Imuran Shortage Update: What Patients Need to Know in 2026

If you take Imuran (azathioprine) for a kidney transplant, rheumatoid arthritis, inflammatory bowel disease, or another condition, you may have noticed increased difficulty filling your prescription. This update covers the current state of the Imuran supply in 2026, what is and isn't in shortage, and practical steps you can take to keep your therapy on track.

Current Shortage Status: Injectable vs. Oral Azathioprine

The Imuran shortage in 2026 is a tale of two formulations:

Injectable azathioprine (100 mg vials): Formally in shortage. Hikma, one of the primary manufacturers of azathioprine sodium 100 mg vials, placed this product on back order in late 2024 with no estimated release date. This formulation is on the FDA's official drug shortage list and primarily affects hospitals and infusion centers serving patients who cannot take oral medications.

Oral azathioprine tablets (50 mg generics, Imuran brand): Not in formal shortage. Oral tablets are not on the FDA's shortage list, and multiple generic manufacturers continue to produce them. However, patients are experiencing intermittent difficulty at individual pharmacy locations due to distribution unevenness. The problem is less about total supply and more about how that supply is allocated across the country.

What Is Causing the Oral Availability Problems?

Even though oral tablets are technically available, several factors make them harder to find at any specific pharmacy on any given day:

Limited manufacturer base. A small number of companies produce generic azathioprine in the U.S. Any quality issue or raw material delay can tighten supply quickly.

Injectable shortage spillover. When hospitals can't get IV azathioprine, some crush oral tablets for patients who cannot swallow, directly competing with retail demand.

Wide prescription base. Azathioprine is prescribed by at least five different specialties. Demand is broad and continuous — there are no seasonal troughs to build up buffer stock.

Wholesaler allocation patterns. Major chain pharmacies may receive priority allocations during periods of tight supply, leaving smaller and independent pharmacies with less or no stock.

The History of Imuran Shortages

This is not the first time azathioprine supply has been stressed. From 2014 to 2016, oral azathioprine tablets experienced a documented shortage when multiple manufacturers had problems sourcing active pharmaceutical ingredient (API) and at least one manufacturer exited the market entirely. That shortage resolved when new generic suppliers entered. The current injectable shortage is more persistent, with no end date announced as of early 2026.

How Much Does Imuran Cost Right Now?

Generic azathioprine 50 mg tablets remain among the most affordable immunosuppressants available:

With a GoodRx or SingleCare coupon: as low as $13–$17 for 30 tablets (50 mg)

Without a coupon: $40–$70 for a 30-day supply

With insurance: Typically Tier 1 or Tier 2; copays of $5–$25 on most plans

Brand Imuran tablets: Significantly higher cost at full retail price

What Should You Do If Your Pharmacy Is Out?

The most important step is not to miss doses without medical guidance. Here is what to do:

Contact your prescriber right away — especially if you're a transplant patient.

Ask your pharmacist to check with their wholesaler for incoming stock or alternative generic sources.

Use medfinder to quickly identify which pharmacies in your area currently have azathioprine in stock.

Ask your doctor about a 90-day supply to reduce refill frequency when you do find stock.

Outlook for 2026

The oral azathioprine supply situation is expected to remain manageable through 2026, though individual pharmacy-level gaps will continue. The injectable shortage timeline remains uncertain pending manufacturer resolution. Patients who plan ahead, use 90-day supplies, and use tools like medfinder are best positioned to maintain uninterrupted therapy. If you're unable to find Imuran, read about alternatives to Imuran to discuss with your doctor.