The Hydroxocobalamin Shortage in 2026: Here's What's Happening

If you depend on Hydroxocobalamin — the injectable form of vitamin B12 used to treat pernicious anemia and B12 deficiency — you've probably felt the impact of the ongoing drug shortage. In 2026, finding this medication at your local pharmacy can feel nearly impossible.

This post breaks down everything you need to know: whether Hydroxocobalamin is still in shortage, why it's hard to find, what it costs, what new options exist, and how you can locate it in stock today.

Is Hydroxocobalamin Still in Shortage?

Yes. As of early 2026, Hydroxocobalamin injection remains in short supply across the United States. Here's the current situation:

• Generic IM injection (1000 mcg/mL, 30 mL vial): Actavis Pharma / Hikma Farmaceutica — the primary U.S. manufacturer of the generic intramuscular formulation — reported the product as temporarily unavailable in December 2025 due to a shortage of active ingredient. Estimated resupply: June 2026.
• Cyanokit IV (5 g, for cyanide poisoning): Serb Pharmaceuticals placed batches on hold due to a quality issue at their contract manufacturer related to sterility assurance. The FDA allowed certain batches to be released after they met testing specifications, but the supply remains limited.

The FDA and ASHP (American Society of Health-System Pharmacists) continue to monitor the shortage and provide updates as they become available.

Why Is Hydroxocobalamin Hard to Find?

The current shortage is the result of several overlapping problems:

Active Ingredient Supply Disruption

The main reason the generic IM injection is unavailable is a shortage of the active pharmaceutical ingredient (API) needed to manufacture Hydroxocobalamin. When the raw material supply is disrupted, manufacturers simply can't produce the drug — no matter how much demand exists.

Limited Manufacturing Base

Very few companies manufacture Hydroxocobalamin injection for the U.S. market. Hikma/Actavis is the dominant generic supplier. When that single supplier goes offline, there's no backup capacity to absorb the demand.

Quality Issues With Cyanokit

Serb Pharmaceuticals' Cyanokit — the IV formulation used for cyanide poisoning — has faced recurring quality concerns. While this formulation serves a different purpose than the routine B12 injection, it further strains the overall Hydroxocobalamin supply chain.

Growing Demand

Demand for injectable B12 has been rising. More patients are being diagnosed with B12 deficiency, and wellness clinics and integrative medicine practices have increased their use of B12 injections. This added demand compounds the supply problem.

For more background, read our detailed post on why Hydroxocobalamin is so hard to find.

How Much Does Hydroxocobalamin Cost in 2026?

When you can find it, here's what you can expect to pay:

Generic IM Injection (1000 mcg/mL, 30 mL vial)

• Average cash price: $47 to $58
• With GoodRx coupon: As low as $20.86
• With SingleCare coupon: Around $33
• With insurance: Most plans cover generic B12 injections with low copays, often $5 to $20

Cyanokit IV (5 g, emergency use)

• Cash price: $3,400 to $4,300 per kit
• Covered by insurance as an emergency medication — patients rarely pay out of pocket

Compounded Hydroxocobalamin

• Varies by pharmacy and concentration — typically $30 to $80 for a multi-dose vial
• May not be covered by insurance

For more ways to reduce your costs, check out our guide on saving money on Hydroxocobalamin.

New Options and Developments in 2026

Compounding Pharmacies Filling the Gap

Compounding pharmacies have become a critical resource during this shortage. These pharmacies can prepare Hydroxocobalamin injections from raw materials in various concentrations (such as 10 mg/mL or 20 mg/mL). Some ship nationwide, making them accessible to patients across the country.

Telehealth B12 Prescriptions

Several telehealth platforms — including Heally and Hone Health — now offer B12 injection prescriptions online. They partner with compounding pharmacies or specialty pharmacies that may have Hydroxocobalamin in stock, delivering directly to your door.

Cyanocobalamin as a Bridge

Many doctors are temporarily switching patients from Hydroxocobalamin to Cyanocobalamin injections, which remain more widely available. While Cyanocobalamin requires more frequent dosing (monthly vs. every 2-3 months), it effectively maintains B12 levels for most patients. Read about all your options in our alternatives guide.

How to Find Hydroxocobalamin in Stock Right Now

If you're looking for Hydroxocobalamin today, here are the best strategies:

1. Search on Medfinder: Visit medfinder.com and search for Hydroxocobalamin near your zip code to see which pharmacies currently have it.
2. Contact compounding pharmacies: Compounding pharmacies often have supply when retail pharmacies don't. Ask your doctor for a compounding-friendly prescription.
3. Check independent pharmacies: Locally owned pharmacies may use different wholesalers and have stock.
4. Call early in the week: Pharmacy deliveries often arrive Monday or Tuesday.
5. Ask about backorders: Your pharmacist may be able to put you on a notification list for when stock arrives.

For a comprehensive walkthrough, see our post on how to find Hydroxocobalamin in stock near you.

Final Thoughts

The Hydroxocobalamin shortage is a real challenge for patients in 2026, but it's not insurmountable. The generic IM injection is expected to return by mid-2026, and in the meantime, compounding pharmacies, telehealth prescriptions, and alternative B12 formulations can help bridge the gap.

The key is to stay proactive: use tools like Medfinder to track availability, talk to your doctor about your options, and don't skip your B12 treatment. B12 deficiency is serious — especially for patients with pernicious anemia — and maintaining consistent treatment protects your nerve health and overall well-being.

Be sure to check out our posts on Hydroxocobalamin side effects and drug interactions for more helpful information about this medication.