When Your Patient Calls Back: "The Pharmacy Doesn't Have It"

You prescribed Nystatin/Triamcinolone for a patient with cutaneous candidiasis. A day later, your front desk gets a call: the pharmacy doesn't have it in stock. The patient wants to know what to do, and your staff needs a quick answer.

This scenario is increasingly common with Nystatin/Triamcinolone, a widely prescribed antifungal/corticosteroid combination that faces intermittent supply disruptions due to its limited generic manufacturer base. While the medication isn't in a formal FDA shortage, real-world availability can be unpredictable.

This guide provides a practical, step-by-step approach for providers and their clinical teams to help patients find Nystatin/Triamcinolone — or a suitable alternative — as efficiently as possible.

Current Availability Snapshot

Nystatin/Triamcinolone cream and ointment (100,000 units/0.1%, available in 15g, 30g, and 60g tubes) is produced by several generic manufacturers including Taro, Perrigo, Glenmark, and Teva. Supply is adequate nationally but can be inconsistent at the pharmacy level due to:

• Centralized distribution models at chain pharmacies
• Periodic production pauses by individual manufacturers
• Seasonal demand increases during warm months

The medication is generally available somewhere in most markets — the challenge is connecting the patient to the right pharmacy.

Why Patients Can't Find It

Understanding why patients encounter stock-outs helps you address the issue more effectively:

Chain Pharmacy Dependency

Most patients default to large chains (CVS, Walgreens, Rite Aid). These chains order from centralized distributors, so when a distributor runs low, multiple locations in an area may be simultaneously out of stock — giving patients the impression of a widespread shortage.

Patients Don't Know to Look Elsewhere

Many patients assume that if their pharmacy doesn't have a medication, it must be unavailable everywhere. They may not think to check independent pharmacies, compounding pharmacies, or mail-order options without guidance from their provider.

Delayed Communication

Patients often don't learn the medication is out of stock until they arrive at the pharmacy in person. By that point, they're frustrated and may delay treatment or seek care elsewhere rather than troubleshooting the supply issue.

What Providers Can Do: 5 Practical Steps

Step 1: Check Real-Time Availability Before Prescribing

Use Medfinder for Providers to check which pharmacies near your patient currently have Nystatin/Triamcinolone in stock. This takes less than a minute and can prevent the callback loop entirely.

If your office prescribes Nystatin/Triamcinolone regularly, consider making this check a standard part of your prescribing workflow for this medication.

Step 2: E-Prescribe to a Pharmacy With Stock

Once you've identified a pharmacy with availability, e-prescribe directly to that location. This is more reliable than sending the prescription to the patient's default pharmacy and hoping for the best.

If the patient prefers a different pharmacy, let them know which locations currently have stock so they can request a transfer.

Step 3: Provide the Patient With a Backup Plan

When writing the prescription, consider including a note about acceptable alternatives. For example:

• "If Nystatin/Triamcinolone unavailable, may substitute Clotrimazole/Betamethasone cream"
• "If combination product unavailable, fill as separate Nystatin cream + Triamcinolone 0.1% cream"

This empowers the pharmacist to make a substitution without requiring a callback to your office.

Step 4: Direct Patients to Self-Service Tools

Share Medfinder with your patients so they can check pharmacy stock independently. This is especially helpful for refills, when the patient may not be in contact with your office.

A simple patient instruction might be: "If your pharmacy is out of stock, go to medfinder.com and search for Nystatin/Triamcinolone to find another pharmacy near you that has it."

Step 5: Have Your Staff Follow a Standard Protocol

Create a brief office protocol for handling "pharmacy out of stock" callbacks for commonly affected medications. The protocol might include:

1. Check Medfinder for alternative pharmacy availability
2. Offer to transfer the prescription to a pharmacy with stock
3. If no availability found, contact prescriber for alternative medication order
4. Document the substitution or transfer in the patient's chart

Therapeutic Alternatives When Stock Is Unavailable

If Nystatin/Triamcinolone cannot be located in your area, these are the most common clinical substitutions:

• Clotrimazole/Betamethasone (Lotrisone) — Broader antifungal spectrum; higher-potency steroid. Caution in pediatric patients and thin-skinned areas. Generic available, $15–$40.
• Separate Nystatin + Triamcinolone — Same active ingredients prescribed individually. More widely stocked. Requires patient education on layering.
• Ketoconazole cream 2% — Antifungal alone. Good when steroid is not essential or should be avoided.
• OTC Miconazole + Rx Triamcinolone — Patient can obtain antifungal immediately OTC while filling the steroid prescription separately.

For detailed clinical comparisons, see Alternatives to Nystatin/Triamcinolone.

Workflow Tips for Your Practice

Build a Quick-Reference Card

Create a laminated card or EHR quick note with:

• Nystatin/Triamcinolone — standard dosing and tube sizes
• Top 3 alternative medications with dosing
• Medfinder URL for real-time stock checking
• Local independent and compounding pharmacy phone numbers

Use Prescription Notes Effectively

When e-prescribing, add a pharmacist note: "If unavailable, please contact office for alternative — or may substitute per protocol." This reduces pharmacist hesitation and patient delays.

Proactive Refill Planning

For patients who use Nystatin/Triamcinolone regularly (e.g., for recurrent candidiasis in skin folds), encourage early refills and consider prescribing larger quantities (60g vs. 30g) to reduce the frequency of pharmacy visits and refill-related stock-out encounters.

Final Thoughts

Medication availability issues are an increasingly common challenge in outpatient practice, and Nystatin/Triamcinolone is a textbook example of a widely used generic that can be intermittently hard to find. By integrating real-time availability tools like Medfinder for Providers into your prescribing workflow and maintaining a ready list of alternatives, you can minimize treatment delays and reduce the administrative burden of stock-out callbacks.

For more on the current supply situation, see our Nystatin/Triamcinolone shortage update for providers.