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

Furosemide (Lasix) injection has been on the ASHP drug shortage list since April 2020, and as of 2026, the shortage remains active across multiple manufacturers. Furosemide oral solution entered shortage in March 2026. For clinicians managing heart failure, renal disease, and fluid overload — conditions where furosemide is often the backbone of therapy — this ongoing shortage requires strategic planning, proactive patient communication, and familiarity with evidence-based therapeutic alternatives.

Current ASHP Shortage Status (2026)

As of 2026, the furosemide landscape by formulation:

Furosemide injection (10 mg/mL): Active shortage. Manufacturers with available supply include Avenacy, Avet Pharmaceuticals, Baxter, Devatis, Eugia, Fresenius Kabi, and Meitheal. American Regent is not actively marketing; Amneal has discontinued. Pfizer has limited supply with projected recovery dates extending through 2027 for some vial sizes. Hikma reported back order on select vial sizes with estimated release in early 2026.

Furosemide oral solution (10 mg/mL): Active shortage as of March 2026 due to shortage of an inactive ingredient component. Estimated return to availability is TBD. Furosemide 40 mg/5 mL oral solution and 10 mg/mL solution all affected.

Furosemide tablets (20 mg, 40 mg, 80 mg): Not in national shortage. Multiple generic manufacturers are producing tablets, and retail pharmacies generally have adequate supply.

Clinical Management: Therapeutic Alternatives to Furosemide Injection

When IV furosemide is unavailable or in limited supply, the following alternatives should be considered based on clinical context:

Option 1: IV-to-Oral Furosemide Conversion

For patients who can tolerate oral medications, IV-to-oral furosemide conversion is the most straightforward approach. Due to furosemide's variable oral bioavailability (average ~60–64% vs 100% IV), the oral dose is typically doubled from the IV dose. Example: IV furosemide 20 mg → oral furosemide 40 mg. Monitor fluid status, urine output, and electrolytes closely during conversion.

Option 2: IV Bumetanide

IV bumetanide is an effective and often available alternative for acute decongestion. Key pharmacologic considerations:

Dose equivalence: Bumetanide 1 mg IV ≈ Furosemide 40 mg oral / 20 mg IV

Bumetanide is 40x more potent than furosemide on a mg-per-mg basis

Onset: 15–30 minutes IV; peak effect at 15–45 minutes

Duration: 4–6 hours; may require more frequent dosing than furosemide for equivalent 24-hour diuresis

Side effect profile: Similar to furosemide; risk of hypokalemia, hyponatremia, ototoxicity at high doses

Option 3: Subcutaneous Furosemide (Lasix ONYU / Furoscix)

FDA approved in October 2025, Lasix ONYU (formerly Furoscix) is a subcutaneous on-body infusor delivering 30 mg furosemide over 1 hour followed by 12.5 mg/hour for 4 hours (total 80 mg over 5 hours). It is indicated for treatment of edema in adult outpatients with chronic heart failure. This device enables provider-supervised diuresis without hospital IV access, potentially reducing hospital admissions for volume overload management. SQ Innovation secured a long-term API supply agreement in April 2026 to ensure availability.

Option 4: Oral Torsemide for Outpatient Transition

For stable outpatients being discharged on oral loop diuretic therapy, torsemide offers pharmacological advantages that may improve adherence and outcomes:

Oral bioavailability: 80–100% (vs. furosemide's wide range of 10–79%)

Duration: 12–16 hours, enabling once-daily dosing

Dose conversion: 10–20 mg torsemide PO ≈ 40 mg furosemide PO

Less affected by food intake and gut edema than furosemide

Some data suggests torsemide may have additional anti-fibrotic effects via the RAAS system that could benefit heart failure patients beyond diuresis. However, the large TRANSFORM-HF randomized trial showed no statistically significant mortality difference vs. furosemide, and internal validity concerns limit interpretation.

Oral Solution Alternative for Patients Who Cannot Swallow Tablets

With the oral solution in shortage, consider these options for patients requiring liquid formulations:

Furosemide tablets can be crushed and mixed with food or water — consult with pharmacy about compounding options

Compounding pharmacies may prepare oral furosemide suspensions when commercial oral solution is unavailable

Furosemide 40 mg/5 mL oral solution (alternative concentration) may be available when 10 mg/mL is not — check with your pharmacy and wholesaler

Communicating the Shortage to Your Patients

Patients managing heart failure or kidney disease depend on furosemide for symptom control. When they encounter a pharmacy saying "we're out of stock," it can cause significant anxiety. Here is a framework for proactive communication:

Reassure patients that furosemide tablets are generally available and the shortage primarily affects injectable and oral solution formulations

Instruct patients never to skip doses without calling your office first

Provide a list of alternative pharmacies or recommend patients use a tool like medfinder to locate stock near them

For patients at highest risk (advanced HF, CKD, low margin for missed doses), ensure prescriptions are written for 90-day supply and consider early transition to mail-order pharmacy

Helping Patients Navigate the Pharmacy Landscape

For practices managing large panels of heart failure or nephrology patients, medfinder for providers is a service that contacts pharmacies on behalf of patients to identify which ones have the medication in stock — reducing the burden on your care team and your patients to call multiple pharmacies. Results are texted directly to the patient.