Provider Briefing: Propranolol Supply Disruptions in 2026

Propranolol — one of the most widely prescribed non-selective beta-blockers — has been subject to supply disruptions that continue into 2026. While the shortage primarily affects the oral solution and injectable formulations, the downstream effects are being felt across multiple specialties and patient populations.

This article provides a concise overview for prescribers: what's happening with Propranolol supply, which patients are most affected, how to manage prescribing during disruptions, and what tools are available to help your patients locate their medication.

Shortage Timeline

The current supply issues follow a clear trajectory:

• February 2025: The American Society of Health-System Pharmacists (ASHP) added Propranolol Hydrochloride oral solution to the drug shortage list. Hikma, a primary supplier, placed the 20 mg/5 mL (500 mL bottles) and 40 mg/5 mL (500 mL bottles) on allocation.
• Mid-2025: Propranolol Hydrochloride injection (1 mg/mL, 1 mL vials) was reported on back order by Hikma, with no estimated release date.
• Early 2026: Both formulations remain on the ASHP shortage list. Oral tablets (IR) and extended-release capsules continue to be manufactured by multiple generic companies and are generally available, though some pharmacies report intermittent stock-outs of specific strengths — particularly 10 mg and 20 mg IR tablets.

Prescribing Implications

The shortage has distinct clinical implications depending on the patient population and indication:

Pediatric Patients (Infantile Hemangioma)

The oral solution shortage is most critical for pediatric patients being treated for proliferating infantile hemangioma under the Hemangeol protocol. These patients require precise liquid dosing (typically 1 to 3 mg/kg/day in divided doses) that cannot easily be replicated with tablets. Prescribers should consider:

• Referring patients to a compounding pharmacy that can prepare Propranolol oral solution from powder
• Contacting Pierre Fabre (manufacturer of Hemangeol) to inquire about product availability or patient support programs
• Evaluating whether the patient can be transitioned to tablet form if age and swallowing ability allow

Anxiety and Performance Anxiety (Off-Label)

Propranolol has become increasingly popular for off-label management of performance anxiety, particularly through telehealth platforms. The 10 mg and 20 mg IR tablets are the most commonly prescribed strengths for this indication. While these are not in formal shortage, high demand combined with supply variability means some patients may experience delays.

Clinical considerations:

• The low doses used for anxiety (10 to 40 mg as needed) mean patients may be able to use higher-strength tablets and split them, though this should be confirmed based on tablet scoring
• Alternative anxiolytics should be discussed if Propranolol is persistently unavailable for a given patient

Cardiovascular and Neurological Indications

For patients on Propranolol for hypertension, angina, atrial fibrillation rate control, migraine prophylaxis, or essential tremor, supply disruptions can have more significant clinical consequences. Abrupt discontinuation of Propranolol carries well-documented risks, including rebound tachycardia, worsening angina, and potential myocardial infarction.

Prescribers should:

• Proactively discuss contingency plans with patients on chronic Propranolol therapy
• Consider prescribing 90-day supplies through mail-order pharmacies to reduce refill frequency and improve supply predictability
• Document a backup medication plan in the chart

Availability Picture

Current availability by formulation:

• IR tablets (10, 20, 40, 60, 80 mg): Multiple generic manufacturers. Generally available. Intermittent local stock-outs possible.
• ER capsules (60, 80, 120, 160 mg): Multiple generic manufacturers. Generally available.
• Oral solution (20 mg/5 mL, 40 mg/5 mL): On ASHP shortage list. Hikma on allocation. Limited availability.
• Injectable (1 mg/mL): On back order. No estimated release date. Primarily affects inpatient settings.

Cost and Access Considerations

Propranolol remains one of the most affordable medications in the beta-blocker class:

• Generic IR tablets: Retail $20 to $45 for 30 tablets without insurance. With discount coupons (GoodRx, SingleCare), as low as $4 to $10.
• Generic ER capsules: Retail $35 to $75 for 30 capsules. With coupons, as low as $12 to $20.
• Insurance: Tier 1 preferred generic on most formularies. Typical copay $0 to $15. No prior authorization or step therapy generally required.

For uninsured or underinsured patients, Propranolol is included on several $4 generic lists at Walmart, Kroger, and other chain pharmacies. Patient assistance resources include NeedyMeds (needymeds.org) and RxAssist (rxassist.org).

Tools and Resources for Your Practice

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

Medfinder for Providers

Medfinder offers real-time pharmacy availability data. You can recommend this tool to patients so they can locate pharmacies that have Propranolol in stock near them — reducing failed fills and the phone calls to your office that follow.

ASHP Drug Shortage Resource

The ASHP Drug Shortages Resource Center provides updated shortage information, including affected NDCs, manufacturer status, and alternative therapy recommendations.

Compounding Pharmacy Referrals

For patients who need the oral solution, maintain a list of compounding pharmacies in your area that can prepare Propranolol oral solution. The Professional Compounding Centers of America (PCCA) can help locate member pharmacies.

Therapeutic Alternatives

When Propranolol is unavailable, the most commonly used alternatives include:

• Metoprolol (Tartrate or Succinate): Selective beta-1 blocker. Appropriate for hypertension, rate control, and post-MI. Less effective for migraine prophylaxis and tremor due to beta-1 selectivity.
• Atenolol: Selective beta-1 blocker. Once-daily dosing. Fewer CNS side effects. Not ideal for migraine or anxiety indications.
• Nadolol: Non-selective beta-blocker. Closest pharmacological profile to Propranolol. Once-daily dosing. Renally eliminated — avoid in significant renal impairment. Effective for migraine prophylaxis and tremor.
• Timolol (oral): Non-selective. FDA-approved for migraine prophylaxis. Less commonly prescribed but available.

For a patient-facing version of this comparison, see alternatives to Propranolol.

Looking Ahead

There is no clear timeline for resolution of the oral solution and injectable shortages. Manufacturers have not provided estimated restocking dates. The tablet and capsule supply is expected to remain stable, though localized stock-outs may persist as long as demand remains elevated.

Prescribers can help by:

• Proactively educating patients about the shortage and available alternatives
• Writing prescriptions that allow for formulation flexibility when clinically appropriate (e.g., "Propranolol 20 mg tablets OR equivalent")
• Directing patients to Medfinder to check real-time availability
• Documenting backup medication plans in patient charts

Final Thoughts

The Propranolol shortage is manageable but requires proactive planning — particularly for pediatric patients and those on chronic therapy who cannot safely discontinue. Tablets and capsules remain generally available, and the drug's low cost minimizes the financial burden even for uninsured patients. Use tools like Medfinder for providers to help your patients locate their medication efficiently.

For related provider resources, see our guide on how to help your patients find Propranolol and helping patients save money on Propranolol.