Your Patients Need Ketamine — and They Can't Find It

As a provider prescribing Ketamine in 2026, you've likely received calls from frustrated patients who can't fill their prescriptions. The Ketamine injection shortage has been ongoing, and patients are caught in the middle — bouncing between pharmacies, waiting for backorders, and sometimes going without treatment they depend on.

You can't fix the shortage, but you can help your patients navigate it more effectively. This guide outlines five concrete steps providers can take, plus alternative medication options and workflow tips to keep your practice running smoothly during the supply disruption.

Current Ketamine Availability

As of early 2026, Ketamine injectable supply remains constrained:

• Hikma is the most reliable supplier, with Ketamine injection currently available.
• Eugia has reported shortages due to increased demand and discontinued the 100 mg/mL 10 mL vial configuration in 2025.
• Fresenius Kabi has experienced intermittent supply disruptions.
• AuroMedics has variable availability following its acquisition of Mylan's Ketamine product line.

Compounded Ketamine formulations (oral lozenges, sublingual tablets, nasal sprays) remain generally available through 503A and 503B compounding pharmacies, though FDA scrutiny of these products is increasing.

Why Patients Can't Find Ketamine

Understanding the barriers your patients face helps you guide them more effectively:

• Most retail pharmacies don't stock it. As a Schedule III controlled substance with strict DEA storage and security requirements, Ketamine is simply not carried by many chain pharmacies (CVS, Walgreens, Rite Aid). Patients calling these locations will frequently be told "we don't carry that."
• Patients don't know where to look. They may not be aware that specialty pharmacies, compounding pharmacies, and hospital outpatient pharmacies are more likely to have Ketamine.
• Specific concentrations are unavailable. With Eugia's discontinuation of the 100 mg/mL 10 mL vials, patients prescribed that specific product may need a prescription adjustment.
• Insurance doesn't cover it for off-label use. Patients using Ketamine for depression often pay out of pocket, adding financial stress on top of the supply challenge.

What Providers Can Do: 5 Steps

Step 1: Direct Patients to Medfinder

The single most impactful thing you can do is point patients to Medfinder. Instead of having patients call pharmacy after pharmacy, Medfinder provides real-time availability information for Ketamine at pharmacies in their area.

Consider adding Medfinder to your practice's patient resource sheet or after-visit summary for any patient receiving a Ketamine prescription. This one step can dramatically reduce the number of frustrated callbacks your office receives.

Step 2: Build Relationships With Specialty Pharmacies

Identify 2–3 specialty pharmacies or compounding pharmacies in your area that reliably carry Ketamine. Establish a direct line of communication with their pharmacists so you can check stock before writing prescriptions and send patients to a pharmacy you know has supply.

For clinics prescribing IV Ketamine, consider establishing direct purchasing agreements with wholesalers or manufacturers (Hikma is currently the most reliable supplier) rather than relying on standard pharmacy distribution channels.

Step 3: Be Flexible With Concentrations and Formulations

When writing Ketamine prescriptions, be prepared to adjust:

• If the 100 mg/mL concentration is unavailable, the 50 mg/mL or 10 mg/mL may be in stock — adjust volume accordingly.
• For patients using Ketamine for depression or pain, compounded oral lozenges (troches), sublingual tablets, or nasal sprays from compounding pharmacies may be available even when injectable supply is tight.
• Document in your EMR which formulations and concentrations the patient can use, so staff can quickly pivot if the first choice isn't available.

Step 4: Establish Alternative Medication Protocols

Have clear alternative protocols documented and ready to deploy when Ketamine is unavailable:

For treatment-resistant depression:

• Spravato (Esketamine): FDA-approved nasal spray. Requires REMS certification for your clinic, or establish a referral pathway. Most insurance covers it with prior authorization.
• Auvelity (Dextromethorphan/Bupropion): Oral NMDA-modulating antidepressant. No infusion or clinic visit required. Good for patients who want at-home treatment.

For procedural sedation/anesthesia:

• Propofol, Midazolam + Fentanyl, or Etomidate as situationally appropriate.

For chronic pain:

• Lidocaine infusions, Gabapentin, Pregabalin, Duloxetine, or nerve block procedures.

For a comprehensive overview of alternatives, see: Alternatives to Ketamine If You Can't Fill Your Prescription.

Step 5: Proactively Communicate With Patients

Don't wait for patients to discover the shortage at the pharmacy counter. When you prescribe Ketamine:

• Inform the patient that supply may be limited and that they should check with the pharmacy before making a trip.
• Provide them with a list of pharmacies most likely to have stock (or direct them to Medfinder).
• Let them know the alternative plan if their specific formulation or concentration isn't available.
• For patients using Ketamine for depression, discuss Spravato as a backup option and begin prior authorization if appropriate, even before the shortage affects them directly.

Alternatives to Ketamine: Quick Reference

• Spravato (Esketamine): Nasal spray, FDA-approved for TRD. $800–$1,200/session retail; insurance-covered with PA. Janssen copay program available.
• Auvelity (Dextromethorphan/Bupropion): Oral, FDA-approved for MDD. ~$900–$1,100/month retail; covered by many plans.
• Propofol: IV anesthetic for procedural sedation. Requires deeper respiratory monitoring.
• Midazolam: Benzodiazepine for procedural sedation. Often paired with opioid analgesic.
• Lidocaine infusion: For chronic/neuropathic pain management.

Workflow Tips for Your Practice

• Track supply proactively. Assign a staff member to check Ketamine availability with your primary pharmacy and wholesaler weekly.
• Pre-authorize Spravato for eligible patients. Having insurance pre-authorization in place before a patient needs to switch medications saves critical time.
• Create a patient handout. Include information about the shortage, how to use Medfinder, and what to do if the pharmacy is out of stock. This reduces phone calls to your office and empowers patients.
• Document alternative orders in advance. For patients with standing Ketamine orders, have conditional alternative orders ready in the EMR that can be activated if Ketamine becomes unavailable.
• Join the Medfinder provider network. Visit medfinder.com/providers to access tools designed for prescribers managing patients through drug shortages.

Final Thoughts

The Ketamine shortage places an extra burden on providers who are already stretched thin. But with a proactive approach — building pharmacy relationships, having alternatives ready, communicating clearly with patients, and using tools like Medfinder — you can minimize treatment disruptions and keep your patients on track.

For more on the current shortage situation, see our provider shortage briefing for 2026. For a patient-facing version of this guide, share How to Find Ketamine in Stock Near You with your patients.