Trimo-San Shortage: What Providers and Prescribers Need to Know in 2026

If you manage patients who use vaginal pessaries, you've likely prescribed Trimo-San (oxyquinoline sulfate / sodium lauryl sulfate vaginal jelly) as part of routine pessary care. And you've probably heard from patients who struggled to find it at their pharmacy. This guide gives you the clinical and practical information you need to help those patients in 2026.

Trimo-San Status in 2026: Not in FDA Shortage, But Difficult to Find

As of 2026, Trimo-San is not listed on the FDA Drug Shortage Database and has not been formally declared in shortage by ASHP. However, consistent prescriber and patient feedback indicates that availability is highly variable across pharmacy locations. The product is brand-name only, not FDA-approved, and not covered by Medicare Part D or most commercial insurance plans — all factors that reduce pharmacy stocking incentives.

The product is manufactured by CooperSurgical, Inc. (a subsidiary of CooperCompanies), which distributes it as a companion product to its line of Milex pessaries. The supply chain is intact, but retail pharmacy distribution remains limited compared to mainstream pharmaceuticals.

Why Trimo-San Has a Unique Regulatory Status

Trimo-San is an unapproved drug that the FDA has not evaluated for safety and efficacy. It remains on the market because the FDA exercises enforcement discretion for certain marketed unapproved drugs, particularly when there is no FDA-approved alternative for a specific clinical use. There is currently no FDA-approved product specifically indicated for vaginal pH maintenance in pessary users, which is why Trimo-San continues to be prescribed despite its unapproved status.

Providers should document this discussion with patients: the product is used off-label in the regulatory sense, and patients should be counseled on the lack of formal FDA approval when making prescribing decisions.

Evidence Base and Clinical Use

Trimo-San is widely used in urogynecology for pessary wearers. It is the only vaginal gel specifically tested for compatibility with Milex pessaries (manufactured by the same company). Its formulation — hydroxyquinoline sulfate 0.025% and sodium lauryl sulfate 0.01%, adjusted to pH 4 — targets the core issue of pessary-associated vaginal pH disruption and microbial overgrowth.

A randomized clinical trial (NCT03943823) comparing Trimo-San with vaginal estrogen in postmenopausal pessary wearers has examined vaginal pH outcomes and bacterial vaginosis rates. Providers managing postmenopausal patients should consider whether vaginal estrogen — with its superior evidence base and insurance coverage — may serve as a primary or alternative strategy for those who cannot access Trimo-San.

Clinical Alternatives When Trimo-San Is Unavailable

When Trimo-San is unavailable, consider the following evidence-informed alternatives based on patient profile:

• Postmenopausal patients: Low-dose vaginal estrogen (conjugated equine estrogen 0.3–0.5 mg or estradiol cream) applied 2–3x/week. Superior evidence base; addresses atrophy and pH simultaneously.
• Active BV: Metronidazole vaginal gel 0.75% (FDA-approved) or clindamycin vaginal cream 2% (FDA-approved). Treat then transition to maintenance strategy.
• pH maintenance (premenopausal, no active infection): RepHresh (OTC polycarbophil gel) or boric acid 600 mg vaginal suppositories. Confirm pessary compatibility before recommending.
• Compounding pharmacy option: A compounding pharmacy can prepare an equivalent formulation (hydroxyquinoline sulfate / sodium lauryl sulfate in a pH 4 base) upon provider prescription. Verify compounding quality and sourcing.

Counseling Your Patients on Finding Trimo-San

When prescribing Trimo-San, set expectations with patients that they may need to call ahead to confirm stock. Refer them to medfinder, a service that calls pharmacies to locate medications in stock and texts results to the patient. This removes the burden of repeated pharmacy calls from both patients and your staff.

Documenting Prescribing Decisions for Trimo-San

Because Trimo-San is not FDA-approved, consider documenting the clinical rationale for prescribing it (e.g., long-term pessary use, need for vaginal pH maintenance, compatible with Milex pessary) and that the patient was informed of its unapproved status. This is standard practice for unapproved marketed drugs and protects both the patient and the practice.