What's in short supply: 1,146 shortages, two-thirds injectable, and an anesthesia crisis

The FDA drug shortage database currently lists 1,146 active shortages. Of those, 287 drugs are fully unavailable and another 127 have limited supply. Injectable products account for 70% of all current shortages. And five therapeutic categories — anesthesia, psychiatry, pediatrics, gastroenterology, and analgesia — together represent more than half of every shortage on the list.

The numbers are drawn from the FDA Drug Shortages database, which tracks current and resolved shortages reported by manufacturers. The database captures product-level entries: each shortage record represents a specific NDC-level presentation (strength, package size, manufacturer) from a specific company. The 1,146 entries correspond to roughly 96 unique active ingredients at 1,145 distinct presentation levels. This product-level granularity differs from the ASHP drug shortage tracker, which counts unique drug-level shortages (approximately 223 as of early 2026) rather than individual NDC entries.

The scale of the problem

The 505 "to be discontinued" entries represent products where the manufacturer has announced plans to stop production but supply has not yet fully run out. The 29 resolved shortages, despite being a small share of the total, had an average duration of 846 days — more than two years — before resolution. That resolution timeline underscores a structural problem: once a drug enters shortage, it tends to stay there for a long time.

Therapeutic categories: anesthesia leads

Note: individual shortage records can carry multiple category tags, so shares sum to more than 100%.

Anesthesia dominates with 329 current shortages — 28.7% of the total. These are primarily local anesthetics (lidocaine, ropivacaine, bupivacaine), neuromuscular blockers (rocuronium), and sedatives (dexmedetomidine, midazolam). The American Society of Anesthesiologists has called the injectable shortage situation "one of the most persistent supply challenges in modern hospital practice."

Psychiatry and pediatrics follow, driven largely by stimulant shortages. Lisdexamfetamine (Vyvanse generics) alone has 90 active shortage entries across multiple manufacturers and strengths. Mixed amphetamine salts (Adderall generics) add another 73 entries.

The injectable dominance

Nearly 70% of current shortages are injectable products. This is not random. Injectable drugs require sterile manufacturing, have tighter regulatory requirements, and are produced by a smaller number of manufacturers than oral solid dosage forms. When one injectable manufacturer has a problem — a GMP violation, an API shortage, or a production line failure — the market cannot quickly replace the lost volume.

What is actually unavailable

Of the 287 currently unavailable products, the therapeutic concentration sharpens:

The unavailability rates reveal where supply is most fragile. In cardiovascular, 43% of all current shortages are fully unavailable — meaning patients and hospitals have no supply at all. In analgesia/addiction, the figure is 40%. These are not products with reduced supply; these are products with no supply.

Top unavailable drugs by name

Carboplatin is the most notable oncology entry: 14 of its shortage records are fully unavailable. For an essential chemotherapy agent used across lung, ovarian, and head-and-neck cancers, this represents a direct clinical impact.

Why drugs go short

"Not further specified" accounts for the largest share (133 entries), meaning the manufacturer did not provide a reason or the reason was not captured in a standardized field. Among the specified reasons, demand increase (106) and API shortage (67) together account for 173 entries — suggesting that manufacturing capacity and supply-chain resilience are the core structural problems.

GMP compliance issues, while fewer in number (22), are disproportionately impactful because they typically trigger FDA enforcement action that halts production entirely. The 2019 FDA Drug Shortages Task Force report identified quality-related manufacturing problems as the single most common root cause of sterile injectable shortages.

Who makes the drugs in shortage

Hospira (now part of Pfizer) and Fresenius Kabi together account for 322 of the 1,146 current shortage entries — 28.1%. Both are major sterile injectable manufacturers. Hospira's 165 entries span lidocaine, morphine, midazolam, rocuronium, and other essential hospital drugs. Fresenius Kabi's 157 entries cover a similar injectable portfolio.

The concentration of shortages in two manufacturers reflects a broader structural issue in the generic injectable market. Profit margins on older generic injectables are thin, and the number of qualified manufacturers is small. When the two largest producers simultaneously experience supply disruptions, the system has limited capacity to absorb the shock.

The discontinuation wave

The 505 "to be discontinued" entries represent a secondary but growing concern. These are products where manufacturers have announced they will cease production entirely. By therapeutic area:

Cardiovascular leads with 90 pending discontinuations. These are typically older, low-margin generic products where manufacturers have decided that the cost of maintaining FDA-compliant production exceeds the revenue. Each discontinuation forces hospitals to find alternative suppliers or alternative therapies — and if no alternative exists, it creates a new shortage entry.

What this means for hospital pharmacy and supply chain teams

1. Anesthesia and surgery-center supply chains are under sustained stress. With 329 active shortages in anesthesia and 80 products fully unavailable, procedural delays and therapeutic substitutions are now routine. Pharmacy directors should maintain alternative-product lists for lidocaine, ropivacaine, bupivacaine, and dexmedetomidine, and should monitor the ASHP drug shortage bulletins for lot-level recovery announcements.

2. Stimulant shortages are structural, not temporary. Lisdexamfetamine and mixed amphetamine salts have been in shortage since 2022–2023, driven by DEA quota limits and manufacturing capacity constraints. The 90 and 73 active entries respectively indicate a market-wide problem, not a single-manufacturer issue. Prescribers should anticipate ongoing allocation and plan therapeutic alternatives for ADHD patients.

3. Injectables are the systemic vulnerability. With 70% of shortages in injectable form factors and the two largest sterile injectable manufacturers (Hospira/Pfizer and Fresenius Kabi) responsible for 28% of all shortage entries, the generic injectable supply chain is fragile by design. Hospital systems should consider multi-source contracting, safety-stock policies for critical injectables, and participation in group purchasing organization (GPO) shortage-management programs.

4. Discontinuations are compounding the problem. The 505 pending discontinuations — concentrated in cardiovascular and endocrinology — represent a one-way loss of manufacturing capacity. Once a manufacturer exits a product, the supply is gone unless another company picks up the ANDA. Regulatory and commercial incentives to maintain production of low-margin essential drugs remain inadequate.

5. The resolution timeline is measured in years, not months. The 29 resolved shortages in the database lasted an average of 846 days. Hospitals should not plan on quick recoveries. For drugs currently unavailable, planning should assume the shortage will persist through 2027.

Sources

• FDA Drug Shortages database, current edition; analysis by PharmaDossier, run date 2026-06-10. Shortage records filtered by status = Current. Duration analysis computed from initial_posting_date and update_date fields. https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
• American Society of Health-System Pharmacists (ASHP), Current Drug Shortage Bulletins. https://www.ashp.org/drug-shortages/current-shortages/drug-shortages-list
• FDA, "Drug Shortages: Root Causes and Potential Solutions," 2019 Task Force Report. https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
• American Society of Anesthesiologists (ASA), Drug Shortages resource page. https://www.asahq.org/advocacy-and-asapac/advocacy-topics/drug-shortages