Ondansetron Shortage: A Provider Briefing for 2026

Ondansetron (Zofran) remains one of the most widely prescribed antiemetics in the United States, with applications spanning oncology, anesthesiology, emergency medicine, obstetrics, and primary care. However, intermittent supply disruptions — particularly affecting injectable formulations — have created prescribing and access challenges that providers need to understand and plan for.

This article provides a comprehensive overview of the Ondansetron shortage landscape in 2026, including supply timeline, clinical implications, cost considerations, and practical tools for maintaining patient access.

Shortage Timeline

Ondansetron supply disruptions have occurred in waves over the past several years:

• 2019–2020: Injectable Ondansetron first appeared on the FDA Drug Shortage list due to manufacturing disruptions at multiple facilities. Oral formulations were largely unaffected.
• 2021–2022: Supply stabilized for most formulations, though periodic spot shortages continued for the injectable and ODT forms.
• 2023–2024: Renewed shortages of the injectable formulation emerged, along with spot shortages of the ODT form from specific manufacturers (particularly affecting pediatric and OB/GYN prescribing patterns).
• 2025–2026: The injectable form remains intermittently listed on the FDA shortage database. Oral tablets are generally available from multiple generic manufacturers (Teva, Mylan, Aurobindo, Dr. Reddy's, Sandoz), though individual pharmacy-level stockouts continue to occur.

Prescribing Implications

The shortage pattern has several practical implications for prescribers:

Formulation Flexibility

When writing Ondansetron prescriptions, consider specifying "may substitute formulation" or discussing with patients the acceptability of alternative forms. Ondansetron is available as:

• Conventional oral tablets (4 mg, 8 mg, 24 mg)
• Orally disintegrating tablets — ODT (4 mg, 8 mg)
• Oral solution (4 mg/5 mL)
• Oral soluble film — Zuplenz (4 mg, 8 mg)
• Injectable solution (2 mg/mL) for IV/IM administration

If a patient reports difficulty filling a specific formulation, switching to an alternative form of Ondansetron is often the simplest solution before considering a different drug entirely.

Therapeutic Alternatives

When Ondansetron is genuinely unavailable, the following therapeutic alternatives remain evidence-based options within the 5-HT3 antagonist class:

• Granisetron (Kytril): Available as oral tablets, injection, and transdermal patch (Sancuso). The patch is particularly useful for chemotherapy patients who cannot tolerate oral dosing.
• Palonosetron (Aloxi): Longer half-life (~40 hours) with evidence of superiority for delayed CINV. Primarily IV; oral capsule also available.
• Dolasetron (Anzemet): Oral tablets available; IV form withdrawn in the U.S. due to cardiac concerns.

Outside the 5-HT3 class, Promethazine, Prochlorperazine, Metoclopramide, and Dexamethasone (as adjunctive therapy) remain options depending on the clinical context. For detailed alternative guidance, see alternatives to Ondansetron.

Cardiac Considerations

All 5-HT3 antagonists carry some degree of QT prolongation risk. The FDA's 2012 safety communication regarding dose-dependent QT prolongation with Ondansetron led to withdrawal of the 32 mg single IV dose. When switching between agents in this class, be mindful of additive QT risk with concurrent medications (antiarrhythmics, certain antipsychotics, fluoroquinolones). For a complete list, see Ondansetron drug interactions.

Current Availability Picture

As of early 2026, the availability landscape by formulation is:

• Oral tablets (generic): Widely available. Multiple ANDA holders ensure consistent supply for most pharmacies.
• ODT (generic): Intermittently available. Fewer manufacturers produce this form, leading to periodic gaps.
• Oral solution: Generally available but stocked by fewer pharmacies.
• Injectable: Intermittent shortage. Hospital pharmacies and GPOs may need to manage allocation carefully.
• Zuplenz (oral film): Limited distribution; may require specialty pharmacy sourcing.

Cost and Access Considerations

Generic Ondansetron remains one of the most affordable antiemetics available:

• Retail (no insurance): $4–$25 for oral tablets with discount cards (GoodRx, SingleCare)
• Insurance coverage: Tier 1 on most formularies; copays typically $0–$15
• Prior authorization: Rarely required for generic Ondansetron
• Step therapy: Not typically applied

For patients facing cost barriers, prescription discount cards can reduce prices significantly. Direct your patients to our patient guide on saving money on Ondansetron. For provider-specific cost and access strategies, see how to help patients save money on Ondansetron.

Tools and Resources for Providers

Several tools can help you and your staff manage Ondansetron access for patients:

Medfinder for Providers

Medfinder's provider tools allow your practice to check real-time pharmacy availability for Ondansetron and other medications. This can be integrated into your prescribing workflow — before sending a prescription, verify that the patient's preferred pharmacy has stock.

FDA Drug Shortage Database

The FDA Drug Shortage database provides current status for each affected formulation, including manufacturer-specific information and estimated resolution dates.

ASHP Drug Shortage Resource Center

The American Society of Health-System Pharmacists maintains a comprehensive shortage tracking tool with clinical alternatives and management recommendations.

Practice Workflow Tips

• Train front-desk and nursing staff to proactively ask patients about pharmacy fill issues at each visit.
• Maintain a current list of therapeutic alternatives and their formulary status.
• Consider establishing relationships with independent pharmacies as backup sourcing options.
• Use e-prescribing systems that flag shortage alerts before transmission.

Looking Ahead

The Ondansetron supply situation is expected to remain generally stable for oral formulations through 2026, supported by the number of generic manufacturers in the market. However, the injectable formulation may continue to face intermittent disruptions.

Key trends to watch:

• New generic entrants: Additional manufacturers filing ANDAs for Ondansetron formulations could further stabilize supply.
• Telehealth expansion: Increasing telehealth prescribing of Ondansetron for conditions like morning sickness and gastroenteritis may shift demand patterns.
• Hospital purchasing strategies: GPO contract adjustments and dual-sourcing strategies for injectable Ondansetron can mitigate institutional supply risk.

Final Thoughts

Ondansetron remains an essential medication across multiple clinical settings. While the shortage picture in 2026 is manageable — particularly for oral formulations — providers should stay informed, maintain familiarity with therapeutic alternatives, and leverage tools like Medfinder for providers to support patient access.

For the patient-facing perspective on this shortage, direct your patients to our Ondansetron shortage update for patients. For a step-by-step workflow on helping patients locate this medication, see how to help your patients find Ondansetron in stock.