Provider Briefing: Trifluridine Supply in 2026

Trifluridine 1% ophthalmic solution — one of the foundational topical antivirals for herpes simplex keratitis — continues to face intermittent availability challenges in 2026. For ophthalmologists, optometrists, and emergency physicians who prescribe this medication, the supply disruptions create real clinical and logistical headaches.

This article provides a concise overview of the current Trifluridine supply situation, prescribing considerations during shortages, alternative treatment options, and tools to help your patients locate the medication.

Timeline: How We Got Here

Trifluridine has been FDA-approved since 1980 and has long been a mainstay of herpetic keratitis treatment. However, the medication's supply landscape has narrowed significantly over the years:

• Market consolidation: The original brand, Viroptic, changed hands from Glaxo Wellcome to King Pharmaceuticals to Pfizer. Meanwhile, the generic market has been served by a shrinking pool of manufacturers.
• Akorn exit: Akorn Pharmaceuticals (formerly Hi-Tech), once a key generic manufacturer, ceased operations. This removed a significant supply source from the market.
• Remaining manufacturers: As of early 2026, Sandoz and Apotex are among the few companies still producing generic Trifluridine ophthalmic solution.
• Intermittent disruptions: With only two to three active manufacturers, any production halt — whether due to quality control issues, raw material shortages, or facility maintenance — can trigger nationwide supply gaps.

Prescribing Implications

The limited availability of Trifluridine has several implications for clinical practice:

When to Prescribe Trifluridine

Trifluridine remains indicated for:

• Primary keratoconjunctivitis due to HSV types 1 and 2
• Recurrent epithelial keratitis due to HSV types 1 and 2
• Cases resistant to idoxuridine or vidarabine (though these older agents are now rarely used)

When to Consider Alternatives First

Given supply constraints, many providers have shifted to Ganciclovir gel (Zirgan) as a first-line topical antiviral. This is a reasonable approach, as clinical evidence supports comparable efficacy. Consider reserving Trifluridine for:

• Patients who have responded well to Trifluridine in the past
• Cases where Ganciclovir is not tolerated or unavailable
• Patients with documented resistance patterns

Dosing Reminder

Standard Trifluridine dosing: one drop every two hours while awake (maximum nine drops/day) until corneal re-epithelialization, followed by one drop every four hours while awake (minimum five drops/day) for seven additional days. Do not exceed 21 days of continuous therapy due to potential ocular toxicity.

Current Availability Picture

As of early 2026, Trifluridine availability varies significantly by region and pharmacy. Key observations:

• Chain pharmacies frequently report stockouts, particularly in smaller markets
• Hospital outpatient pharmacies and specialty ophthalmology pharmacies are more likely to maintain supply
• Independent pharmacies with access to secondary wholesalers may have stock when chains do not

Providers can direct patients to Medfinder for Providers to help them locate pharmacies with current Trifluridine inventory.

Cost and Access Considerations

Cost remains a significant barrier for some patients:

• Cash price: $300–$400 per 7.5 mL bottle without insurance
• With coupons: As low as $201 through discount card programs (e.g., SingleCare)
• Insurance: Most commercial plans and Medicare Part D cover generic Trifluridine. Brand-name Viroptic coverage is less consistent.
• Patient assistance: Pfizer RxPathways and programs listed on NeedyMeds and RxAssist may help uninsured or underinsured patients

For a patient-facing cost guide you can share, see: How to Save Money on Trifluridine.

Alternative Treatment Options

When Trifluridine is unavailable, the following alternatives are supported by clinical evidence:

Ganciclovir Ophthalmic Gel 0.15% (Zirgan)

• FDA-approved for acute herpetic keratitis (dendritic ulcers)
• Dosing: one drop five times daily until healed, then three times daily for seven days
• Comparable efficacy to Trifluridine in clinical trials
• Cash price: $500–$700 per tube; may require prior authorization

Oral Antivirals

• Acyclovir: 400 mg five times daily (epithelial) or 400 mg twice daily (prophylaxis)
• Valacyclovir: 500 mg–1,000 mg two to three times daily
• Useful as adjunctive therapy or monotherapy when topical options are unavailable
• Highly cost-effective: generic Acyclovir costs $10–$30 per course

Combination Approaches

For moderate to severe cases during shortages, consider oral Valacyclovir plus Ganciclovir gel. This combination provides both systemic and topical antiviral coverage.

Tools and Resources for Your Practice

• Medfinder for Providers: Real-time pharmacy stock lookup. Share with patients or use in-office to identify pharmacies with Trifluridine in stock.
• ASHP Drug Shortage Database: Monitor official shortage status updates
• FDA Drug Shortage Database: Check for manufacturer communications and estimated resolution timelines

You may also find these patient-facing articles useful to share:

• How to find Trifluridine in stock near you
• Alternatives to Trifluridine

Looking Ahead

The Trifluridine supply situation is unlikely to resolve quickly. The fundamental issue — too few manufacturers for a niche product — requires either new market entrants or policy changes to incentivize production of essential but low-volume medications.

In the meantime, building familiarity with alternative treatment protocols and having systems in place to help patients locate available stock will minimize disruption to patient care.

Final Thoughts

Trifluridine remains a valuable tool in the management of herpetic keratitis, but its unreliable supply demands that prescribers stay flexible. Ganciclovir gel and oral antivirals are well-supported alternatives. Tools like Medfinder can help bridge the gap between prescription and pharmacy pickup.

For the provider-focused guide on helping patients navigate availability, see: How to Help Your Patients Find Trifluridine in Stock.