How to Help Your Patients Find Iopidine in Stock: A Provider's Guide

When you prescribe Iopidine (Apraclonidine), you're relying on a medication with a limited supply chain and low retail pharmacy stocking rates. For your patients, this can mean unexpected delays, multiple pharmacy calls, and frustration. As a provider, there are concrete steps you can take to smooth this process and ensure your patients get the IOP management they need without unnecessary disruption.

This guide outlines the current availability landscape, explains why patients struggle to find Iopidine, and provides five actionable steps you and your staff can implement to improve fill rates.

Current Availability of Iopidine

Iopidine is manufactured by Alcon Laboratories (brand) and a limited number of generic manufacturers (Apraclonidine). The two formulations serve different clinical needs:

• Iopidine 0.5% (multi-dose bottle): Used for short-term adjunctive IOP reduction. Available as both brand and generic. Retail stocking is inconsistent — many chain pharmacies do not carry it routinely.
• Iopidine 1% (single-use dispensers): Used perioperatively for laser surgery. Primarily stocked by surgical centers and hospital pharmacies. Rarely available at retail pharmacies.

As of early 2026, there is no formal FDA or ASHP shortage listing for Apraclonidine. However, the practical availability is limited due to the factors described below.

Why Patients Can't Find Iopidine

Understanding the barriers your patients face can help you proactively address them:

Low Retail Pharmacy Stocking

Apraclonidine represents a very small fraction of ophthalmic prescriptions. Chain pharmacies optimize inventory for high-volume medications, which means Iopidine often isn't on the shelf. Patients who take their prescription to CVS, Walgreens, or Rite Aid may be told it needs to be ordered — or that it's unavailable from the wholesaler.

Limited Generic Manufacturers

With only a few companies producing generic Apraclonidine, any production disruption creates immediate supply pressure. Wholesalers may allocate limited stock, meaning pharmacies that don't regularly order it may have difficulty obtaining it quickly.

Insurance Barriers

Many payers position Apraclonidine as non-preferred, requiring prior authorization or step therapy through Brimonidine. Patients may encounter coverage denials that add further delays to the process, even when the drug is physically available.

Lack of Patient Awareness

Patients may not know that they can request generic Apraclonidine instead of brand Iopidine, or that independent pharmacies may be more likely to carry specialty eye medications. Without guidance, they may give up after one or two pharmacy calls.

What Providers Can Do: 5 Steps to Improve Access

Step 1: Check Pharmacy Stock Before Prescribing

Use Medfinder for providers to check which pharmacies in your patient's area currently have Apraclonidine in stock. This takes seconds and can prevent the most common frustration point — sending a prescription to a pharmacy that doesn't carry it.

Consider making this a standard workflow step: before sending an e-prescription for Apraclonidine, have your staff verify availability at the target pharmacy.

Step 2: Prescribe Generic Apraclonidine by Default

Writing prescriptions for "Apraclonidine 0.5% ophthalmic solution" rather than brand-name "Iopidine" gives pharmacies more flexibility in sourcing the medication. Generic formulations are available from multiple manufacturers and are typically easier to obtain and significantly less expensive for patients.

Step 3: Recommend Independent or Specialty Pharmacies

If your practice area has independent community pharmacies or ophthalmology-focused specialty pharmacies, consider building relationships with them. These pharmacies are more likely to:

• Stock niche ophthalmic medications
• Special-order quickly from specialty wholesalers
• Provide personalized service to your patients

Maintaining a short list of "go-to" pharmacies for specialty eye medications can save your patients significant time and frustration.

Step 4: Proactively Address Insurance Issues

If you know the patient's insurance requires prior authorization or step therapy for Apraclonidine, initiate the PA process at the time of prescribing rather than waiting for the pharmacy to encounter a rejection. For patients who have already tried and failed Brimonidine, document this clearly to streamline the approval process.

Step 5: Educate Patients on Finding and Affording the Medication

Provide patients with practical resources they can use on their own:

• Direct them to Medfinder for real-time pharmacy stock searches
• Inform them about discount coupons (GoodRx can bring generic Apraclonidine down to about $13)
• Mention the Alcon Cares Patient Assistance Program for eligible uninsured patients
• Share our patient guide: How to find Iopidine in stock near you

Alternatives to Consider

When Apraclonidine is unavailable or when clinical circumstances favor a different agent, these are the most common substitutes:

• Brimonidine (Alphagan P) 0.1%, 0.15%, or 0.2%: Most direct substitute. Same drug class, lower allergy rate, suitable for long-term use. Widely available as a generic. Evidence supports its use for both adjunctive IOP therapy and perioperative IOP management.
• Timolol (Timoptic) 0.25% or 0.5%: Beta-blocker eye drop. First-line for chronic open-angle glaucoma. Avoid in patients with asthma, COPD, or bradycardia.
• Latanoprost (Xalatan) 0.005%: Prostaglandin analog. Once-daily dosing. Most potent IOP reduction. Cosmetic side effects (iris darkening, eyelash growth) should be discussed.
• Dorzolamide (Trusopt) 2%: Carbonic anhydrase inhibitor. Can be combined with Timolol (as Cosopt). Avoid in sulfa-allergic patients.

For a detailed comparison, see our post on alternatives to Iopidine.

Workflow Tips for Your Practice

Here are some practical ways to integrate Iopidine access management into your daily workflow:

• Create a pharmacy quick-reference list — Identify 3-5 pharmacies in your area that reliably stock or quickly order Apraclonidine. Share this list with front desk and clinical staff.
• Use e-prescribing notes — When sending an e-prescription, include a note like "If not in stock, please special-order from wholesaler" to prompt pharmacy action.
• Flag Apraclonidine in your EHR — Set up an alert or note template that reminds providers to check availability and discuss alternatives when prescribing Apraclonidine.
• Batch prior authorizations — If multiple patients need Apraclonidine, process PAs together to improve efficiency.
• Follow-up protocol — Have staff call patients 2-3 days after prescribing to confirm the prescription was filled. This catches problems early and prevents gaps in treatment.

Final Thoughts

Iopidine access challenges are manageable with proactive provider involvement. By checking pharmacy stock before prescribing, defaulting to generic Apraclonidine, building relationships with reliable pharmacies, and equipping patients with tools like Medfinder, you can significantly reduce fill failures and patient frustration.

Related resources: Iopidine shortage: What prescribers need to know | How to help patients save money on Iopidine