Terrell (Isoflurane) Shortage: What Providers and Prescribers Need to Know in 2026

Terrell (isoflurane, USP) is an essential component of general anesthesia protocols in operating rooms, ambulatory surgical centers, and critical care settings. While no active national shortage is listed as of 2026, anesthesia departments and pharmacy directors know that localized supply disruptions can materialize rapidly — and the consequences of being unprepared can cascade across an entire surgical schedule.

This provider-focused guide covers the current supply landscape, clinical management strategies during shortages, best practices for sourcing Terrell when your primary distributor runs out, and how to help your patients when downstream medication needs arise.

Current Shortage Status (2026)

As of early 2026, neither the FDA Drug Shortages Database nor the ASHP Drug Shortages List carry an active shortage entry for isoflurane. Piramal Critical Care, Inc. — the manufacturer of Terrell and the second-largest global producer of isoflurane — has not issued any public supply disruption notices.

However, facility-level constraints can arise due to just-in-time inventory practices, distributor allocation policies, or surges in surgical demand. The global isoflurane market is relatively small ($19.89 million in 2025), with a projected CAGR of 4.5% through 2034. This modest market size means limited manufacturing redundancy.

Risk Factors That Create Facility-Level Shortages

• Single-source distribution contracts: Facilities locked into a single distributor are more vulnerable when that distributor's allocation is reduced.
• Just-in-time (JIT) inventory: Lean inventory practices reduce carrying costs but leave no buffer for unexpected demand spikes or delivery delays.
• Competing veterinary demand: Isoflurane is widely used in veterinary medicine, and demand surges in that sector can tighten human-use allocations.
• Regional surgical volume spikes: Mass casualty events, seasonal elective surgery backlogs, or new facility openings can temporarily outpace distributor stock.

Proactive Procurement: How to Protect Your Supply

The ASHP recommends that facilities maintain at minimum a 30-day safety stock of critical anesthetics. Specific strategies include:

1. Maintain multi-distributor relationships so you can pivot quickly when your primary source runs short.
2. Register directly with Piramal Critical Care (1-800-414-1901) for direct purchasing options and to be notified of production updates.
3. Leverage your GPO's emergency procurement services for priority access during shortages.
4. Monitor FDA and ASHP shortage lists weekly; subscribe to FDA shortage email alerts.
5. Ensure your formulary includes alternative agents (sevoflurane, desflurane, propofol) and that compatible vaporizers are available and maintained.

Conservation Strategies During Shortage Conditions

If Terrell stock is limited, implement the following conservation measures:

• Low-flow anesthesia technique: Reduce fresh gas flow to 0.5–1 L/min after initial equilibration. This can reduce isoflurane consumption by 50–70% without sacrificing anesthetic depth or patient safety.
• Anesthetic gas recapture systems: Systems such as MIRUS (Piramal) can recapture exhaled isoflurane and re-deliver it, cutting agent consumption by up to 90%.
• Case prioritization: Triage surgical cases, reserving isoflurane for patients where specific clinical indications favor it (e.g., coronary artery disease management, specific pediatric cases). Shift appropriate elective cases to TIVA.
• Vaporizer maintenance: Inspect vaporizers for leaks. Even minor vaporizer leaks can result in significant isoflurane waste during a shortage.

Clinical Alternatives: What the Evidence Supports

All of the following alternatives are FDA-approved and clinically well-established. Selection should be individualized based on patient and procedural factors:

• Sevoflurane (Sojourn/Ultane): Best general-purpose substitute. Preferred for pediatric induction, outpatient procedures. Requires a sevoflurane vaporizer.
• Desflurane (Suprane): Rapid emergence; preferred for long cases and obese patients. Environmental concerns (high GWP) limit use at some institutions.
• Propofol TIVA ± remifentanil: No vaporizer needed; lower PONV rates; appropriate for patients at MH risk or when inhaled agents are unavailable.

How medfinder Helps Your Patients

While isoflurane is procured through institutional channels, your patients may face their own challenges finding pre-operative or post-operative medications at their local pharmacies. medfinder for providers makes it easy to direct patients to a service that calls local pharmacies and texts them the results — reducing time spent on the phone and improving medication access.

Also see: How to help your patients find Terrell in stock: a provider's guide.