Paromomycin Shortage: What Providers and Prescribers Need to Know in 2026

Paromomycin occupies a unique and difficult-to-replace role in antiparasitic therapy in the United States. As the only FDA-approved luminal amebicide with consistent evidence for intestinal amebiasis cyst eradication — and one of the few antiparasitic options in pregnancy — its ongoing unavailability in generic form presents real clinical challenges. This guide summarizes what prescribers need to know in 2026.

Current Supply Situation

As of 2026, the paromomycin shortage documented by ASHP in May 2023 remains active. Avet Pharmaceuticals permanently discontinued its generic paromomycin sulfate oral capsules in September 2021. The sole commercially available product is

Humatin 250 mg capsules (Waylis Therapeutics), NDC 80725-0250-01, available in 100-count bottles. No generic alternatives are currently on the US market.

Clinical Indications and Where Paromomycin Is Irreplaceable

Paromomycin has two FDA-approved indications and several important off-label uses:

Intestinal amebiasis (luminal phase): Standard of care involves a nitroimidazole (metronidazole or tinidazole) for tissue-invasive disease, followed by paromomycin 25–35 mg/kg/day in 3 divided doses for 5–10 days to eradicate luminal cysts. Iodoquinol is the primary alternative when paromomycin is unavailable.

Hepatic coma (adjunctive): 4 g/day in divided doses for 5–6 days. Rifaximin is the primary alternative for hyperammonemia management.

Giardiasis in pregnancy: Poor GI absorption makes paromomycin one of the safest options in the first trimester; options are severely limited if unavailable.

Cryptosporidiosis in immunocompromised patients: Paromomycin ± azithromycin is an option when nitazoxanide fails or is unavailable; antiretroviral restoration of immune function remains the top priority in HIV.

Dientamoeba fragilis: Paromomycin has demonstrated superior eradication rates (81.8%) compared to metronidazole (65.4%) in clinical studies.

Alternative Agents by Indication

When paromomycin is unavailable, consider these evidence-based alternatives (always consult current IDSA/CDC guidelines for the most up-to-date recommendations):

Luminal amebiasis cyst eradication: Iodoquinol 650 mg TID × 20 days (avoid in iodine hypersensitivity or thyroid disease)

Cryptosporidiosis: Nitazoxanide 500 mg BID × 3 days (immunocompetent); optimize ART in HIV

Giardiasis (non-pregnant): Metronidazole 250 mg TID × 5–7 days or tinidazole 2 g single dose

Hepatic encephalopathy: Rifaximin 550 mg BID (preferred for maintenance); lactulose for acute management

Prior Authorization and Insurance Navigation

Expect prior authorization requirements for Humatin on most commercial plans. Given that paromomycin is brand-only and expensive, insurers frequently require step therapy documentation or specialist letters of medical necessity. Key strategies:

Submit prior auth at time of prescribing, not at point of dispensing — this reduces treatment delays.

Include diagnosis code, microbiologic evidence (stool ova and parasite results), and clinical rationale in the PA request.

For pregnancy or immunocompromised patients, document why alternatives are insufficient.

Patient Assistance Programs

Waylis Therapeutics offers two programs to help patients access Humatin:

Humatin TotalCare Copay Program: Eligible commercially insured patients pay as little as $5 per prescription. BIN 610600, PCN AS, RxGroup 373, ID 37305128031.

Patient Assistance Program: Patients without insurance, Medicare, or TRICARE may qualify for free medication. Forms available at humatintotalcare.com; fax completed forms to 844-470-1931.

How medfinder Can Help Your Patients

When patients are sent to fill a paromomycin prescription and come back unable to find it, this creates care gaps and delays. medfinder for providers is a paid service designed to reduce these gaps — it calls pharmacies in the patient's area to identify which ones can fill the prescription, sending results by text so patients don't have to navigate this search on their own.

See also: How to Help Your Patients Find Paromomycin in Stock: A Provider's Guide