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

Clinicians who prescribe Relagard (acetic acid 0.9% / oxyquinoline 0.025% vaginal gel) for bacterial vaginosis management, vaginal pH restoration, or infection prevention are increasingly hearing from patients who cannot locate the medication at their pharmacy. This guide provides clinical context and practical guidance for navigating Relagard availability challenges in 2026.

Clinical Background: What Relagard Does and Why It's Prescribed

Relagard is a non-antibiotic vaginal gel that works by acidifying the vaginal environment. Its two active ingredients — glacial acetic acid (0.9%) and oxyquinoline (0.025%) — work synergistically: acetic acid lowers vaginal pH to the normal physiologic range of 3.8–4.3, while oxyquinoline provides additional antiseptic activity against bacteria and fungi.

Clinically, Relagard is used as:

Adjunctive therapy alongside antibiotics (metronidazole or clindamycin) for active bacterial vaginosis

Long-term maintenance therapy for patients with recurrent BV to suppress relapse between antibiotic courses

Prevention of pH shifts following menstruation, intercourse, or antibiotic use

Supportive care in peri- and post-menopausal patients experiencing vaginal atrophy-related pH imbalance

Regulatory Status: Why Relagard Falls Outside Standard Shortage Reporting

Relagard is not FDA-approved. It is marketed under the FDA's enforcement discretion for unapproved drugs that have been in use for many years and for which no adequate FDA-approved alternative exists. This unapproved status means:

Manufacturers are not required to report supply disruptions to the FDA

Relagard will not appear on the FDA Drug Shortage Database even if supply is severely constrained

Insurance formulary coverage is inconsistent, reducing pharmacy stocking incentives

There are no federally mandated stockpiling or distribution requirements

Clinical Alternatives When Relagard Is Unavailable

When Relagard cannot be found, the following evidence-based alternatives are appropriate depending on clinical indication:

For pH balance and maintenance (same mechanism):

Fem pH (acetic acid 0.9% / oxyquinoline 0.025%) — identical active ingredients under a different brand name; prescribe by generic name or as Fem pH

Compounded acetic acid / oxyquinoline vaginal gel — accredited compounding pharmacies can prepare this formulation on prescription

Boric acid 600 mg vaginal capsules — off-label but commonly used for recurrent BV and vulvovaginal candidiasis; supported by clinical evidence

For active BV treatment (antibiotic alternatives):

Metronidazole 500 mg orally twice daily for 7 days (or 0.75% vaginal gel daily for 5 days) — CDC-recommended first-line treatment

Clindamycin 300 mg orally twice daily for 7 days (or 2% vaginal cream nightly for 7 days) — CDC-recommended first-line treatment

Secnidazole 2g oral granules as a single dose — FDA-approved for BV; convenient single-dose regimen

Tinidazole 2g orally once daily for 2 days or 1g once daily for 5 days — FDA-approved for BV

Prescribing Tips to Improve Patient Access

Write the prescription generically: Prescribe as 'acetic acid 0.9% / oxyquinoline 0.025% vaginal gel — may substitute Fem pH or equivalent' to give pharmacies flexibility to fill with available brand.

Direct patients to compounding pharmacies: A compounding prescription allows accredited pharmacies to prepare the formulation fresh, bypassing manufacturer supply issues.

Refer patients to medfinder: medfinder (medfinder.com/providers) is a service that calls pharmacies on behalf of patients to locate medications in stock. Recommending it can save patients significant time and reduce appointment callbacks.

Provide a bridge prescription: If a patient's Relagard supply runs out before they can locate more, having a metronidazole or boric acid bridge prescription ready can prevent symptom relapse.

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Patient Communication Guidance

When patients report difficulty finding Relagard, provide clear guidance on the steps they can take: searching via medfinder, contacting independent pharmacies, and requesting a compounded preparation. Proactively discussing this at the time of prescribing — rather than waiting for a callback — improves patient outcomes. Learn more about how medfinder supports providers and their patients.