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

For ophthalmologists and optometrists managing acute herpetic keratitis, Zirgan (ganciclovir ophthalmic gel 0.15%) is a preferred first-line topical agent — offering selective antiviral activity, favorable tolerability, and a convenient dosing schedule compared to older alternatives. But your patients may return to you unable to fill their prescription.

This guide summarizes what eye care providers need to know about Zirgan's availability landscape in 2026 and how to ensure your patients can start treatment without delay.

Current Zirgan Availability Status (2026)

Zirgan is not currently listed on the FDA Drug Shortages Database. Bausch + Lomb continues to manufacture and distribute the product. However, the medication presents consistent availability challenges at the retail pharmacy level:

No FDA-approved generic exists, limiting formulary access and increasing cost sensitivity

Originally granted orphan drug designation for herpetic keratitis — a diagnosis with significant morbidity but limited market size

Retail chain pharmacies frequently don't stock it routinely due to low prescription volume

Distribution tends to concentrate at independent pharmacies and specialty mail-order pharmacies

Clinical Context: Why Timely Treatment Matters

HSV epithelial keratitis (dendritic ulcer) is a time-sensitive diagnosis. Delay in antiviral therapy increases the risk of viral spread into deeper corneal stroma, exacerbating the risk of corneal scarring, thinning, and permanent visual impairment. The Herpetic Eye Disease Study (HEDS) and subsequent literature consistently emphasize rapid initiation of antiviral therapy.

In Phase 3 clinical trials, Zirgan achieved clinical resolution in 77% of dendritic ulcer patients at Day 7, compared to 72% with acyclovir 3% ointment — demonstrating non-inferiority and generally better tolerability. This efficacy and its selective activity (inactive in healthy corneal cells) make it a preferred choice — but only when patients can actually access it.

Evidence-Based Alternatives When Zirgan Is Unavailable

Trifluridine 1% Ophthalmic Solution (Generic)

Trifluridine remains an FDA-approved, widely available topical alternative. Dosing: 1 drop every 2 hours while awake (max 9 drops/day) until ulcer resolution, then every 4 hours for one week. The Cochrane review of nearly 6,000 treated eyes confirmed that trifluridine, acyclovir, and ganciclovir all achieve comparable clinical outcomes for epithelial HSV keratitis. Limitation: greater ocular surface toxicity with extended use versus ganciclovir gel.

Oral Antivirals

For epithelial keratitis, oral antivirals are effective as monotherapy or combined with topical agents. All are widely available as generics:

Acyclovir: 400 mg five times daily for 10–14 days (epithelial); 800 mg five times daily for suspected VZV.

Valacyclovir: 500 mg three times daily; preferred for compliance; prodrug of acyclovir.

Famciclovir: 250 mg three times daily; third-line oral option.

Note: For stromal keratitis with epithelial ulceration, topical steroids combined with oral antiviral prophylaxis remain standard of care. Oral antivirals alone are generally insufficient for deep stromal disease without steroid coverage.

Practice Strategies to Minimize Pharmacy-Related Delays

Consider implementing these protocols in your practice:

Maintain Zirgan samples. Contact your Bausch + Lomb representative about sample availability through the Bausch Sample Vault. Dispensing a sample at the time of diagnosis ensures patients begin treatment immediately.

Know your local pharmacy landscape. Identify 1–2 pharmacies in your area that reliably stock Zirgan. Independent and ophthalmology-affiliated pharmacies are your best bets. Share this information with patients at the point of prescribing.

Write a dual prescription. Consider issuing both a Zirgan prescription and a trifluridine prescription simultaneously, instructing the patient to fill whichever they can find first and to call your office.

Educate your staff. Ensure your front desk team knows which pharmacies carry Zirgan and can proactively direct patients when calling in prescriptions.

Inform patients about medfinder. medfinder calls pharmacies on behalf of patients to find which ones have Zirgan in stock, then texts results directly to the patient — reducing delays and improving treatment adherence.

Cost and Insurance Considerations for Patients

Zirgan's average retail price is $571–$650 for a 5g tube. The Bausch + Lomb Access Program reduces this to:

$25 copay for eligible commercially insured patients at participating pharmacies (up to 6 fills per 12 months)

$70 for uninsured or not-covered patients

$0 for patients qualifying for the Bausch + Lomb Patient Assistance Program

Refer cost-burdened patients to bauschaccessprogram.com or GoodRx for the most current pricing. Trifluridine 1% generic remains a significantly cheaper topical alternative at $30–$80 per bottle.

A Resource for Your Patients

For a step-by-step patient resource on how to locate Zirgan, point your patients to medfinder. Providers can learn more about how to integrate medfinder into their practice workflow at medfinder.com/providers. Also see: How to Help Your Patients Find Zirgan In Stock.