Helping Patients Navigate the Atropine Shortage

When patients can't fill their Atropine prescriptions, they often turn to their prescriber for help. As a provider, you're in a unique position to connect patients with the right resources, suggest alternatives, and streamline the process of locating Atropine in stock.

This guide provides a practical, step-by-step approach to helping your patients access Atropine during the ongoing 2026 shortage.

Current Atropine Availability

As of early 2026, the Atropine Sulfate Injection shortage continues. Here's a quick summary:

• Available manufacturers: Fresenius Kabi, Hikma, and Medefil are currently producing Atropine injection
• Discontinued: Pfizer ended production of Atropine Abboject LifeShield syringes in mid-2025
• Back ordered: Somerset/Civica prefilled syringes have estimated resupply dates ranging from late 2026 to 2028
• Ophthalmic forms: Generic Atropine Sulfate 1% eye drops are generally available from multiple manufacturers, though spot shortages occur
• Compounded formulations: Low-dose Atropine (0.01%-0.05%) for myopia control is available from specialty compounding pharmacies

For real-time availability data, use Medfinder for Providers.

Why Patients Can't Find Atropine

Understanding the patient perspective helps you provide better guidance:

• Chain pharmacy limitations: Major chains like CVS and Walgreens may be out of stock due to centralized purchasing that's constrained during shortages
• Lack of information: Patients don't know which pharmacies have Atropine in stock and resort to calling around — often unsuccessfully
• Formulation confusion: Patients may not realize their specific formulation (prefilled syringe vs. vial, 1% drops vs. 0.01% drops) matters for availability
• Cost barriers: AtroPen auto-injectors cost $300-$800+, and some injectable formulations can exceed $300, creating financial hurdles alongside availability issues
• Urgency: For patients needing Atropine for emergency preparedness (e.g., AtroPen) or active cardiac conditions, delays feel critical

What Providers Can Do: 5 Steps

Step 1: Direct Patients to Medfinder

The single most helpful thing you can do is point patients to Medfinder. This tool shows real-time Atropine availability at pharmacies near the patient's location, eliminating the need for dozens of phone calls.

Consider adding Medfinder to your practice's patient resource handouts or including it in after-visit summaries when prescribing medications affected by shortages.

Step 2: Specify the Exact Formulation on the Prescription

Be precise on prescriptions to avoid delays:

• Specify concentration (e.g., Atropine Sulfate 0.4 mg/mL injection, or Atropine Sulfate 1% ophthalmic solution)
• Note whether a vial is acceptable (instead of only a prefilled syringe, which is in shorter supply)
• For ophthalmic prescriptions, specify whether the patient needs 1% solution, 0.5% solution, or a compounded low-dose formulation

Clear, specific prescriptions help pharmacists fill orders faster and reduce the chance of rejections or confusion.

Step 3: Recommend Independent and Compounding Pharmacies

When chain pharmacies can't source Atropine, independent pharmacies often can. They frequently work with different wholesalers and may have stock that chains don't.

For patients needing low-dose Atropine eye drops for myopia control, compounding pharmacies like Imprimis Pharmaceuticals are a reliable source. Maintain a list of compounding pharmacies in your area that you can refer patients to.

Step 4: Evaluate and Prescribe Alternatives When Appropriate

If Atropine genuinely cannot be obtained, consider whether an alternative medication is clinically appropriate:

• Glycopyrrolate: For antisialagogue/vagolytic needs. Five times more potent for secretion reduction. Does not cross the blood-brain barrier.
• Cyclopentolate: For cycloplegic refraction and pupil dilation. Shorter duration (4-24 hours vs. 1-2 weeks).
• Scopolamine: For secretion management in palliative care. Available as transdermal patch.
• Tropicamide: For mydriasis only (not cycloplegia). Shortest duration of action.

Document the reason for the therapeutic substitution and discuss the change with the patient. For more clinical detail on each alternative, see our provider shortage briefing.

Step 5: Help Patients Manage Costs

For patients paying out of pocket or with high-deductible plans, the cost of Atropine can be a barrier on top of the availability challenge:

• Recommend coupon programs: GoodRx and SingleCare can reduce Atropine ophthalmic drops from about $54 retail to as low as $21
• Suggest our patient savings guide for detailed cost-saving strategies
• For expensive formulations like AtroPen, explore whether insurance authorization or manufacturer programs can help

Alternatives at a Glance

Here's a quick-reference table for clinical decision-making:

• Bradycardia (ACLS): No substitute — Atropine is first-line. Ensure institutional stock.
• Organophosphate poisoning: No substitute — Atropine is essential (used with Pralidoxime).
• Perioperative antisialagogue: Glycopyrrolate (preferred alternative).
• Cycloplegic refraction: Cyclopentolate (shorter duration, adequate for most exams).
• Amblyopia treatment: Atropine preferred per AAO guidelines; Cyclopentolate is a less-effective alternative.
• Myopia control: Low-dose Atropine (compounded) — no widely accepted pharmacologic alternative.
• Death rattle (palliative): Glycopyrrolate or Scopolamine.

Workflow Tips for Your Practice

• Flag shortage medications: Set up alerts in your EHR for medications on the FDA shortage list so you're aware of potential fill issues before prescribing
• Pre-authorize alternatives: For patients already on Atropine, proactively discuss backup plans in case they can't fill their next prescription
• Coordinate with pharmacy: Build relationships with a few reliable pharmacies (including compounders) that you can refer patients to during shortages
• Use Medfinder in clinic: Pull up Medfinder during patient visits to check availability before the patient leaves with a prescription they can't fill
• Document shortages: Note in the patient chart when a prescription change is driven by drug shortage rather than clinical preference

Final Thoughts

The Atropine shortage is a real challenge, but providers can make a significant difference in how patients experience it. By directing patients to the right tools, prescribing with precision, maintaining a network of reliable pharmacies, and being ready with appropriate alternatives, you can ensure that patients continue to receive the care they need.

Medfinder for Providers is designed to help you do exactly that. Use it to check availability, share it with patients, and integrate it into your shortage management workflow.

For more resources, explore our provider shortage briefing, provider guide to helping patients save on Atropine, and Atropine drug interactions guide.