Your Patients Are Calling About Alphagan — Here's How to Help

You know the call: a patient with open-angle glaucoma or ocular hypertension has been using Alphagan P (Brimonidine tartrate) for months or years, and now their pharmacy says it's out of stock. They're worried, unsure what to do, and looking to your office for answers.

While Brimonidine is not in an official FDA shortage, pharmacy-level availability can be inconsistent — and for a condition as sight-threatening as glaucoma, even a few missed days of treatment raises the stakes. This guide gives you and your staff practical steps to help patients navigate availability issues efficiently.

Current Availability Landscape

As of 2026, Brimonidine tartrate ophthalmic solution remains available from multiple generic manufacturers in both 0.15% and 0.2% concentrations. Brand Alphagan P (0.1% and 0.15%) continues to be manufactured by AbbVie/Allergan.

The availability challenges patients encounter are typically driven by:

• Distributor allocation limits on lower-volume ophthalmic products
• Individual manufacturer production timeline variability
• Formulary restrictions directing patients to specific versions that may not be locally stocked
• Pharmacies that don't maintain safety stock for eye drops with smaller patient populations

These are distribution gaps, not supply gaps — an important distinction. The medication is being produced; the challenge is getting it to the right pharmacy shelf at the right time.

Why Patients Can't Find Alphagan

Understanding the patient experience helps you respond effectively:

• Their regular pharmacy is out: The most common scenario. The pharmacy placed an order but the distributor hasn't shipped, or the preferred generic manufacturer is temporarily unavailable from that distributor.
• Insurance complications: Their plan covers a specific concentration or manufacturer that's harder to find locally. Switching to a different, equally available generic would solve the problem, but requires a new prescription.
• Limited pharmacy options: Patients in rural areas or those dependent on a single pharmacy location may have fewer alternatives to try.
• Cost barriers: Brand Alphagan P at $150-$270 per bottle may be unaffordable, but the patient doesn't know about the $9-$10 generic option with a coupon.

What Providers Can Do: 5 Practical Steps

Step 1: Prescribe for Maximum Flexibility

When writing or renewing Brimonidine prescriptions, consider:

• Prescribing "Brimonidine tartrate ophthalmic solution" with generic substitution permitted (DAW 0)
• Including a concentration range note if clinically appropriate (e.g., "0.1% or 0.15%, pharmacist may substitute")
• Avoiding brand-only prescriptions unless there's a specific clinical reason (e.g., Purite preservative preference for ocular surface disease patients)

This flexibility allows pharmacies to dispense whatever formulation or manufacturer they have in stock, dramatically reducing fill failures.

Step 2: Direct Patients to Availability Tools

Medfinder for Providers is a free tool that shows pharmacy-level stock availability for Brimonidine in the patient's area. You can:

• Search on behalf of the patient during the office visit
• Print or text the patient a link to search results for their area
• Integrate the recommendation into your post-visit instructions: "If your pharmacy is out of Brimonidine, search for availability at medfinder.com"

This simple step can save your patient hours of phone calls and prevent missed doses.

Step 3: Maintain Sample Inventory

Keep a reasonable supply of Brimonidine samples in your office. When a patient calls reporting they can't fill their prescription:

• Offer to see them briefly (or have them come by during office hours) for a bridge supply
• This buys time to resolve the pharmacy issue without treatment interruption
• Document the sample dispensation in their chart per your state's requirements

Step 4: Have a Switching Protocol Ready

For patients who experience repeated difficulty finding Brimonidine, have a clear protocol for therapeutic alternatives. Your decision tree might look like:

1. First-line switch: Latanoprost 0.005% (Xalatan generic) — once daily at bedtime, widely available, $5-$15 with coupon
2. If beta-blocker safe: Timolol 0.5% (Timoptic generic) — twice daily or once daily (gel-forming), very affordable (<$10 with coupon)
3. If on multiple drops: Consider a combination product — Combigan (Brimonidine + Timolol) or Simbrinza (Brimonidine + Brinzolamide) to simplify the regimen
4. If none of the above are suitable: Dorzolamide 2% or Brinzolamide 1% as alternatives

Having this protocol documented and accessible to your clinical staff means faster turnaround when patient calls come in. For more detail on alternatives, refer patients to our Alphagan alternatives guide.

Step 5: Educate on Proactive Refill Behavior

During eye appointments, counsel patients to:

• Request refills when they have at least 5-7 days of drops remaining
• Ask their pharmacy to set up automatic refill reminders
• Keep a note of their medication details (drug name, concentration, pharmacy phone number) so they can troubleshoot quickly if an issue arises

This preventive education reduces after-hours calls to your office and helps patients feel empowered.

When to Consider Alternatives

Beyond availability issues, there are clinical scenarios where switching from Brimonidine makes sense:

• Allergic conjunctivitis from Brimonidine: Occurs in 10-20% of patients with chronic use. Switching to a different drug class is appropriate.
• Insufficient IOP control: If target pressure isn't being met, adding or switching to a prostaglandin analog may be more effective.
• Adherence challenges: The three-times-daily dosing of Brimonidine is a real barrier. Once-daily prostaglandin analogs have better adherence rates in the literature.
• CNS side effects: Drowsiness and fatigue from systemic Brimonidine absorption can impact quality of life, especially in older patients.

Workflow Tips for Your Practice

To handle Alphagan availability issues efficiently:

• Train front desk and phone staff to check Medfinder when patients call about unavailable medications — this can resolve many calls without requiring provider time.
• Create a templated after-visit summary that includes: medication name, concentration, "generic OK," refill timeline, and a link to medfinder.com.
• Pre-authorize common switches: Create standing protocols that allow your clinical staff to initiate a prescription change to pre-approved alternatives when a patient reports repeated fill failures — with provider review and sign-off within 24 hours.
• Document availability patterns: If you notice recurring difficulty with specific formulations in your area, consider adjusting your first-line prescribing preferences to favor the most readily available options.

Final Thoughts

Medication access issues shouldn't be a barrier to glaucoma care. As a provider, the steps above — flexible prescribing, proactive patient education, availability tools, and having a switching protocol ready — can make a meaningful difference in your patients' treatment continuity.

For a broader view of the current Brimonidine supply situation, see our provider shortage briefing. And for cost-related strategies, our provider's guide to helping patients save money on Alphagan covers savings programs, coupons, and patient assistance options.