Your Patient Needs Itraconazole — and Can't Find It

It's a scenario that's become all too common: you prescribe Itraconazole for a patient with onychomycosis, blastomycosis, histoplasmosis, or another fungal infection, and within hours your office gets a call — the pharmacy doesn't have it.

Itraconazole availability has been inconsistent in recent years, particularly for the oral solution formulation. As a prescriber, you're in a unique position to help your patients navigate these challenges before they become treatment disruptions.

This guide outlines the current availability landscape, explains why patients are struggling, and gives you five practical steps to improve fill rates.

Current Itraconazole Availability

Here's the formulation-by-formulation picture in 2026:

• Generic capsules (100 mg): Most available form. Multiple generic manufacturers (Teva, Lannett, Patriot, and others). Moderate-to-good supply at most retail pharmacies, though regional gaps occur.
• Oral solution (10 mg/mL): Intermittently short. Fewer manufacturers, more vulnerable to supply chain disruptions. Patients requiring the solution (e.g., for better bioavailability or swallowing difficulties) face the most challenges.
• Sporanox (brand capsules): Limited retail stocking. Available through specialty distribution but rarely kept on retail shelves.
• Tolsura (65 mg SUBA-itraconazole): Specialty pharmacy access. Enhanced bioavailability allows lower dosing and food-independent administration.
• Onmel (200 mg tablets): Onychomycosis only. Limited distribution.

For the latest supply data and a patient-facing overview, see our Itraconazole shortage update for 2026.

Why Patients Can't Find Itraconazole

Understanding the barriers helps you anticipate and address them:

Supply Chain Constraints

Itraconazole API (active pharmaceutical ingredient) is sourced from a limited number of global suppliers. Any disruption — quality issues, regulatory holds, shipping delays — creates downstream shortages that affect multiple finished-product manufacturers simultaneously.

Pharmacy Stocking Models

Most retail pharmacies use just-in-time inventory. They don't maintain buffer stock of medications with lower prescription volume. Itraconazole, while important, isn't dispensed at the volume of medications like Lisinopril or Metformin, so many pharmacies keep minimal or zero stock on hand.

Formulation Confusion

Patients may not realize that capsules and oral solution are different products with different availability. A pharmacy may have capsules but not the solution (or vice versa), leading to fill failures if the prescription specifies a formulation that's out of stock.

Insurance Barriers

Prior authorization requirements for brand-name versions (Sporanox, Tolsura) can delay access by days. Step therapy requirements may force patients to try and fail on generic capsules before accessing Tolsura, even when the SUBA formulation is clinically preferable.

What Providers Can Do: 5 Steps

Step 1: Check Availability Before You Prescribe

Use Medfinder for Providers to verify which pharmacies near your patient currently have Itraconazole in stock. Sending a prescription to a pharmacy that actually has the medication eliminates the most common failure point.

This takes about 30 seconds and can be integrated into your prescribing workflow — have your MA or nurse check availability while you finalize the encounter note.

Step 2: Prescribe Flexibly When Possible

Consider these approaches to maximize fill probability:

• Allow generic substitution — Ensure your prescription permits dispensing any manufacturer's generic product.
• Consider Tolsura — For patients on PPIs, H2 blockers, or those who can't reliably take capsules with food, Tolsura's food-independent, acid-independent absorption may be clinically superior anyway. The 65 mg dose provides comparable exposure to 100 mg conventional capsules.
• Specify "or equivalent formulation" — While legally the pharmacist will follow what's written, discussing flexibility with your patient and having a documented plan for formulation switching reduces callback volume.

Step 3: Identify Reliable Pharmacy Partners

Build relationships with pharmacies that consistently stock antifungals:

• Independent pharmacies with flexible wholesaler relationships
• Specialty pharmacies focused on infectious disease medications
• Hospital outpatient pharmacies that maintain antifungal stock for discharged patients
• Compounding pharmacies that can prepare custom formulations when commercial products are unavailable

Step 4: Proactively Address Cost Barriers

Cost is a treatable barrier. At the point of prescribing:

• Mention that generic capsules can cost as little as $15–$30 with a discount card from GoodRx or SingleCare
• Direct uninsured patients to patient assistance programs via NeedyMeds.org or RxAssist.org
• Consider prescribing 90-day supplies when appropriate — often cheaper per unit and reduces refill-related access gaps
• For a comprehensive cost guide to share with patients: How to save money on Itraconazole

Step 5: Have a Backup Plan Ready

Know your second-line agents for each indication so you can switch quickly if Itraconazole can't be sourced:

• Onychomycosis: Terbinafine 250 mg daily (actually first-line per many guidelines)
• Blastomycosis/Histoplasmosis (mild-moderate): Fluconazole 400–800 mg daily as alternative; Voriconazole as second-line
• Aspergillosis (chronic/allergic): Voriconazole (first-line for invasive); Posaconazole for prophylaxis
• Oropharyngeal candidiasis: Fluconazole (actually first-line for most patients)

For a detailed comparison, see our provider briefing on the Itraconazole shortage.

Workflow Tips for Your Practice

Build a "Shortage Protocol"

Create a simple protocol for your care team when a patient reports they can't fill Itraconazole:

1. Check Medfinder for Providers for nearby availability
2. If found: transfer prescription or send new Rx to stocking pharmacy
3. If not found: assess whether formulation switch is appropriate (e.g., capsules → Tolsura)
4. If formulation switch isn't feasible: initiate alternative agent based on indication
5. Document the change and schedule follow-up

Educate Patients Proactively

At the time of prescribing, tell patients:

• "This medication can sometimes be hard to find. If your pharmacy doesn't have it, here's what to do..."
• Share how to find Itraconazole in stock as a resource
• Encourage them to refill 7–10 days early to avoid treatment gaps

Leverage Your EHR

Add a note or alert to your Itraconazole order set flagging potential availability issues and listing your preferred alternative agents. This ensures any provider in your practice can handle the situation consistently.

Final Thoughts

Itraconazole access challenges are a systems problem, but individual providers can make a meaningful difference. By checking availability before prescribing, maintaining pharmacy relationships, addressing cost proactively, and having backup plans ready, you can protect your patients from treatment disruptions.

Start using Medfinder for Providers to check Itraconazole availability in real time and streamline your prescribing workflow.