Provider Briefing: Itraconazole Supply in 2026

If your patients are reporting difficulty filling Itraconazole prescriptions, the reports are consistent with broader supply trends. Itraconazole — a workhorse triazole antifungal for conditions ranging from onychomycosis to life-threatening systemic mycoses — has experienced intermittent availability issues that show no signs of fully resolving in 2026.

This briefing covers the current supply landscape, prescribing implications, cost and access considerations, and practical tools to help your patients maintain continuity of care.

Timeline: How We Got Here

Itraconazole supply disruptions are not new. Key milestones include:

• 2019: The Itraconazole oral solution began experiencing intermittent shortages due to manufacturing issues at key production facilities.
• 2020–2021: COVID-19 pandemic exacerbated global pharmaceutical supply chain disruptions. Raw material sourcing from limited API (active pharmaceutical ingredient) suppliers became unreliable.
• 2022–2023: Rising demand for antifungals driven by increasing fungal disease burden — more immunocompromised patients, geographic expansion of endemic mycoses, and post-COVID fungal complications (including mucormycosis globally).
• 2024–2025: Multiple generic manufacturers experienced production delays. Oral solution availability remained inconsistent. Capsule supply stabilized somewhat but continued to face regional gaps.
• 2026: Generic capsules remain the most reliably available formulation. Oral solution shortages persist intermittently. Brand products (Sporanox, Tolsura, Onmel) have limited but consistent distribution through specialty channels.

Prescribing Implications

The availability picture directly affects prescribing decisions in several ways:

Formulation Considerations

Itraconazole capsules and oral solution are not interchangeable. Key differences:

• Capsules (100 mg): Require gastric acid for absorption. Must be taken with food, preferably a fatty meal. Absorption is reduced by PPIs, H2 blockers, and antacids. Multiple generic manufacturers.
• Oral solution (10 mg/mL): Better bioavailability than capsules (approximately 30% higher). Should be taken on an empty stomach. Swish and swallow. Contains cyclodextrin carrier — use with caution in renal impairment. Fewer manufacturers, more supply-vulnerable.
• Tolsura (65 mg SUBA-itraconazole): Super bioavailability formulation. 65 mg Tolsura provides comparable exposure to 100 mg conventional capsules. Can be taken without regard to food or gastric pH. May be a practical alternative when patients have absorption concerns or cannot take capsules with food.

When to Consider Switching Agents

If Itraconazole is unavailable and a therapeutic delay is unacceptable, consider these evidence-based alternatives:

• Onychomycosis: Terbinafine 250 mg daily is actually the preferred first-line agent in many guidelines (IDSA, AAD) with higher mycological cure rates. Fluconazole 150–300 mg weekly is a third-line option.
• Blastomycosis (mild-moderate): Itraconazole remains preferred. Voriconazole and Fluconazole are second-line alternatives. Lipid formulation Amphotericin B for severe disease.
• Histoplasmosis (mild-moderate): Itraconazole is first-line. Fluconazole 400–800 mg daily is an alternative for mild disease. Voriconazole or Posaconazole for refractory cases.
• Aspergillosis: Voriconazole is actually first-line for invasive aspergillosis. Itraconazole is used for chronic/allergic forms. Posaconazole and Isavuconazole are alternatives.
• Oropharyngeal/esophageal candidiasis: Fluconazole is first-line. Posaconazole for Fluconazole-refractory cases.

For a patient-facing summary of alternatives, see alternatives to Itraconazole.

The Availability Picture

Current availability by formulation:

• Generic capsules 100 mg: Moderate-to-good availability. Multiple manufacturers (Teva, Lannett, Patriot, others). Regional shortages occur but typically resolve within 1–2 weeks.
• Sporanox capsules 100 mg: Limited availability. Not routinely stocked at most retail pharmacies. Available through specialty distributors.
• Oral solution 10 mg/mL: Intermittent shortages. Single-digit number of manufacturers. Most vulnerable formulation.
• Tolsura 65 mg: Available through specialty channels. Not stocked at most chain pharmacies but can be ordered.
• Onmel 200 mg tablets: Limited distribution. Specialty pharmacy access.

Providers can direct patients to Medfinder for Providers to check real-time pharmacy availability in their area.

Cost and Access Considerations

Cost remains a significant access barrier, particularly for uninsured and underinsured patients:

• Generic capsules: $30–$150/month cash price. As low as $15–$30 with discount cards (GoodRx, SingleCare).
• Brand Sporanox: $600–$900+/month cash price.
• Tolsura: $500–$800/month cash price.
• Oral solution: $200–$500/month cash price.

Most commercial insurance plans cover generic Itraconazole capsules as Tier 2. Brand products typically require prior authorization with documented generic failure or intolerance. Medicare Part D plans vary but generally cover the generic.

For patients with financial barriers, consider:

• Prescription discount cards (GoodRx, SingleCare, RxSaver)
• NeedyMeds and RxAssist patient assistance program databases
• 340B pricing at eligible health centers and hospitals
• State pharmaceutical assistance programs

Tools and Resources for Your Practice

Real-Time Availability Checking

Medfinder for Providers enables your care team to check which pharmacies near your patient have Itraconazole in stock before sending the prescription, reducing callback burden and improving patient satisfaction.

Patient Education Resources

Direct patients to these resources:

• What is Itraconazole? — Overview of uses, dosage, and key information
• Itraconazole side effects — What to expect and when to seek help
• Itraconazole drug interactions — Critical interaction information for patients
• Saving money on Itraconazole — Discount cards, coupons, and assistance programs

Monitoring Reminders

For patients on prolonged Itraconazole therapy, ensure appropriate monitoring:

• Baseline and periodic LFTs (hepatotoxicity risk, including rare fatal cases)
• Signs and symptoms of CHF (negative inotropic effect — boxed warning)
• Drug interaction review at each visit (potent CYP3A4 inhibitor)
• Therapeutic drug monitoring for serious systemic infections (trough levels)

Looking Ahead

The antifungal supply landscape is evolving. Several factors may improve Itraconazole access over time:

• New generic manufacturers entering the market
• Improved API supply chain diversification
• Tolsura's SUBA formulation gaining broader insurance coverage and pharmacy stocking
• New antifungal agents in development (Olorofim, Fosmanogepix) may eventually reduce demand pressure on existing azoles

However, the underlying drivers of increased antifungal demand — growing immunocompromised populations, climate-driven fungal disease expansion — are likely to persist.

Final Thoughts

Itraconazole remains an essential antifungal, but supply challenges require proactive management. Consider formulation flexibility, know your alternative agents for each indication, and leverage tools like Medfinder for Providers to streamline access for your patients. Staying ahead of supply issues protects treatment continuity and patient outcomes.