL): On allocation. Limited and inconsistent availability at retail pharmacies.
• Injectable (5 mg/mL): Shortage. Fresenius Kabi back-ordered; Pfizer in limited supply. Hospital pharmacies should coordinate directly with wholesalers.
• Rectal gel (Diastat): Available but may require specialty pharmacy sourcing.
• Nasal spray (Valtoco): Available. Often requires prior authorization for insurance coverage. Neurelis offers copay assistance.

Cost and Access Considerations

Cost varies significantly by formulation:

• Generic oral tablets: $5 to $25 for a 30-day supply (cash price with discount coupons). Covered by most insurance plans on Tier 1 or Tier 2.
• Oral solution: When available, approximately $20 to $60 depending on supply conditions.
• Diastat (rectal gel): $300 to $700+ cash price. Insurance coverage varies; prior authorization commonly required.
• Valtoco (nasal spray): $600 to $900+ cash price. Neurelis offers a copay savings program reducing cost to as low as $0 for commercially insured patients. Patient assistance available for uninsured/underinsured patients through the myNEURELIS program.

For patients struggling with cost, pharmacist-mediated discount programs (GoodRx, SingleCare) can significantly reduce out-of-pocket costs for generic tablets. Patients may also benefit from our patient-facing savings guide which covers coupon programs and patient assistance.

Tools and Resources for Providers

Several tools can help streamline medication access for your patients:

• Medfinder for Providers: Real-time pharmacy availability search. Direct patients to pharmacies that have Diazepam in stock, reducing failed fills and patient frustration.
• ASHP Drug Shortage Database: Monitor shortage status updates and estimated resupply dates at ashp.org.
• FDA Drug Shortage Database: Additional shortage tracking at fda.gov.
• Neurelis myNEURELIS Program: Support for Valtoco access including copay cards, prior authorization assistance, and patient education materials.

Therapeutic Alternatives Reference

When Diazepam is unavailable, consider these evidence-based alternatives:

• Anxiety disorders: Lorazepam 0.5–2 mg BID-TID; Clonazepam 0.25–2 mg BID; or consider non-benzodiazepine options (SSRIs, Buspirone) for chronic management.
• Alcohol withdrawal: Chlordiazepoxide 25–100 mg per protocol; Lorazepam (preferred in hepatic impairment); Phenobarbital as adjunct or alternative.
• Muscle spasticity: Baclofen 5–20 mg TID; Tizanidine 2–8 mg TID; or Clonazepam for spasticity with concurrent anxiety/seizure component.
• Seizure rescue: Valtoco (Diazepam nasal spray); Midazolam nasal spray (Nayzilam); Lorazepam.
• Status epilepticus: IV Lorazepam (first-line in most current protocols); IV Midazolam; IM Midazolam if IV access unavailable.

For a patient-oriented overview of alternatives, see Alternatives to Diazepam.

Looking Ahead

The Diazepam injectable and oral solution shortages show no clear end date as of early 2026. Key factors to watch:

• Fresenius Kabi's anticipated mid-February 2026 release of back-ordered syringes
• Any new generic entrants into the injectable market
• DEA production quota adjustments for the 2026 calendar year
• Valtoco adoption as a rescue therapy alternative to Diastat

Maintaining current awareness of supply conditions and having established alternative protocols will be essential throughout 2026.

Final Thoughts

The Diazepam shortage requires a multifaceted approach: awareness of which formulations are affected, established alternative protocols, proactive communication with pharmacy teams, and patient-facing tools to support medication access.

Medfinder for Providers can help your practice reduce the burden of medication access issues by giving both you and your patients real-time visibility into pharmacy stock. For complementary guidance, see our provider guide on how to help your patients find Diazepam in stock.