Comprehensive medication guide to Zirgan including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$25–$100 copay depending on plan tier; typically Tier 3–4 on commercial plans; eligible insured patients can use the Bausch + Lomb Access Program to pay no more than $25 per fill. Prior authorization may be required.
Estimated Cash Pricing
$571–$650 retail for the brand-name 5g tube; as low as $35 with a GoodRx coupon or $70 with the Bausch + Lomb Access Program for uninsured patients. No generic is currently available.
Medfinder Findability Score
62/100
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Zirgan is the brand name for ganciclovir ophthalmic gel 0.15%, a prescription antiviral medication manufactured by Bausch + Lomb. It is indicated for the treatment of acute herpetic keratitis (dendritic ulcers) — a corneal infection caused by herpes simplex virus (HSV) — in adults and pediatric patients aged 2 years and older. FDA approved in September 2009, Zirgan was the first new ophthalmic antiviral approved in the United States in 30 years.
Zirgan comes as a sterile, preserved, clear, colorless ophthalmic gel in a 5-gram aluminum tube. It is applied as a drop (one small squeeze) into the affected eye, using the dosing schedule prescribed by your eye care provider. There is currently no FDA-approved generic version of Zirgan available in the United States.
Herpetic keratitis is the leading infectious cause of unilateral corneal blindness in developed countries, affecting an estimated 500,000 Americans per year. Zirgan's selective activity against virus-infected cells — while leaving healthy corneal cells intact — makes it a preferred topical antiviral for eye care providers managing this condition.
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Zirgan contains ganciclovir, a nucleoside analog antiviral. Ganciclovir mimics guanosine, one of the natural building blocks of DNA. When applied to an infected eye, ganciclovir enters cells and is converted to its active form — ganciclovir triphosphate — through phosphorylation. The first and most critical step in this activation is performed by a viral enzyme called thymidine kinase (TK), which is produced only by herpes simplex virus in infected cells.
Once activated to ganciclovir triphosphate inside an infected cell, the drug works through two mechanisms: (1) it competitively inhibits the viral DNA polymerase enzyme, slowing DNA replication; and (2) it gets incorporated into the growing viral DNA chain, causing chain termination and halting viral replication entirely. Because ganciclovir requires the viral thymidine kinase for activation, it is selectively active in virus-infected cells and relatively inactive in healthy corneal cells — giving it a much better tolerability profile than older agents like trifluridine.
The maximum daily dose from ophthalmic use is approximately 0.375 mg — less than 0.04% of the oral maintenance dose — meaning systemic absorption and systemic side effects are minimal with proper topical use.
0.15% — ophthalmic gel
1 drop in the affected eye 5 times per day until ulcer heals, then 1 drop 3 times per day for 7 days. Supplied in 5-gram aluminum tube.
Zirgan is not on the FDA Drug Shortage Database and is actively manufactured by Bausch + Lomb, but patients routinely encounter difficulty filling this prescription at retail pharmacies. Its findability score is 62 out of 100 — meaning availability is intermittent, particularly at large chain pharmacies. The primary reasons for limited retail stocking are its brand-only status (no generic), low prescription volume relative to mainstream drugs, and specialty ophthalmic distribution channels.
Independent pharmacies and specialty mail-order pharmacies tend to have better Zirgan availability. Your prescribing ophthalmologist's office may also keep samples that can bridge the gap while you fill the prescription. If your pharmacy needs to order it, expect 1–2 business days.
If you're struggling to find Zirgan in stock, medfinder calls pharmacies near you to check which ones have it available and texts you the results, saving you hours of searching.
Zirgan is not a controlled substance, so it can be prescribed by any licensed healthcare provider with prescribing authority in their state. However, because herpetic keratitis requires a slit-lamp examination for proper diagnosis, the following providers are most appropriate:
Ophthalmologists (MD/DO) — The most qualified for diagnosing and managing all forms of herpetic keratitis, including complications
Optometrists (OD) — Can diagnose and treat herpetic keratitis in most states; scope of practice varies by state
Cornea specialists — Ophthalmologists with subspecialty fellowship training; appropriate for complex or recurrent cases
Emergency physicians — May prescribe for acute presentations in the ED; typically refer to eye specialist for confirmed cases
Telehealth is generally not appropriate for the initial diagnosis of herpetic keratitis, as diagnosis requires a slit-lamp examination with fluorescein staining that cannot be performed remotely. Patients with established, recurrent HSV keratitis who recognize their symptoms may be able to obtain a refill from their regular ophthalmologist via telehealth, but this is at provider discretion.
No. Zirgan (ganciclovir ophthalmic gel 0.15%) is not a controlled substance and is not scheduled by the DEA. It is a prescription-only medication, but it does not require special DEA prescribing privileges, special prescription forms, or refill restrictions associated with controlled substance scheduling.
Any licensed prescriber with authority to write prescriptions in your state can prescribe Zirgan. Pharmacies can dispense it as a standard prescription without the additional record-keeping requirements that apply to Schedule II–V medications. There are no mandated prescription refill limits based on controlled substance status, though the Bausch + Lomb Access Program limits its savings program to 6 fills per 12-month period.
The following side effects were reported in clinical trials and represent the most common reactions to Zirgan:
Blurred vision (60%) — Temporary, occurs due to the gel formulation coating the eye surface; resolves within minutes of application
Eye irritation (20%) — Stinging or burning upon application; usually mild and brief
Punctate keratitis (5%) — Small superficial corneal lesions monitored by your eye care provider
Conjunctival hyperemia (5%) — Redness of the white of the eye
Contact your eye care provider immediately if you experience:
Increasing eye pain during treatment (may indicate infection progression)
Worsening redness, itching, or inflammation
Persistent blurred vision that doesn't clear between doses
No improvement after 7 days of treatment
Signs of allergic reaction: severe eyelid swelling, hives, difficulty breathing (rare; seek emergency care)
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Trifluridine 1% (generic Viroptic)
Widely available generic topical antiviral; FDA-approved for herpetic keratitis; 9 drops/day initial dosing; lower cost ($30-$80); higher ocular toxicity than Zirgan with extended use
Acyclovir (oral, generic)
Oral antiviral; 400 mg five times daily; effective for HSV keratitis especially stromal disease; $10–$30 generic; available everywhere
Valacyclovir (oral, generic Valtrex)
Oral prodrug of acyclovir; 500 mg three times daily; convenient dosing; generic available; effective for HSV eye infections
Famciclovir (oral, generic Famvir)
Oral antiviral; 250 mg three times daily; third-line oral option for HSV keratitis; generic available
Prefer Zirgan? We can find it.
No known drug interactions
minorZirgan ophthalmic gel has no clinically significant known drug-drug interactions due to extremely low systemic absorption (maximum 0.375 mg/day). Always inform all providers and pharmacists of all medications being used.
Zirgan (ganciclovir ophthalmic gel 0.15%) is a highly effective, well-tolerated first-line topical treatment for acute herpetic keratitis. Its selective activity in virus-infected cells gives it a safety and tolerability advantage over older agents, and its 5-times-daily dosing (versus 9 times for trifluridine) improves compliance. Clinical trials show approximately 77% resolution of dendritic ulcers within 7 days.
The primary challenges with Zirgan are its high retail cost ($571–$650 without savings) and inconsistent pharmacy availability due to its brand-only status and specialty distribution. Savings programs like the Bausch + Lomb Access Program ($25 with insurance, $70 without) and discount cards significantly reduce the cost burden. Finding it in stock may require calling multiple pharmacies or using a mail-order service.
If you're struggling to fill your Zirgan prescription, medfinder calls pharmacies near you to check who has it in stock and texts you the results — so you can start treatment quickly and protect your vision.
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