How to Help Your Patients Find Dexamethasone/Tobramycin in Stock: A Provider's Guide

You prescribed Dexamethasone/Tobramycin for a patient with post-operative ocular inflammation. Two hours later, your front desk gets a call — the pharmacy doesn't have it. The patient is frustrated, the condition isn't waiting, and your team is stuck making phone calls instead of seeing patients.

This scenario plays out more often than it should. While Dexamethasone/Tobramycin (brand names TobraDex, TobraDex ST) is not in a formal shortage, intermittent pharmacy-level stock-outs remain a real obstacle for patients. As a provider, a few proactive steps can dramatically reduce treatment delays — and save your staff hours of phone time.

This guide walks through the current availability landscape, why patients struggle to fill this prescription, and concrete workflow changes that can help.

Current Availability of Dexamethasone/Tobramycin

As of early 2026, Dexamethasone/Tobramycin is not listed on the FDA or ASHP drug shortage databases. Generic Tobramycin/Dexamethasone suspension is manufactured by multiple companies, and brand TobraDex products remain in active production by Novartis/Alcon. For a full breakdown of the supply situation, see our Dexamethasone/Tobramycin shortage update for providers.

That said, the picture varies by formulation:

• Generic suspension (0.1%/0.3%) — Most widely stocked. Multiple manufacturers. Best chance of same-day fill.
• TobraDex ST (0.05%/0.3%) — No generic equivalent. Many pharmacies don't routinely stock it and will need to special-order.
• TobraDex ointment — Available but less commonly prescribed. Most pharmacies carry it by order only.
• Brand TobraDex suspension — Stocked at larger chains and specialty pharmacies. Not universally available at independents.

Why Patients Can't Find Dexamethasone/Tobramycin

The fact that a medication isn't in a formal shortage doesn't mean patients can always fill it on demand. Several factors conspire to make ophthalmic combination products harder to locate at the retail level:

• Just-in-time pharmacy inventory — Most retail pharmacies operate on tight inventory cycles. Specialty eye drops with lower prescription volume may not be reordered until existing stock runs out, creating gaps.
• Limited generic manufacturers — Sterile ophthalmic products have high manufacturing barriers to entry. Fewer manufacturers means less redundancy in the supply chain.
• Brand-only formulations — TobraDex ST has no generic, which means pharmacies face higher inventory costs to stock it and may choose not to.
• Distributor allocation — Wholesaler distribution priorities can create regional pockets of unavailability even when national supply is adequate.
• Patient confusion — Patients may go to only one pharmacy, hear "we don't have it," and assume the medication is unavailable everywhere — then delay treatment.

Five Steps Providers Can Take to Help

These are practical, implementable changes that can reduce prescription access failures for your patients.

1. Prescribe Generically and Allow Substitution

This is the single most impactful thing you can do. Writing for "Tobramycin/Dexamethasone 0.3%/0.1% ophthalmic suspension" instead of brand-name TobraDex accomplishes two things: it gives pharmacists the flexibility to dispense whatever manufacturer they have in stock, and it saves your patient significant money ($28–$55 with a discount card vs. $200–$350 for brand).

Make sure DAW (Dispense As Written) is not checked unless there's a genuine clinical reason. If you use EHR templates that default to brand names, consider updating them to generic.

2. Verify Stock Before Sending the Prescription

A 30-second stock check before e-prescribing can prevent hours of downstream frustration. Tools like Medfinder for Providers let your staff search for pharmacies that currently have Dexamethasone/Tobramycin in stock near your patient's location. You can verify availability, then send the prescription to a pharmacy you know can fill it.

This is especially important for post-surgical patients who need to start the medication promptly. Don't assume the patient's usual pharmacy has it — confirm first.

3. Offer the Ointment When Clinically Appropriate

Many patients and providers default to the suspension, but the Dexamethasone/Tobramycin ointment is a valid option for certain scenarios — nighttime use, patients who struggle to instill drops, or pediatric patients. The ointment uses a different supply chain and may be available when the suspension is not.

One caveat: the ointment causes more blurred vision than drops, so it's not ideal for daytime-only use in patients who need clear vision for driving or work.

4. Proactively Discuss Cost and Savings Options

Cost is a hidden barrier to fill rates. A patient who sees a $300 price tag on brand TobraDex may simply not fill the prescription — and may not tell you. Mention that generic options are available in the $28–$55 range with discount cards, and that manufacturer savings programs exist for brand products. You can direct patients to our guide on saving money on Dexamethasone/Tobramycin.

For uninsured patients, Novartis Patient Assistance NOW (patientassistancenow.com) offers access programs that your office can help facilitate.

5. Have a Backup Plan Ready

Don't wait for the pharmacy to call you. When you prescribe Dexamethasone/Tobramycin, tell the patient what to do if they can't find it. Options include:

• Calling your office so you can send the prescription to a different pharmacy
• Using separate Tobramycin and Dexamethasone drops as individual components (space instillation by 5–10 minutes)
• Switching to a therapeutic alternative like Zylet (Tobramycin/Loteprednol) or Maxitrol (Neomycin/Polymyxin B/Dexamethasone)

For a full rundown of alternative options and their clinical considerations, see our article on alternatives to Dexamethasone/Tobramycin.

Therapeutic Alternatives at a Glance

When Dexamethasone/Tobramycin is unavailable, the following combination ophthalmic products may be substituted depending on clinical context:

• Zylet (Tobramycin 0.3%/Loteprednol 0.5%) — Same antibiotic paired with a softer steroid. Lower IOP elevation risk makes it preferred for patients with glaucoma risk factors or when longer treatment courses are anticipated. Loteprednol is metabolized locally, reducing systemic steroid exposure.
• Maxitrol (Neomycin/Polymyxin B/Dexamethasone) — Retains the same steroid component with broader antibiotic coverage. Be aware of the 8–10% contact sensitization rate with Neomycin, especially in patients with prior allergic reactions to topical antibiotics.
• Pred-G (Prednisolone/Gentamicin) — An alternative aminoglycoside-steroid combination with a different steroid and antibiotic. Consider when Tobramycin sensitivity is a concern.
• Separate components — Prescribing Tobramycin 0.3% drops and Dexamethasone 0.1% drops individually is always an option. Both components are widely available as standalone generics. The main trade-off is patient adherence — two bottles and spaced administration is less convenient than a single combination product.

Workflow Tips for Your Practice

Integrating availability awareness into your prescribing workflow doesn't require a major overhaul. Here are targeted changes that work:

Update Your EHR Favorites

If your prescribing favorites or order sets still default to brand TobraDex, switch them to generic Tobramycin/Dexamethasone. This costs nothing, takes five minutes, and prevents avoidable access and cost issues for every future prescription.

Build a Pre-Prescription Stock Check into Post-Op Workflows

For surgical practices, add a stock verification step to your post-op medication protocol. Before surgery day, have a staff member confirm the patient's pharmacy has Dexamethasone/Tobramycin in stock — or use Medfinder for Providers to identify a pharmacy that does. This is especially critical for cataract and LASIK patients who need immediate post-operative medication access.

Create a Backup Protocol

Establish an office protocol for what to do when a patient reports they can't find the medication. A simple decision tree might look like:

1. Check Medfinder for Providers for nearby pharmacies with stock
2. Transfer the prescription to a pharmacy with confirmed availability
3. If no nearby pharmacy has it, switch to separate Tobramycin + Dexamethasone drops with spacing instructions
4. If the patient has clinical reasons to avoid separate components, switch to Zylet or another appropriate alternative

Having this protocol documented means your staff can handle most availability issues without pulling a provider away from patient care.

Educate Patients at the Point of Care

When handing a patient their post-visit instructions, take 30 seconds to mention that if their pharmacy doesn't have the medication, they should call your office rather than skip the prescription. You can also point patients to our guide on finding Dexamethasone/Tobramycin in stock near you so they know how to search on their own.

Build Pharmacy Relationships

If your practice regularly prescribes ophthalmic combination products, develop a relationship with 2–3 pharmacies in your area that reliably stock them. This is particularly valuable for ophthalmology and optometry practices. A quick quarterly check-in with your preferred pharmacies about their stocking practices can prevent surprises.

Special Considerations for Post-Surgical Prescribing

Dexamethasone/Tobramycin is frequently prescribed after cataract surgery, LASIK, and other ophthalmic procedures where both infection prevention and inflammation control are needed. In these settings, delays in starting the medication can have clinical consequences. Consider these strategies:

• Pre-surgical prescription fill — Send the prescription 2–3 days before the procedure so the patient has it on hand for the day of surgery.
• In-office dispensing — Some surgical practices keep a small stock of post-operative eye drops to dispense directly, bypassing pharmacy availability issues entirely.
• Pre-op stock confirmation — Include pharmacy stock verification in your pre-operative checklist, just like you confirm NPO status and consent forms.

Final Thoughts

Dexamethasone/Tobramycin is not in a shortage, but that doesn't mean every patient can fill it at their first pharmacy visit. The gap between national supply and pharmacy-level availability is real, and it's a gap that providers are uniquely positioned to close.

The strategies in this guide — prescribing generically, verifying stock before sending prescriptions, offering alternatives proactively, and building pharmacy relationships — don't require new technology or dramatic workflow changes. They're small adjustments that add up to meaningfully better medication access for your patients.

Medfinder for Providers is a free tool designed to help your practice locate pharmacies with specific medications in stock. Try it as part of your next post-operative prescribing workflow and see how it fits.