Fluorouracil Shortage Update: What Patients Need to Know in 2026

Fluorouracil — known as 5-FU and sold under brand names including Adrucil (injection) and Efudex (topical cream) — is one of the most widely used chemotherapy drugs in the world. It also has an ongoing supply problem that has persisted since 2023 and continues to affect patients in 2026.

If you take fluorouracil — for colorectal cancer, pancreatic cancer, breast cancer, or a skin condition like actinic keratosis — here's everything you need to know about the current shortage and how to protect your treatment.

Current Shortage Status as of Early 2026

According to the ASHP Drug Shortage Database, fluorouracil injection (50 mg/mL) remains on the current shortage list as of early 2026. The shortage was first documented in January 2023, making it a multi-year supply disruption.

Current manufacturer status:

Accord: On shortage due to manufacturing delays. 100 mL vials on back order with a projected release date of January 2026. Short-dated 10 mL and 20 mL vials available with expiration June 2026.

Alembic: On shortage; no reason given. 50 mL and 100 mL vials affected.

Eugia US: On shortage; no reason disclosed.

Xiromed: On shortage; no reason disclosed.

Fresenius Kabi: Available — 10 mL, 20 mL, and 100 mL vials in stock.

Sagent: Available.

What Caused the Fluorouracil Shortage?

The causes are structural rather than a single event. Fluorouracil was approved by the FDA in 1962 and has been generic for decades. As a generic sterile injectable, it is produced by a small number of manufacturers with thin profit margins. When manufacturing delays, quality control issues, or raw material shortfalls affect even one or two suppliers, the entire national supply tightens. The high and consistent demand from oncology practices makes the imbalance particularly acute.

How Does This Shortage Affect Cancer Treatment?

For cancer patients, a fluorouracil shortage is not just an inconvenience — it can have real consequences for treatment timing. Fluorouracil is a core component of several first-line and adjuvant chemotherapy regimens:

FOLFOX: Fluorouracil + leucovorin + oxaliplatin — standard for colorectal cancer.

FOLFIRI: Fluorouracil + leucovorin + irinotecan — colorectal cancer, second line.

FLOT: Fluorouracil + leucovorin + oxaliplatin + docetaxel — perioperative gastric and GEJ adenocarcinoma.

CMF: Cyclophosphamide + methotrexate + fluorouracil — used in some breast cancer regimens.

Delayed treatment cycles can reduce the effectiveness of chemotherapy and affect patient outcomes. If your infusion center is struggling to obtain fluorouracil, it's important to communicate directly with your oncologist — don't wait for a crisis.

What About the Topical Fluorouracil Shortage?

While the FDA shortage list focuses on the injectable form, topical fluorouracil cream has also faced supply challenges. Carac 0.5% cream has experienced persistent supply disruptions. Generic 5% fluorouracil cream (Efudex equivalent) is generally more available, but availability varies by pharmacy and region. Patients in some areas may need to search multiple pharmacies or consider alternatives like tirbanibulin (Klisyri) or imiquimod for actinic keratosis.

Steps Every Fluorouracil Patient Should Take Right Now

Check with your pharmacy or infusion center now — before you need your next dose.

Ask your oncologist if alternative regimens (like capecitabine-based) have been considered in case of ongoing shortage.

Use medfinder to search multiple pharmacies at once if you're having trouble locating the medication.

Document any treatment delays caused by the shortage — this information can be relevant to insurance and disability records.

For help finding fluorouracil in stock, see our guide on how to find fluorouracil near you, or start your search on medfinder.com.