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

The difluprednate (Durezol) shortage that began in April 2024 continues to affect patients and practices in 2026. For ophthalmologists and optometrists who routinely prescribe Durezol for post-surgical inflammation and anterior uveitis, understanding the current shortage landscape is essential for managing patient expectations, adjusting treatment plans, and ensuring uninterrupted care.

This guide provides a clinical overview of the shortage, evidence-based alternatives, prior authorization strategies, and resources to help your patients get the medication they need.

Current Shortage Status: Clinical Summary

As of early 2026, difluprednate ophthalmic emulsion 0.05% remains listed on the ASHP drug shortage database. The shortage was initiated in April 2024 when Exelan Pharmaceuticals — a major U.S. generic manufacturer — placed its 5 mL bottles of difluprednate ophthalmic emulsion on long-term back order with no estimated return date as of the August 2025 ASHP update.

Supply summary:

Brand Durezol (Novartis/Alcon): Generally available; $250–$400 per 5 mL bottle at cash price

Exelan generic: Long-term back order; no release date

Dr. Reddy's / Amneal generics: Available in some markets; limited and variable supply

Why This Shortage Is Clinically Significant

Difluprednate's unique pharmacological profile — including its high binding affinity for glucocorticoid receptors and emulsion-based delivery system that promotes superior corneal penetration — makes it the most potent topical ophthalmic steroid currently available. Clinical data demonstrates that difluprednate 0.05% dosed QID is therapeutically equivalent to prednisolone acetate 1% dosed 8 times daily for anterior uveitis, with a more convenient dosing schedule that may improve adherence.

For high-risk patients — those with severe uveitis, complex surgical histories, or high-stakes post-operative periods — the inability to access difluprednate at an affordable price can meaningfully affect outcomes.

Evidence-Based Alternatives During the Shortage

When difluprednate is unavailable or unaffordable, the following alternatives have the strongest evidence base for post-surgical inflammation and anterior uveitis:

1. Prednisolone Acetate 1% (Pred Forte)

Prednisolone acetate 1% is the most evidence-backed alternative for patients who cannot obtain difluprednate. Phase III randomized controlled trials confirm non-inferiority when dosed 8 times daily for anterior uveitis vs. difluprednate QID. For post-surgical inflammation, dosing typically begins at 6 times daily and is tapered over 4–6 weeks.

Key consideration: Requires patient education on vigorous shaking before each instillation. Generic suspension uniformity may vary — branded Pred Forte has shown more consistent particle size in comparative studies.

IOP monitoring: Comparable IOP elevation risk to difluprednate, though clinical data suggests difluprednate-related IOP increases, when they occur, tend to be slightly higher in magnitude. Monitor closely regardless of which agent is used.

2. Loteprednol Etabonate (Lotemax, Lotemax SM)

Loteprednol etabonate is an appropriate alternative for patients at elevated risk for steroid-induced IOP elevation or in cases of mild to moderate post-surgical inflammation. Its retrometabolic design results in rapid deactivation after receptor binding, significantly reducing systemic and ocular side effects.

Available formulations: 0.5% suspension (Lotemax), 0.5% gel (Lotemax Gel), 0.38% gel (Lotemax SM — submicron particle size for enhanced aqueous penetration), 0.2% suspension (Alrex, for allergic conjunctivitis)

Best for: Patients with glaucoma, ocular hypertension history, or mild to moderate post-surgical cases

Caution: May not provide adequate control for severe uveitis or high-risk post-surgical scenarios where difluprednate was specifically selected

3. Dexamethasone (Maxidex, Dextenza Intracanalicular Insert)

Dexamethasone ophthalmic is a viable bridge option, particularly the intracanalicular insert form (Dextenza), which delivers sustained dexamethasone over up to 30 days post-placement and eliminates adherence concerns. Dextenza is FDA-approved for post-operative inflammation and pain after ocular surgery and may be a practical option for patients who are already in the clinic.

Prior Authorization and Insurance Considerations

During the shortage, several insurance-related issues may arise for your patients:

Generic unavailability and brand substitution: If the generic is not available, some insurers will cover brand Durezol at the generic tier temporarily. Submit a pharmacy exception or call the insurer's prior authorization line with documentation of the generic shortage.

Step therapy overrides: Some plans require patients to try prednisolone acetate before approving difluprednate. When submitting for prior authorization, document clinical rationale clearly — e.g., severity of post-surgical inflammation, prior steroid response history, or severity of uveitis.

Novartis Patient Assistance Foundation: Qualifying patients can receive brand Durezol at no cost. Eligibility is based on income; encourage staff to assist patients in applying.

How to Help Your Patients Find Difluprednate

Directing patients to medfinder for providers is one of the most practical steps you can take. medfinder contacts pharmacies on behalf of patients to find which ones have Durezol or generic difluprednate in stock, sparing patients the frustration and delay of calling around on their own. This is especially important for post-surgical patients who need their medication quickly.

Documentation and Clinical Risk Management

When modifying therapy due to a shortage, document clearly in the chart:

The reason for the medication change (drug shortage)

The alternative prescribed and adjusted dosing schedule

Any risks discussed with the patient related to alternative therapy

Follow-up plan and monitoring schedule (particularly IOP monitoring for all steroid courses >10 days)

See our patient-facing Durezol shortage update for patients for information you can share directly with patients struggling to find their medication.