Pred-G Shortage: What Providers and Prescribers Need to Know in 2026

If your patients are calling your office frustrated because they can't fill their Pred-G prescriptions, you're not imagining a trend. Pred-G (gentamicin sulfate 0.3% / prednisolone acetate 1% ophthalmic suspension) has become increasingly difficult to locate at chain pharmacies in recent years, creating challenges for ophthalmologists, optometrists, and other eye care providers who rely on it for post-surgical care, ocular inflammation, and bacterial eye infections. This guide provides a clinical overview of the availability landscape and actionable guidance for managing patient access in 2026.

Current Availability Status

As of 2026, Pred-G is not listed on the FDA Drug Shortage Database or the ASHP current shortage list. Allergan has not reported a supply disruption to regulatory authorities. However, clinical reports from practitioners and patient feedback consistently indicate that Pred-G is difficult to find at chain pharmacies, even when the medication is technically available at the manufacturer level.

The gap between "not in shortage" and "available on the shelf" is a structural one: Pred-G is a brand-only specialty ophthalmic with a single manufacturer, low prescription volume at retail chains, and no generic equivalent that pharmacies can substitute. This creates a systemic stocking problem that doesn't trigger federal shortage thresholds but meaningfully affects patient access.

Clinical Situations Where Pred-G Is Most Commonly Prescribed

Understanding where Pred-G fills a unique clinical role helps prioritize which patients need proactive supply management:

• Post-operative cataract and ocular surgery care: Combination antibiotic-steroid drops are a standard post-surgical protocol. Delay in filling Pred-G for these patients can compromise outcomes.
• Uveitis and inflammatory eye disease: Prednisolone acetate 1% (the same steroid concentration as Pred Forte) is a high-potency ophthalmic corticosteroid appropriate for anterior segment inflammation. The gentamicin component provides bacterial prophylaxis.
• Chemical and radiation burns: Eye injuries requiring simultaneous anti-inflammatory and antibacterial coverage.
• Blepharokeratoconjunctivitis: Conditions where both bacterial and inflammatory components need simultaneous management.

Clinical Considerations for Switching to Alternatives

When Pred-G is unavailable, the most important clinical decision is whether the full-strength prednisolone acetate 1% component is essential to the treatment goal. If it is — such as in significant anterior segment inflammation — consider whether a switch to a dexamethasone-based combination (Tobradex) provides adequate steroid potency for your specific patient.

Key clinical alternatives to consider, with prescriber notes:

• Generic tobramycin/dexamethasone (Tobradex): Widely available, cost-effective. Uses dexamethasone 0.1% (vs. prednisolone 1%) and tobramycin (vs. gentamicin). Strong Gram-positive and Gram-negative coverage. Most accessible substitution for typical post-op or infection cases.
• Generic Maxitrol (neomycin/polymyxin B/dexamethasone): Very low cost ($15–$40 with coupon), broad antibacterial coverage. Higher neomycin allergy rate — screen patients before substituting. Less appropriate if neomycin sensitivity is suspected.
• Zylet (tobramycin/loteprednol 0.5%): Preferred for patients with elevated IOP risk or glaucoma history. Loteprednol's softer steroid profile reduces the risk of steroid-induced hypertension. Less steroid potency for severe intraocular inflammation.
• Separate prednisolone acetate 1% + antibiotic drops: If the specific prednisolone potency is critical and a combination is unavailable, prescribing Pred Forte (or generic prednisolone acetate 1%) plus a separate antibiotic such as tobramycin or ciprofloxacin maintains the full steroid potency at the cost of additional drops and reduced compliance convenience.

Proactive Protocols for Your Practice

Given the persistent stocking challenges with Pred-G, practices that prescribe it regularly may benefit from implementing proactive protocols:

1. Maintain an office supply for surgical patients. For post-operative cases, consider stocking Pred-G samples or a limited dispensary supply for day-of-surgery distribution, so patients leave with their first bottle in hand rather than scrambling at a pharmacy.
2. Pre-identify reliable pharmacies in your area. Know which independent pharmacies in your geographic area reliably stock or can order Pred-G. Communicate this to your front desk and surgical scheduling team.
3. Write pre-authorized alternate prescriptions. For time-sensitive post-op cases, consider writing a second prescription for an alternative (e.g., Tobradex or generic tobramycin/dexamethasone) on the same encounter, with instructions to fill only if Pred-G is unavailable, so patients don't need to call back.
4. Recommend medfinder to patients. medfinder is a service that contacts pharmacies near a patient to find which ones can fill their specific prescription. For post-operative patients who may be impaired or have limited mobility, medfinder reduces the burden of locating the medication.

Monitoring Your Patients During Supply Disruptions

Patients who are unable to fill Pred-G and delay treatment are at risk for worse outcomes, particularly post-surgical patients. Ensure your office has a clear protocol for patients who call in reporting they cannot find the medication: a same-day callback from clinical staff to resolve the prescription — either via special order guidance, a sample, or an alternative prescription — prevents treatment interruptions.

Summary for Prescribers

Pred-G remains a clinically valuable combination ophthalmic, particularly for situations requiring full-strength prednisolone acetate 1%. Its availability challenges are structural and persistent, not the result of a declared shortage. The most effective provider response combines proactive patient counseling, pre-identified specialty pharmacy resources, and a prepared set of clinical alternatives. For a full implementation guide, see how to help your patients find Pred-G in stock.