The Complex Web of Reasons for the Triamcinolone Backorder
The ongoing shortage of triamcinolone, a versatile corticosteroid used to treat a wide range of inflammatory conditions, is not attributable to a single cause but rather a confluence of factors affecting multiple manufacturers. The pharmaceutical industry's supply chain is intricate and vulnerable to disruption, and triamcinolone is a clear illustration of this fragility.
Manufacturer-Specific Problems
One of the primary drivers behind the shortage is related to issues at individual manufacturing facilities, including delays and quality control failures. A few notable examples include:
- Harrow Eye, LLC (Triesence): The company reported a shortage of its triamcinolone acetonide intravitreal injection due to manufacturing delays related to complying with good manufacturing practices (GMP). This issue arose after Harrow acquired the product from Novartis in 2023, and as the sole supplier, this disruption significantly impacted availability.
- Bristol Myers Squibb (BMS) (Kenalog): The company reported backorders on certain vial sizes of Kenalog-40 injectable suspension with no estimated release date. For some formulations, a fall disruption was expected. Related brand formulations have been discontinued in other markets due to commercial viability and supply chain issues.
- Long Grove: This manufacturer cited increased demand as a reason for its triamcinolone acetonide injectable shortage.
- Pacira Pharmaceuticals (Zilretta): A recall was issued for this extended-release triamcinolone formulation due to a potential stability issue.
- Other Manufacturers: Several other manufacturers, including Teva, Eugia, Hikma, and Viatris, have also reported shortages or backorders for their triamcinolone products.
Systemic Supply Chain Vulnerabilities
Beyond specific manufacturer problems, broader systemic issues contribute to the triamcinolone shortage:
- Market Consolidation: For many generic sterile injectable drugs, only a few manufacturers exist in the market. If one or two of these companies face production challenges, the entire market is affected, and other manufacturers cannot easily fill the void.
- Raw Material Sourcing: The global sourcing of active pharmaceutical ingredients (APIs) and other materials means that geopolitical events, natural disasters, or transport issues can easily disrupt the supply chain.
- Commercial Viability: Manufacturers may make business decisions to discontinue or de-prioritize certain products if they are less profitable, leading to further reductions in available supply.
Increased Demand
In some cases, the demand for a medication can outstrip the manufacturing capacity, especially if the supply chain is already stressed. For some triamcinolone formulations, increased demand has been noted as a contributing factor.
Manufacturer Status and Resupply Estimates (as of October 2025)
| Manufacturer (Brand) | Product | Shortage Reason | Resupply Estimate | Status Update Source |
|---|---|---|---|---|
| Harrow Eye, LLC (Triesence) | Intravitreal Injection | GMP manufacturing delays | Estimated 12 months (from Sept 2025) | Drugs.com |
| Bristol Myers Squibb (Kenalog) | 40 mg/mL vials | Backorder; no release date estimate | Unavailable | ASHP |
| Long Grove | 40 mg/mL vials | Increased demand | Intermittent availability | ASHP |
| Viatris | 40 mg/mL vials | Backorder | Mid-December 2025 (for 10 mL) | ASHP |
| Medexus (Hexatrione) | Hexacetonide Injection | Delay in shipping | Unavailable (temporarily imported) | Drugs.com |
| Hikma | 40 mg/mL vials | Backorder | Late-October 2025 (for 1 mL) | ASHP |
Navigating the Triamcinolone Shortage: A Guide for Patients and Providers
Strategies for Healthcare Providers
To manage the impact of the shortage on patient care, providers can take several proactive steps:
- Consult official drug shortage resources from the FDA and ASHP for the most current availability information.
- Engage with multiple pharmaceutical suppliers to understand allocation limits and potential sourcing options.
- Evaluate alternative treatments, such as other corticosteroids, based on the patient's specific condition and needs.
- Form a drug product shortage team to identify key staff who can expedite decision-making and access information.
Strategies for Patients
Patients affected by the shortage can take the following steps to ensure continuity of care:
- Communicate with your doctor about the shortage and inquire about potential alternatives or different dosage forms.
- Contact your pharmacy to check stock levels and ask if other pharmacies in their chain have the medication.
- Use official databases, like those from the ASHP, to see the latest status updates on specific manufacturers and formulations.
- Do not switch to an alternative medication without first consulting with your healthcare provider, as potencies and appropriate dosages can differ significantly.
Exploring Alternatives to Triamcinolone
When triamcinolone is unavailable, healthcare providers can consider a number of alternative corticosteroids. The most appropriate substitute will depend on the specific condition being treated, the desired potency, and the administration method (e.g., oral, topical, injectable).
- Injectable Alternatives: For intramuscular or intra-articular injections, alternatives with similar potency and action may be used. Methylprednisolone (Depo-Medrol) is often a comparable alternative for certain conditions. Dexamethasone and betamethasone are other options, but their potencies and durations of action may differ, requiring careful dosage adjustment.
- Topical Alternatives: For inflammatory skin conditions like eczema or psoriasis, other topical corticosteroids can be used. Hydrocortisone (low-to-medium potency) and Clobetasol (super-potent) offer different strengths depending on the severity of the condition.
Conclusion
The triamcinolone backorder is a complex, multi-faceted problem stemming from manufacturer-specific issues, increased demand, and inherent vulnerabilities within the global pharmaceutical supply chain. As different formulations face different issues, communication between patients, pharmacists, and prescribers is paramount to ensuring continuity of treatment. By consulting official resources like the ASHP and FDA and exploring clinically appropriate alternatives, healthcare teams can effectively navigate the shortage and minimize its impact on patient health. While the shortage is ongoing, informed decision-making and proactive management remain the most effective strategies. Read more on drug shortage management guidelines.
