Methotrexate Shortage Update: What Patients Need to Know in 2026

Methotrexate — a critical treatment for rheumatoid arthritis, psoriasis, leukemia, and other cancers — has been on the FDA's official drug shortage list since March 13, 2023. Here is the most current update for patients managing this shortage in 2026.

Current Shortage Status (2026 Update)

As of 2026, methotrexate injection remains on the FDA Drug Shortage Database. The shortage is not uniform — it depends heavily on which manufacturer, vial size, and concentration you need. Here is the current picture by manufacturer:

Fresenius Kabi: Generally available across most formulations

Hikma Pharmaceuticals: Generally available

Pfizer: Available but has had intermittent allocation periods

Accord Healthcare: Some formulations on back order; restarted production in late 2023 but certain vial sizes remain constrained

Teva: On allocation due to increased demand; some formulations intermittently available

Oral methotrexate tablets (2.5 mg) remain more widely available and are generally stocked at most retail pharmacies.

What Caused This Shortage?

The methotrexate injection shortage has two primary causes:

Manufacturing quality failures: In early 2023, an FDA inspection of a key manufacturing facility uncovered quality control problems, causing the plant to halt production. This single event disrupted supply chains for multiple generic injectable chemotherapy drugs simultaneously.

Low-margin market failure: Methotrexate is a decades-old generic with thin profit margins. Few manufacturers maintain large production reserves for low-margin drugs, making supply chains fragile.

Which Patients Are Most Affected?

The shortage has had the most severe impact on:

Pediatric leukemia patients requiring intrathecal (spinal) methotrexate — a preservative-free formulation that cannot be substituted

Adult cancer patients on high-dose IV methotrexate protocols for lymphoma, osteosarcoma, or breast cancer

RA and psoriasis patients on subcutaneous injections who cannot tolerate or absorb oral methotrexate adequately

Is the Shortage Expected to Resolve?

The short answer: improvement is ongoing, but a full resolution is not guaranteed in the near term. Accord resumed production in late 2023, and additional manufacturers have been authorized to supply the U.S. market. However, the structural problem — too few manufacturers for a critical, low-margin drug — remains. Patients and providers should plan for continued variability in availability through 2026.

What Should Patients Do Right Now?

Don't wait until you're out: Start looking for your next fill 2–3 weeks before you run out

Call your doctor: If injectable methotrexate is unavailable, ask about switching to oral tablets for autoimmune indications

Use a pharmacy search service: Services that call pharmacies on your behalf can save significant time in a shortage

Check hospital pharmacies: For injectable formulations, hospital outpatient pharmacies often have better access than retail chains

If you're struggling to locate your dose, medfinder can call pharmacies near you and find who has it in stock. If none are available, see our guide on methotrexate alternatives to discuss options with your doctor.