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

The ongoing intermittency of prednisolone oral solution supply creates a recurrent challenge for providers and their patients. Patients calling about unfilled Millipred prescriptions may be anxious, confused about why the shortage is happening, and unsure what to do next. This guide provides a systematic approach to helping your patients navigate the situation — from smart prescribing tactics to pharmacy search resources.

Step 1: Understand the Current Availability Landscape

Not all prednisolone formulations are equally affected. The 15 mg/5 mL oral solution has been the most problematic, appearing on the FDA Drug Shortage Database intermittently since 2020. The 10 mg/5 mL Millipred-branded solution has also experienced localized availability issues. Prednisolone 5 mg tablets, however, are generally available. This information should shape your prescribing and substitution strategy before the patient leaves the office.

Step 2: Use Shortage-Aware Prescribing Practices

Prescribe generically: Write 'prednisolone oral solution' rather than 'Millipred' to give pharmacies access to all available manufacturers.

Enable therapeutic substitution: Add a note to the prescription permitting the pharmacist to substitute dexamethasone oral solution (with appropriate dose conversion) if prednisolone is unavailable. This avoids disruptive callback requests during busy periods.

Ask about swallowing capability: For adult patients and older children, tablets are generally available and avoid the liquid shortage entirely. If tablets are feasible, prescribe prednisolone 5 mg tablets (or equivalent prednisone tablets).

Send e-prescriptions to multiple pharmacies: For urgent cases, sending the prescription to several pharmacies simultaneously can expedite the fill process. Document this clearly in the chart.

Step 3: Direct Patients to Effective Pharmacy Search Tools

Most patients don't know where to start when their usual pharmacy is out of stock. Equipping them with the right tools saves time and frustration:

medfinder: Direct patients to medfinder.com. They enter their medication, dosage, and zip code, and medfinder calls pharmacies near them to find which ones have it in stock. Results are sent by text — eliminating the need for patients to call pharmacy after pharmacy.

Independent pharmacies: Advise patients to specifically call independent pharmacies in addition to chains. Independent pharmacies use different distributors and often have stock when chains don't.

Costco pharmacy: Costco pharmacies (no membership required for pharmacy services) often source differently than retail chains and can be a good option.

Step 4: Establish a Compounding Pharmacy Relationship

Compounding pharmacies have become a critical safety net for prednisolone liquid during shortage periods. Many now routinely stock prednisolone API and can prepare oral solutions on demand. Proactively establishing a relationship with a PCAB-accredited compounding pharmacy in your area before the shortage season peaks — typically October through March — allows you to offer an immediate referral option when needed.

Note that compounded medications are generally not covered by insurance and will be an out-of-pocket cost for patients. Discussing this upfront helps prevent confusion.

Step 5: Communicate Clearly About Abrupt Discontinuation Risk

A critical patient safety issue during shortages is the risk of abrupt corticosteroid discontinuation. Patients on short courses (under 1–2 weeks at low doses) can generally stop without taper. However, patients on longer-term therapy or higher doses face risk of adrenal insufficiency if they stop abruptly.

When a patient calls about inability to fill their prescription, triage based on:

Duration of current therapy (days vs. weeks vs. months)

Current daily dose

Whether they have any remaining supply to bridge to an alternative

Providing Patients with Written Instructions

Consider creating a standard after-visit instruction for patients with prednisolone prescriptions during shortage periods. This might include:

The generic name and exact formulation to request at pharmacies

A list of pharmacy types to try beyond their usual pharmacy

Instructions on what to do if supply runs out (call the office; do not stop abruptly)

A mention of medfinder as a pharmacy-search tool

For a broader clinical briefing on the prednisolone shortage, see our provider shortage briefing for 2026.