Iopidine Shortage: What Providers and Prescribers Need to Know in 2026

Apraclonidine (Iopidine) availability has been an intermittent concern for ophthalmology practices and surgical centers. While not always making headlines like shortages of GLP-1 agonists or stimulant medications, the limited supply of this alpha-2 adrenergic agonist can create real workflow disruptions — especially when patients can't fill their 0.5% prescriptions or when surgical centers need 1% formulations for perioperative IOP management.

This briefing covers the current state of Apraclonidine supply, prescribing implications, cost and access considerations, and tools to help your patients and practice navigate availability challenges in 2026.

Current Shortage Status and Timeline

As of early 2026, Apraclonidine is not listed on the FDA Drug Shortage Database or the ASHP shortage list. There is no formally recognized national shortage.

However, the practical reality is more nuanced. Apraclonidine has a limited manufacturer base — only a few companies produce generic formulations, and Alcon remains the primary source for the 1% surgical formulation. This creates a supply chain that is susceptible to disruption. Historically, Apraclonidine has experienced intermittent regional supply gaps, and providers should be aware that pharmacy-level stockouts can occur without triggering a formal shortage designation.

Key timeline points:

• Original approval: Iopidine 1% was approved by the FDA for perioperative IOP management. Iopidine 0.5% was subsequently approved for short-term adjunctive therapy in glaucoma.
• Generic availability: Generic Apraclonidine 0.5% has been available for several years, but the number of active manufacturers remains limited.
• Recent years: No formal shortage has been declared, but sporadic supply disruptions have been reported by dispensing pharmacies and ophthalmology practices.

Prescribing Implications

The supply dynamics of Apraclonidine have several implications for prescribing providers:

Short-Term Use Profile

Apraclonidine 0.5% is indicated only for short-term adjunctive IOP reduction — it is not a first-line or maintenance therapy. The high incidence of local allergic reactions (reported in up to 48% of patients with prolonged use) limits its utility beyond a few weeks. This means demand is episodic rather than continuous, which contributes to pharmacies not stocking it routinely.

Surgical Use (1% Formulation)

The 1% formulation is used perioperatively for argon laser trabeculoplasty, argon laser iridotomy, and Nd:YAG posterior capsulotomy. Surgical centers should maintain adequate on-hand supply and consider Brimonidine 0.2% as a readily available substitute when needed. Studies have demonstrated Brimonidine's efficacy in preventing post-laser IOP spikes, and it is often preferred due to its better side effect profile.

Formulary and Prior Authorization

Many insurance formularies position Apraclonidine as a non-preferred or prior-authorization-required medication, instead directing patients toward Brimonidine as the preferred alpha agonist. Prescribers should be prepared for potential insurance barriers and should consider specifying "generic Apraclonidine" on prescriptions to minimize coverage issues.

Availability Picture in 2026

The availability of Apraclonidine varies by formulation and setting:

• Generic Apraclonidine 0.5% (5 mL bottle): Available from a limited number of generic manufacturers. Stocking varies widely by pharmacy. Chain pharmacies may not carry it routinely; independent and specialty pharmacies are more likely to stock or quickly order it.
• Iopidine 1% (single-use dispensers): Distributed by Alcon. Primarily used in surgical settings. Ambulatory surgery centers and hospital pharmacies typically maintain stock; retail availability is very limited.

Providers can help patients locate pharmacies with current stock by recommending Medfinder for providers, which offers real-time pharmacy availability data.

Cost and Access Considerations

Cost can be a barrier for patients, particularly those without insurance or with high-deductible plans:

• Average retail price (generic 0.5%, 5 mL): $86-$128
• With discount coupons (GoodRx, SingleCare): $13-$68
• Brand Iopidine 0.5%: Up to $183
• Brand Iopidine 1% (surgical): Approximately $58 per unit

Patient assistance options:

• Alcon Cares Patient Assistance Program: May provide Alcon medications at no cost for eligible uninsured patients. Application must be initiated by a prescribing provider.
• Prescription discount cards: GoodRx, SingleCare, and RxSaver offer significant discounts on generic Apraclonidine at participating pharmacies.
• NeedyMeds and RxAssist: Databases that can help identify additional assistance programs.

For a patient-facing resource on costs and savings, direct patients to our guide on saving money on Iopidine.

Tools and Resources for Providers

Several tools can help your practice manage Apraclonidine access challenges:

Medfinder for Providers

Medfinder enables real-time pharmacy stock searches, helping your staff identify which pharmacies in your area currently have Apraclonidine available. This can be incorporated into your prescription workflow — check availability before sending the prescription to avoid patient frustration.

Therapeutic Substitution Protocols

Consider developing a practice protocol for Apraclonidine substitution when supply is unavailable:

• For 0.5% (adjunctive IOP therapy): Brimonidine 0.15% or 0.2% is the most direct substitute. Timolol 0.5% or Dorzolamide 2% are alternatives from different drug classes.
• For 1% (perioperative use): Brimonidine 0.2% is well-supported by evidence for post-laser IOP management and is readily available.

ASHP and FDA Monitoring

Subscribe to ASHP drug shortage alerts at ashp.org/drug-shortages to receive notifications if Apraclonidine is formally added to the shortage list.

Looking Ahead

The supply situation for Apraclonidine is unlikely to change dramatically in the near term. The small patient population and niche indication make it an unlikely candidate for new generic entrants. Providers should:

• Maintain awareness of the limited supply landscape
• Have substitution protocols in place
• Use tools like Medfinder to streamline pharmacy selection
• Educate patients about the importance of planning refills in advance

For the patient perspective on this issue, see our post on what patients need to know about the Iopidine shortage in 2026.

Final Thoughts

Apraclonidine remains a useful tool in the ophthalmologist's armamentarium, particularly for perioperative IOP management and short-term adjunctive therapy. While formal shortages have not been declared, the practical supply challenges are real. By incorporating availability-checking tools, having substitution protocols, and proactively managing patient expectations around access and cost, providers can minimize disruption to patient care.

Additional resources: How to help your patients find Iopidine in stock | How to help patients save money on Iopidine