By the PharmaTradz BD Team. Published October 2026.
Every few weeks, a new set of medicines goes on the US shortage lists. October's additions read like a familiar roll call: older cancer injectables, a basic hospital infusion, and a handful of tablets and topicals that a manufacturer has decided to stop making. None of these products is new or complicated. They are short because making them has become hard to justify, or because there is only one source to begin with. For licensed manufacturers and distributors who can supply them properly, each shortage is a real need and a real opening. This piece looks at what has gone short, why it keeps happening, and how compliant supply actually reaches patients.
What went short in the past few weeks
These were added to the ASHP and FDA shortage databases between late September and mid-October 2026:
| Product | Type | What was reported |
|---|---|---|
| Irinotecan injection | Chemotherapy, sterile injectable | Shortage across 10 products from three manufacturers (listed 12 October) |
| Dextrose 50% injection | Hospital essential, syringes and vials | Three products affected (9 October) |
| Bleomycin injection | Chemotherapy, sterile injectable | Four vial products affected (7 October) |
| Cytarabine injection | Chemotherapy, sterile injectable | Four products, all from a single manufacturer (7 October) |
| Felodipine extended-release tablets | Cardiovascular, oral solid | Some strengths discontinued (7 October) |
| Fluocinonide 0.05% ointment | Topical corticosteroid | One presentation discontinued (2 October) |
| Dextroamphetamine transdermal system | ADHD, transdermal patch | Disruption linked to an API shortage (1 October) |
| Ivermectin 3 mg tablets | Antiparasitic, oral solid | A branded presentation is due to be discontinued on 31 October |
They join a long existing list. ASHP counted 227 active shortages in the second quarter of 2026, the third quarterly rise in a row. That is well below the record of 323 in early 2024, but the trend is going the wrong way. Platinum chemotherapies, other oncology injectables and CT contrast agents have been under pressure for much of the year.
Why the same kinds of products keep running short
The pattern is consistent, and it is mostly about economics rather than science.
- Thin margins on old generics. When the price of a decades-old injectable drifts towards cost, manufacturers struggle to justify investment in quality systems, spare capacity or a second line. When something goes wrong, there is no buffer.
- Sole sources. According to ASHP, almost half of new shortages in 2026 involved products with only one supplier. Cytarabine this month is a clear example: every affected presentation comes from the same maker.
- Quality problems at one site. A single failed inspection or contamination event can remove a large share of US supply overnight. That is what happened with ifosfamide earlier this year.
- Business decisions. Discontinuations, such as the felodipine strengths and the fluocinonide ointment, leave remaining suppliers to absorb the demand, sometimes without warning.
- Upstream inputs. The dextroamphetamine patch shows how an API shortage moves straight through to the finished product.
Most of these products are generics, which are currently exempt from the new US tariff on patented medicines. Duty is not the main barrier. Approval, capacity and reliability are.
How compliant supply reaches the market
A shortage does not open the door to unapproved product. In the United States there are three realistic routes, and each one depends on documentation.
| Route | Who it suits | What it takes |
|---|---|---|
| Increase supply under an existing US approval | Manufacturers that already hold an ANDA or NDA for the product | Spare capacity, API on hand and quick release; FDA can expedite reviews of supplements that add capacity |
| Relaunch or transfer a dormant approval | Companies with an approved but unmarketed product, or a CDMO partner | A current GMP status for the site, a supply agreement and time to restart |
| FDA temporary importation | Manufacturers with the same product approved in a well-regulated market | FDA agreement in a critical shortage; a risk-based quality review of the site; labelling differences explained to clinicians |
Temporary importation is used more often than many people think. One study counted at least 21 cases for generic sterile injectables alone since 2017. It is still a last resort, however, decided case by case. Approaches go through FDA's drug shortage staff, not through a buyer's purchase order.
The same products are often short outside the United States as well. Hospitals and tender agencies in Europe, the Gulf, Latin America and Asia look for alternative registered sources too. A supplier with complete documents for one market is usually well placed for several.
What suppliers should have ready
- the marketing authorisation, and the reference markets where the product is approved;
- the site's recent inspection history and GMP certificates;
- real available capacity, by presentation, and realistic lead times;
- certificates of analysis, stability data and the API source with its DMF or CEP;
- cold chain and shipping arrangements where they apply.
Buyers, in turn, should qualify any new source as carefully in a shortage as at any other time. Our guide on how to verify a pharmaceutical supplier covers the checks that matter. Shortages are exactly when counterfeit and diverted product appears.
How we can help
We work only with licensed buyers and suppliers: hospitals, wholesalers, tender agencies, importers and authorised distributors. We do not supply unapproved product into any market. If you hold an approval for a product that is short somewhere, or you need a qualified alternative source, tell us the product, presentation and market. You can send a request for a quote, or look at our sterile injectable manufacturing network for longer-term capacity.
Sources: ASHP and FDA drug shortage databases as summarised by Becker's Hospital Review (14 October 2026); ASHP quarterly shortage statistics reported by AJMC (July 2026); published research on FDA temporary importation of generic sterile injectables (2025). Shortage status changes often; check the FDA and ASHP databases for the latest position.
Frequently Asked Questions(FAQs)
Which drugs went into shortage in the US in October 2026?
New listings from late September to mid-October included irinotecan, bleomycin and cytarabine injections, dextrose 50% injection, a dextroamphetamine patch, and discontinuations of some felodipine extended-release strengths, a fluocinonide ointment and a branded ivermectin 3 mg tablet.
How many active drug shortages are there in the US?
ASHP counted 227 active shortages in the second quarter of 2026, the third quarterly increase in a row. The record was 323 in early 2024.
Why do generic injectables keep running short?
Mainly economics. Low prices leave little room for spare capacity or quality investment. Many products have only one supplier, so a single quality problem or discontinuation can cut supply sharply.
Can a foreign-approved medicine be imported during a US shortage?
Sometimes. In a critical shortage, FDA can allow temporary importation of a version approved in a well-regulated market, after a risk-based quality review. It is decided case by case through FDA's drug shortage staff.
Does the new US pharma tariff apply to drugs in shortage?
Most products in shortage are generics, which are currently exempt from the Section 232 tariff on patented medicines. Approval, capacity and reliability are the bigger barriers.
