Provider Briefing: The Prednisolone Oral Solution Shortage

The intermittent shortage of Prednisolone Sodium Phosphate oral solution — marketed as Orapred — continues to affect patient care in 2026. For providers who routinely prescribe this medication, particularly pediatricians, allergists, and pulmonologists, understanding the current landscape is essential for maintaining treatment continuity and managing patient expectations.

This post provides a clinical overview of the shortage, its timeline, prescribing implications, and practical resources for your practice.

Shortage Timeline

Prednisolone oral solution shortages have been a recurring issue since approximately 2020. Key milestones include:

• 2020-2021: Initial supply disruptions linked to pandemic-era manufacturing slowdowns and raw material sourcing challenges.
• 2022-2023: The "tripledemic" (concurrent RSV, influenza, and COVID-19 surges) drove unprecedented demand for pediatric corticosteroid liquids, leading to acute shortages during fall and winter months.
• 2024: Manufacturing capacity improved modestly, but supply remained inconsistent. The FDA/ASHP drug shortage database continued to list Prednisolone oral solution.
• 2025-2026: The shortage has become chronic rather than acute. Supply is generally adequate during spring and summer but remains tight during respiratory illness season (October through March). Regional variability persists.

Prescribing Implications

The ongoing shortage creates several challenges for prescribers:

Formulation Availability

The primary impact is on the liquid oral solution (15 mg/5 mL), which is the preferred formulation for pediatric patients who cannot swallow tablets. Providers should be aware that:

• Brand-name Orapred solution and generic equivalents may be intermittently unavailable.
• Orapred ODT (orally disintegrating tablets: 10 mg, 15 mg, 30 mg) is an alternative but significantly more expensive ($200-$500+ cash price).
• Prednisolone tablets are rarely in shortage but are not suitable for all pediatric patients.

Therapeutic Substitution Considerations

When Prednisolone liquid is unavailable, the most evidence-supported alternatives include:

• Dexamethasone oral solution: Increasingly used as a first-line alternative in pediatrics. For mild-to-moderate asthma exacerbations, a 1- to 2-day course of Dexamethasone (0.6 mg/kg/day, max 16 mg) has demonstrated non-inferiority to a 3- to 5-day course of Prednisolone (1-2 mg/kg/day, max 60 mg). Dexamethasone's longer half-life (36-54 hours vs. 12-36 hours) and shorter course duration may improve adherence.
• Prednisone: Converted to Prednisolone in the liver. Tablets can be crushed for older children. Liquid Prednisone is available but may also face supply constraints.
• Methylprednisolone: Available as tablets (Medrol Dosepak). Approximately 1.25x the anti-inflammatory potency of Prednisolone. No commercial liquid formulation.

Dose Equivalence Reference

When switching between corticosteroids, use the following approximate equivalences:

• Prednisolone 5 mg = Prednisone 5 mg = Methylprednisolone 4 mg = Dexamethasone 0.75 mg = Hydrocortisone 20 mg

Adjust doses based on the specific indication, patient weight, and clinical context. The above equivalences are approximate and based on anti-inflammatory potency.

Current Availability Picture

As of early 2026, the availability of Prednisolone oral solution varies significantly by region and pharmacy type:

• Chain pharmacies (CVS, Walgreens, Rite Aid): Frequently report stock-outs during peak season. These pharmacies typically source from a single primary wholesaler, limiting their flexibility.
• Independent pharmacies: Often maintain relationships with multiple distributors and may have better access to limited-supply medications.
• Hospital pharmacies: Generally maintain adequate supply through dedicated procurement channels, though some facilities have reported periodic shortages.
• Compounding pharmacies: Can prepare Prednisolone oral solutions when commercial products are unavailable, though compounded formulations carry different quality assurance considerations.

Cost and Access Considerations

The cost landscape for Prednisolone products in 2026:

• Generic Prednisolone oral solution: $15-$50 (cash price); typically Tier 1 on insurance formularies
• Brand Orapred oral solution: $50-$200+ (cash price); may require prior authorization
• Orapred ODT: $200-$500+ (cash price); coverage varies
• Generic Prednisone tablets: $4-$10 (widely available on $4 generic lists)
• Generic Dexamethasone: $5-$25 (cash price)

For patients experiencing financial barriers, discount programs (GoodRx, SingleCare) and patient assistance programs (NeedyMeds, RxAssist) can help reduce out-of-pocket costs. See the patient-facing guide on saving money on Orapred to share with your patients.

Tools and Resources for Your Practice

Several tools can help you and your patients navigate the shortage:

Medfinder for Providers

Medfinder allows providers and patients to check real-time pharmacy stock for Orapred and Prednisolone in their area. Consider recommending this tool to patients who are having difficulty filling prescriptions. For provider-specific features, visit medfinder.com/providers.

FDA Drug Shortage Database

The FDA Drug Shortage Database provides official information on active and resolved drug shortages, including estimated resolution dates when available.

ASHP Drug Shortage Resource Center

ASHP maintains a comprehensive drug shortage resource center with clinical guidance, alternative therapy recommendations, and shortage management strategies.

Proactive Prescription Strategies

Consider these workflow adjustments:

• When prescribing Prednisolone liquid, include "or therapeutic equivalent" in pharmacy communications where appropriate and permitted.
• Provide patients with a backup prescription for an alternative corticosteroid (e.g., Dexamethasone liquid) to use if their primary prescription cannot be filled.
• Discuss the shortage proactively with families of patients who have recurrent conditions requiring corticosteroid bursts.

Looking Ahead

The structural factors driving the Prednisolone oral solution shortage — limited manufacturers, complex liquid production requirements, and seasonal demand volatility — are unlikely to resolve quickly. Providers should plan for continued intermittent availability through at least the next several respiratory illness seasons.

Advocacy for increased manufacturing capacity, FDA incentives for producing essential pediatric formulations, and diversification of the corticosteroid supply chain may help address the root causes over time.

In the meantime, proactive prescribing practices, familiarity with therapeutic alternatives, and tools like Medfinder can help minimize the impact on patient care.

Final Thoughts

The Prednisolone oral solution shortage is a persistent challenge that requires ongoing attention from prescribers. By understanding the current availability landscape, maintaining familiarity with evidence-based alternatives, and leveraging available tools and resources, you can continue to provide effective treatment for your patients even when supply is constrained.

For a patient-facing version of this information, see our Orapred shortage update for patients. For guidance on helping patients locate medications, read our provider's guide to helping patients find Orapred.