Provider Briefing: Natacyn (Natamycin) Availability in 2026

Natacyn (Natamycin ophthalmic suspension 5%) remains the sole FDA-approved topical antifungal for ophthalmic use in the United States. For providers managing fungal keratitis, conjunctivitis, and blepharitis, understanding the current supply landscape is essential to ensuring timely patient care.

This briefing covers the current availability picture, prescribing considerations, alternative therapies, cost and access challenges, and tools to help your patients find Natacyn in stock.

Timeline and Current Status

Natacyn has been available in the U.S. since its FDA approval in 1978. Manufactured exclusively by Alcon Laboratories (Fort Worth, Texas), it has remained a single-source branded product with no FDA-approved generic throughout its market history.

Key timeline points:

• 1955: Natamycin (pimaricin) discovered
• 1978: FDA approval of Natacyn for ophthalmic fungal infections
• 2008: Most recent FDA label revision
• 2026: No generic approved; Alcon remains sole manufacturer

As of February 2026, Natacyn is not listed on the FDA Drug Shortage database. However, intermittent supply disruptions and limited retail pharmacy stocking continue to create access barriers for patients.

Prescribing Implications

Indications

Natacyn is indicated for fungal blepharitis, conjunctivitis, and keratitis caused by susceptible organisms, including Fusarium solani, Aspergillus, Candida, Cephalosporium, and Penicillium.

Dosing Protocol

• Fungal keratitis: 1 drop every 1-2 hours initially, reducing to 6-8 times daily after 3-4 days
• Blepharitis/conjunctivitis: 4-6 times daily
• Duration: 14-21 days; consider gradual taper at 4-7 day intervals

Pharmacokinetic Considerations

Natamycin achieves therapeutic concentrations in the corneal stroma but demonstrates poor intraocular penetration. It is not effective as monotherapy for fungal endophthalmitis. Systemic absorption following topical ophthalmic administration is negligible.

Clinical Pearl

If keratitis does not improve after 7-10 days of Natacyn therapy, consider that the causative organism may not be susceptible. Re-evaluate clinically and obtain additional cultures and sensitivity testing.

Current Availability Picture

Despite no official shortage, providers should be aware of several practical access challenges:

• Limited retail stocking: Most chain pharmacies (CVS, Walgreens, Rite Aid) do not carry Natacyn as a routine inventory item
• Single-source vulnerability: Any manufacturing or distribution disruption has immediate market impact
• Special-order delays: Patients requiring urgent treatment may face 1-3 business day delays when pharmacies must order from wholesalers
• No generic competition: The absence of generic alternatives keeps supply concentrated and prices elevated

Providers managing acute fungal keratitis should proactively address pharmacy availability at the time of prescribing rather than assuming the patient will be able to fill without difficulty.

Cost and Access Considerations

The financial burden on patients is significant:

• Cash price: $400-$700 per 15 mL bottle
• Insurance: Often requires prior authorization; may fall under medical benefit when dispensed in-office
• Patient assistance: Alcon may offer assistance for eligible uninsured/underinsured patients (1-800-757-9195)

For patients facing cost barriers, providers should consider:

• Initiating prior authorization early to minimize delays
• Exploring in-office dispensing where permitted
• Referring patients to patient assistance resources
• Considering compounded alternatives when clinically appropriate

Alternative Therapies

When Natacyn is unavailable or clinically suboptimal, the following compounded alternatives are widely used in ophthalmology practice:

Voriconazole 1% Ophthalmic Solution (Compounded)

• Triazole antifungal with superior corneal penetration
• Effective against Fusarium, Aspergillus, and other filamentous fungi
• Can be supplemented with oral Voriconazole for deep infections
• Requires sterile compounding pharmacy

Amphotericin B 0.15%-0.5% Ophthalmic Solution (Compounded)

• Polyene antifungal (same class as Natamycin)
• Particularly effective against Candida species
• Higher irritation profile than Natacyn
• Requires sterile compounding pharmacy

Fluconazole 0.2% Ophthalmic Solution (Compounded)

• Triazole antifungal with good ocular tissue penetration
• Best suited for Candida keratitis
• Limited activity against filamentous fungi

Note: None of these alternatives are FDA-approved as ophthalmic formulations. Clinical judgment should guide selection based on culture results, infection severity, and patient factors.

Tools and Resources for Providers

To help your patients access Natacyn and navigate availability challenges:

• Medfinder for Providers — Search pharmacy inventory for Natacyn availability in your patient's area
• Alcon Customer Service: 1-800-757-9195 for supply inquiries and patient assistance
• FDA Drug Shortage Database: accessdata.fda.gov/scripts/drugshortages for official shortage updates
• NeedyMeds: needymeds.org for patient assistance program information

For detailed workflow recommendations, see our companion guide: How to Help Your Patients Find Natacyn in Stock.

Looking Ahead

Several factors will shape Natacyn access going forward:

• Generic pipeline: No FDA-approved generics have been announced, though the market opportunity exists for generic manufacturers
• Compounding regulation: FDA oversight of compounding pharmacies continues to evolve, which may affect availability of compounded alternatives
• New antifungal development: Research into novel ophthalmic antifungal formulations continues, though no products are in late-stage clinical trials as of early 2026

In the meantime, maintaining relationships with specialty pharmacies and compounding facilities ensures your practice can provide timely treatment regardless of Natacyn availability fluctuations.

Final Thoughts

Natacyn remains an essential medication in the ophthalmology armamentarium. While it is not in official shortage, the practical reality of limited stocking, single-source manufacturing, and high cost means providers must be proactive about access.

Key recommendations:

• Verify pharmacy availability before the patient leaves your office
• Consider in-office dispensing for acute cases
• Maintain compounding pharmacy relationships for alternatives
• Direct patients to Medfinder to find pharmacies with stock
• Address cost concerns early with prior authorization and assistance programs

By anticipating access challenges and having contingency plans in place, providers can ensure that patients with fungal eye infections receive prompt, effective treatment.