Florical Availability: What Providers and Prescribers Need to Know in 2026

Florical (sodium fluoride 8.3 mg / calcium carbonate 364 mg oral capsule, Mericon Industries) remains the go-to calcium-fluoride supplement for otolaryngologists managing active otosclerosis and cochlear otospongiosis. Despite not appearing on the FDA drug shortage list, many of your patients are struggling to find it — and some may be interrupting treatment as a result.

This guide gives you current availability context, clinical background, and practical guidance you can share with your patients to prevent treatment gaps.

Current Availability Status

As of 2026, Florical is not on the FDA Drug Shortage Database. Mericon Industries continues to manufacture the product at their Peoria, Illinois facility. The DailyMed label was last updated January 15, 2025, confirming active commercial status.

The patient-facing availability problem is a last-mile stocking issue, not a manufacturing or supply chain shortage. Most chain pharmacies (CVS, Walgreens, Rite Aid) do not consistently stock Florical because per-location demand is insufficient to justify routine ordering. Patients often need to seek it online or through independent/specialty pharmacies.

Clinical Background: Why Florical Remains Relevant in 2026

No FDA-approved pharmacological treatment for otosclerosis currently exists. Sodium fluoride therapy, first proposed by Shambaugh and Scott in 1964, remains one of the few medical interventions with a body of clinical evidence — despite its limitations.

A 2023 systematic review (PMC10008770) confirmed that sodium fluoride administration for at least 6 months stabilizes hearing thresholds, improves vestibular symptoms, and delays tinnitus worsening. A prospective study published in 2024 evaluating 128 patients over 5 years found statistically significant reductions in Tinnitus Handicap Inventory scores in patients with mild-to-moderate otosclerosis-related tinnitus treated with Florical specifically.

Florical's specific formulation — 3.75 mg fluoride (as 8.3 mg sodium fluoride) combined with 145 mg calcium (as 364 mg calcium carbonate from oyster shell) — allows for a measured, consistent fluoride dose combined with calcium to support bone mineralization and reduce hypocalcemia risk associated with higher fluoride dosing.

Dosing Protocols Your Patients May Be Using

Clinical dosing for otosclerosis varies across ENT practices. Common protocols include:

• Active otosclerosis (cochlear involvement): 2 capsules three times daily (TID) with meals for the first two years of treatment, providing 22.5 mg fluoride daily
• Maintenance dose: 1 capsule once daily after 2 years of active treatment, per the Shambaugh protocol
• Osteoporosis prevention: 1 capsule daily as labeled on the product

At the active otosclerosis dose (6 capsules/day), patients consume 1 bottle of 100 capsules approximately every 16-17 days. At this rate, supply continuity is critical — a patient who can't find Florical for even a few weeks may face meaningful treatment interruption.

Side Effects and Monitoring Considerations

Florical has a generally favorable safety profile. Known side effects include:

• Occasional gastric distress (mitigated by taking with meals)
• Allergic itching
• Increased joint pain in some patients — discontinue if arthritis aggravation occurs
• Hypercalcemia and hyperfluorosis risk in patients with pre-existing mineral imbalances — check levels before initiating

Florical is contraindicated in patients contemplating pregnancy and in patients with known hypercalcemia or hyperfluorosis. Regular neuro-otological follow-up is warranted for patients on long-term sodium fluoride therapy.

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When to Consider Alternatives

If a patient cannot reliably obtain Florical, bisphosphonates are the most evidence-backed alternative for otosclerosis management. Alendronate 70 mg weekly and risedronate 35 mg weekly have demonstrated significant hearing improvement, dizziness reduction, and tinnitus remission in systematic reviews when used for at least 6 months. Third-generation bisphosphonates (zoledronate) are being actively investigated for sensorineural hearing loss in otosclerosis. Sodium fluoride is also available as a standalone prescription formulation for providers who prefer to titrate fluoride dose separately from calcium intake.

How to Help Your Patients Find Florical

The most practical advice to give patients at the time of recommendation: order online. Amazon, Walgreens.com, and Target.com have consistent stock. For patients who need same-day local pickup, medfinder for providers can contact local pharmacies to identify which ones carry it — so patients receive clear next steps rather than sending them to call pharmacy after pharmacy.

For a provider-facing guide on helping your patients source Florical, see: How to Help Your Patients Find Florical in Stock: A Provider's Guide