Your Patient Needs Trifluridine — Now What?

You've diagnosed herpetic keratitis, written the prescription for Trifluridine 1% ophthalmic solution, and sent your patient to the pharmacy. An hour later, they call back: "They don't have it." This scenario has become all too familiar for ophthalmologists and optometrists in 2026.

Trifluridine (Viroptic) faces ongoing supply challenges due to limited generic manufacturers and the specialized nature of the product. As a prescriber, you're in a unique position to help your patients navigate these barriers. This guide outlines practical steps you can take to ensure your patients get the treatment they need.

Current Trifluridine Availability

As of early 2026, the Trifluridine supply landscape looks like this:

• Active manufacturers: Sandoz and Apotex are among the few companies producing generic Trifluridine 1% ophthalmic solution
• Brand-name Viroptic: Distributed by Pfizer, but availability has been inconsistent
• Pharmacy stock: Chain pharmacies are most likely to be out of stock; hospital and specialty pharmacies tend to be more reliable
• Regional variation: Availability differs significantly by geography, with urban areas generally having better access

Why Patients Can't Find Trifluridine

Understanding the root causes helps you counsel patients more effectively:

1. Few manufacturers: With only two to three active generic producers, any single production disruption cascades into widespread shortages
2. Cold chain requirements: Trifluridine requires refrigeration (36°–46°F), which limits which pharmacies choose to stock it and complicates distribution
3. Low commercial incentive: Small patient population and modest margins make Trifluridine a low priority for pharmaceutical manufacturers and pharmacies alike
4. Pharmacy stocking decisions: Many retail pharmacies don't keep Trifluridine in regular inventory because they fill the prescription infrequently

What Providers Can Do: 5 Actionable Steps

Step 1: Build a Local Pharmacy Network

Identify two to three pharmacies in your area that reliably stock Trifluridine. Good candidates include:

• Hospital outpatient pharmacies (especially at institutions with ophthalmology departments)
• Independent pharmacies near your practice
• Specialty compounding pharmacies

Keep a list at your front desk or in your EHR for easy reference when writing prescriptions. Call these pharmacies periodically to confirm they still carry Trifluridine.

Step 2: Direct Patients to Medfinder

Medfinder for Providers allows you and your staff to check real-time Trifluridine availability at nearby pharmacies. You can:

• Search before the patient leaves your office
• Send the prescription electronically to a pharmacy that has it in stock
• Give patients the Medfinder link so they can check on their own

This single step can eliminate the cycle of patients calling multiple pharmacies and calling your office back in frustration.

Step 3: Keep Samples on Hand

If your practice can obtain Trifluridine samples from manufacturer representatives or through purchasing agreements, keep a small supply for acute cases. This allows you to start treatment immediately while the patient locates a pharmacy with stock for their ongoing supply.

Step 4: Have a Ready Alternative Protocol

When Trifluridine is unavailable, be prepared to pivot quickly. A pre-built alternative protocol saves time and reduces patient anxiety:

• First alternative: Ganciclovir ophthalmic gel 0.15% (Zirgan) — one drop five times daily until healed, then three times daily for seven days
• Second alternative: Oral Valacyclovir 500 mg–1,000 mg two to three times daily, with or without topical therapy
• Budget option: Generic oral Acyclovir 400 mg five times daily — widely available at $10–$30 per course

Document your alternative protocols so support staff can assist with prescription changes efficiently.

Step 5: Proactive Prescription Management

For patients with recurrent herpetic keratitis who will need Trifluridine again:

• Write prescriptions with refills before the patient runs out
• Advise patients to request their refill one to two weeks early
• Discuss prophylactic oral antiviral therapy to reduce recurrence frequency
• Encourage patients to bookmark Medfinder for future searches

Alternatives to Trifluridine: Quick Reference

Here's a quick comparison for your clinical decision-making:

• Ganciclovir gel 0.15% (Zirgan): Topical antiviral, FDA-approved for dendritic ulcers. Comparable efficacy. Cash price $500–$700.
• Oral Acyclovir: 400 mg five times daily. Well-studied for HSV keratitis. Cash price $10–$30.
• Oral Valacyclovir: Better bioavailability than Acyclovir. 500 mg–1,000 mg two to three times daily. Cash price $15–$50.

For a detailed comparison, see our clinical article: Trifluridine shortage — what providers need to know.

Workflow Tips for Your Practice

• Front desk protocol: When scheduling follow-ups for herpetic keratitis patients, have staff verify Trifluridine availability before the visit so you can adjust the treatment plan in real time
• EHR templates: Create an order set that includes Trifluridine as first choice with Ganciclovir gel and oral antivirals as automatic alternatives
• Patient handout: Create a one-page sheet with Medfinder instructions, local pharmacy contacts, and basic information about alternative treatments. Share our patient guide: How to find Trifluridine in stock near you
• Staff training: Ensure your technicians and support staff know how to use Medfinder and can help patients navigate availability issues

Final Thoughts

Trifluridine supply challenges are frustrating for providers and patients alike, but a proactive approach can minimize the impact on patient care. By building a local pharmacy network, using tools like Medfinder, and having alternative protocols ready, you can ensure your patients get effective antiviral treatment without unnecessary delays.

For more provider resources, visit Medfinder for Providers. See also our companion article: How to help patients save money on Trifluridine.