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

The Dofetilide capsule shortage — first reported by ASHP in April 2023 — continues to affect prescribers and patients heading into 2026. With multiple generic manufacturers having exited the market and only two suppliers remaining, electrophysiologists and cardiologists need to stay current on the evolving supply landscape to maintain continuity of care for their atrial fibrillation and atrial flutter patients.

This briefing covers the shortage timeline, current manufacturer status, prescribing implications, alternative agents, cost considerations, and practical tools to help your patients stay on therapy.

Shortage Timeline

• April 2023: ASHP first reports Dofetilide capsule shortage
• 2023–2024: Accord Healthcare discontinues Dofetilide capsules. Sun Pharmaceutical discontinues all three strengths (125 mcg, 250 mcg, 500 mcg).
• 2025–2026: Supply remains constrained. Market reduced to two manufacturers: Novadoz (generic) and Pfizer (brand Tikosyn). ASHP shortage listing updated June 2025.

No new generic entrants have been announced, and there is no published timeline for resolution.

Prescribing Implications

The shortage creates several clinical and operational challenges for prescribers:

New Initiations

Before scheduling a patient for inpatient Dofetilide initiation (minimum 3-day monitored stay), confirm with the discharging pharmacy that they can supply the medication. The last thing a patient needs is to complete a costly hospital stay only to be unable to fill their discharge prescription.

Ongoing Therapy

For patients currently stable on Dofetilide, proactively address supply continuity at follow-up visits. Recommend early refills and ask patients to report any difficulty obtaining their medication immediately rather than missing doses.

Brand vs. Generic Considerations

If the generic (Novadoz) is unavailable, brand Tikosyn (Pfizer) may be accessible. Consider writing prescriptions that allow brand substitution, or provide a separate Tikosyn prescription if the patient's pharmacy cannot source generic. Note the significant cost difference: generic with coupons can be under $25/month, while brand Tikosyn retails at $830+/month.

Current Availability Picture

As of early 2026:

• Novadoz: Generic capsules (125 mcg, 250 mcg, 500 mcg) listed as available. This is the primary generic source.
• Pfizer (Tikosyn): Brand capsules available in all three strengths. Higher cost but may be available when generic is not.
• Accord, Sun: Discontinued. No longer manufacturing Dofetilide.

Availability at the pharmacy level may vary by wholesaler and region. Hospital pharmacies and specialty cardiac pharmacies tend to have more reliable access than retail chains.

Cost and Access Considerations

The cost differential between generic and brand Dofetilide is substantial and can affect patient adherence:

• Generic with discount coupon: $18–$25/month
• Generic retail (no insurance/coupon): $400–$530/month
• Brand Tikosyn retail: $830+/month

For patients who need brand Tikosyn due to generic unavailability, Pfizer's RxPathways patient assistance program may provide support for eligible patients. Prescription discount cards (GoodRx, SingleCare) can significantly reduce generic costs for uninsured or underinsured patients.

Alternative Agents

When Dofetilide is unavailable and a therapeutic switch is necessary, the choice of alternative depends heavily on the patient's underlying cardiac substrate:

• Heart failure with reduced EF: Amiodarone is the primary alternative. Dofetilide and Amiodarone are the only antiarrhythmics with evidence supporting use in HFrEF.
• No structural heart disease: Flecainide, Propafenone, Sotalol, or Dronedarone may all be considered, depending on other patient factors.
• Coronary artery disease (no HF): Sotalol, Dronedarone, or Amiodarone. Class IC agents (Flecainide, Propafenone) are contraindicated.
• Significant LVH: Amiodarone is preferred. Other agents carry increased proarrhythmic risk in the setting of hypertrophy.

Remember that switching from Dofetilide to Sotalol requires the same inpatient monitoring protocol, while Amiodarone, Dronedarone, and Flecainide can typically be initiated outpatient.

Tools and Resources for Your Practice

Several tools can help your practice navigate the shortage and assist patients in locating supply:

• Medfinder for Providers — A pharmacy availability tool that can help your staff identify pharmacies with Dofetilide in stock near your patients' locations. Can be used by care coordinators to proactively source medication before scheduling initiations.
• ASHP Drug Shortages Database — Monitor the official shortage listing for manufacturer updates and estimated resolution dates.
• Pfizer RxPathways — For patients who need brand Tikosyn and face cost barriers, the Pfizer patient assistance program may provide access at reduced or no cost.

Looking Ahead

With no new generic manufacturers announced and two major producers having permanently exited the market, the Dofetilide supply situation is unlikely to normalize quickly. Providers should plan for continued supply variability and consider establishing pharmacy partnerships that prioritize Dofetilide stocking for their patient populations.

For patients who have been stable on Dofetilide, maintaining therapy should remain the goal. Switching antiarrhythmics always carries risk, and Dofetilide's unique role in heart failure patients makes it particularly difficult to replace for certain populations.

Final Thoughts

The Dofetilide shortage requires proactive management from prescribers. Verify supply before inpatient initiations, counsel patients on early refills, maintain awareness of alternative agents appropriate to each patient's cardiac substrate, and use available tools to help patients locate pharmacies with stock.

Learn how Medfinder for Providers can help your practice navigate drug shortages and keep patients on therapy.