Provider Briefing: Muro 128 Supply in 2026

The intermittent shortage of Muro 128 (Sodium Chloride Hypertonicity Ophthalmic, Bausch + Lomb) has been an ongoing challenge for eye care providers and their patients. If you're an ophthalmologist, optometrist, or primary care provider who prescribes this product, here's what you need to know about the current supply situation, prescribing considerations, and tools to help your patients access treatment.

Shortage Timeline

Muro 128 availability issues have followed a recurring pattern since 2020:

• 2020-2021: Initial supply disruptions emerge, primarily affecting the 5% ointment formulation. Manufacturing slowdowns at Bausch + Lomb facilities contribute to inconsistent distribution.
• 2022-2023: Shortage intensifies. Both the 5% drops and ointment are affected, with the ointment being particularly difficult for pharmacies to source. The FDA drug shortage database intermittently lists the product.
• 2024: Partial recovery in drop availability. Ointment supply remains unreliable. Generic Sodium Chloride 5% products from additional manufacturers begin to provide some relief.
• 2025-2026: Supply continues to fluctuate. The 5% drops are generally findable with effort; the 5% ointment remains the most supply-constrained formulation. The 2% concentration is relatively unaffected.

Prescribing Implications

The shortage has several practical implications for clinical practice:

Prescription Writing

Consider writing prescriptions for "Sodium Chloride 5% Ophthalmic Solution" rather than specifying "Muro 128" by brand name. This gives pharmacists the flexibility to fill with any available equivalent product — whether brand-name Muro 128, a generic, or another branded alternative like Sochlor.

If the ointment is specifically needed (e.g., for bedtime use in Fuchs' dystrophy patients), write for "Sodium Chloride 5% Ophthalmic Ointment" generically, with a note allowing therapeutic substitution.

Patient Counseling

Patients should be informed proactively about potential availability issues. Key counseling points include:

• The generic is therapeutically equivalent to Muro 128 — patients should accept it if offered
• Patients should refill early (with at least a week's supply remaining) to allow time to locate stock
• Independent pharmacies and compounding pharmacies may have better access
• Online stock-checking tools like Medfinder for Providers can help locate inventory

Treatment Plan Flexibility

For patients who cannot find the ointment, consider whether a drops-only regimen could be adequate, potentially with increased frequency. For patients who cannot find any hypertonic sodium chloride product, a compounded preparation from a reputable compounding pharmacy is a reasonable alternative.

Current Availability Picture

As of early 2026, the availability landscape looks like this:

• Muro 128 5% Drops: Moderately available. Most pharmacies can order it, though it may not be routinely stocked. Turnaround from order to shelf is typically 1-5 business days when the wholesaler has stock.
• Muro 128 5% Ointment: Limited availability. Many pharmacies report weeks-long gaps in supply. This is the formulation most likely to require alternative sourcing.
• Generic Sodium Chloride 5% (drops and ointment): Availability varies by manufacturer. Multiple generic options exist, which collectively offer better availability than relying on Muro 128 alone.
• Compounded preparations: Available on demand from compounding pharmacies. No supply constraints, though cost and insurance coverage vary.

Cost and Access Considerations

Understanding the cost landscape helps when counseling patients:

• Brand-name Muro 128: $20-$35 per unit (drops or ointment) at cash price
• Generic Sodium Chloride 5%: $10-$25 per unit
• Compounded preparations: $20-$50, typically not covered by insurance
• Insurance coverage: Most plans cover Muro 128 or generic equivalent with a $5-$20 copay. Some plans classify it as OTC and don't cover it.

Patients facing cost barriers can benefit from discount card programs (GoodRx, SingleCare, RxSaver) and patient assistance programs. Direct them to our provider's guide to helping patients save on Muro 128 for specific resources.

Tools and Resources for Your Practice

Several tools can help streamline the process of getting patients their medication:

Medfinder for Providers

Medfinder allows you and your staff to check real-time pharmacy stock for Muro 128 and alternatives. This can be integrated into your workflow when writing prescriptions — check availability first, then send the prescription to a pharmacy that has it.

Compounding Pharmacy Relationships

Establishing a relationship with one or two local compounding pharmacies ensures you have a fallback option when commercial products are unavailable. Some compounding pharmacies can prepare sterile ophthalmic products same-day.

Electronic Prescribing

Use your EHR's e-prescribing features to check pharmacy inventory before sending prescriptions. Some systems now integrate real-time stock data, allowing you to route prescriptions to pharmacies with confirmed availability.

Patient Education Materials

Consider sharing these patient-facing resources:

• How to Find Muro 128 in Stock Near You
• Alternatives to Muro 128
• How to Save Money on Muro 128

Looking Ahead

The hypertonic ophthalmic market remains fragile due to its small number of manufacturers and the specialized production requirements for sterile eye products. While additional generic manufacturers entering the space is a positive trend, the market is unlikely to achieve robust redundancy in the near term.

Providers should continue to:

• Write prescriptions generically to maximize pharmacy flexibility
• Maintain awareness of current availability through tools like Medfinder
• Proactively discuss alternative options with patients before they run out
• Consider compounding as a viable backup for the ointment formulation

Final Thoughts

The Muro 128 shortage is a supply-side problem that requires demand-side creativity. By prescribing generically, leveraging availability tools, and maintaining open communication with patients about alternatives, providers can minimize the clinical impact of this ongoing shortage.

For a patient-facing version of this information, see our Muro 128 shortage update for patients. For guidance on helping individual patients locate stock, see our provider's guide to helping patients find Muro 128.