In 1949, Warner Bros. released a film based on the book, starring Gary Cooper as Howard Roark, Patricia Neal as Dominique Francon, Raymond Massey as Gail Wynand, and Kent Smith as Peter Keating. Rand, who had previous experience as a screenwriter, was hired to adapt her own novel. The film was directed by King Vidor. It grossed $2.1 million, $400,000 less than its production budget. Critics panned the movie. Negative reviews appeared in publications ranging from newspapers such as The New York Times and the Los Angeles Times, to movie industry outlets such as Variety and The Hollywood Reporter, to magazines such as Time and Good Housekeeping.
In letters written at the time, Rand's reaction to the film was positive. She said it was the most faithful adaptation of a novel ever made in Hollywood and a "real triumph". Sales of the novel increased as a result of interest spurred by the film. She displayed a more negative attitude later, saying she disliked the entire movie and complaining about its editing, acting, and other elements. Rand said she would never sell rights to another novel to a film company that did not allow her to pick the director and screenwriter, as well as edit the film.
Various filmmakers have expressed interest in doing new adaptations of The Fountainhead, although none of these potential films has begun production. In the 1970s, writer-director Michael Cimino wanted to film his own script for United Artists. In 1992, producer James Hill optioned the rights and selected Phil Joanou to direct. In the 2000s, Oliver Stone was interested in directing a new adaptation; Brad Pitt was reportedly under consideration to play Roark. In a March 2016 interview, director Zack Snyder also expressed interest in doing a new film adaptation of The Fountainhead. On May 28, 2018, Snyder was asked on the social media site Vero what his next project was, and he responded "Fountainhead".
The Dutch theater company Toneelgroep Amsterdam presented an adaptation for the stage (in Dutch) at the Holland Festival in June 2014. The company's artistic director Ivo van Hove wrote and directed the adaptation. Ramsey Nasr starred as Howard Roark, with Halina Reijn as Dominique Francon. The four-hour production used video projections to show close-ups of the actors and Roark's drawings, as well as backgrounds of the New York skyline. After its debut the production went on tour, appearing in Barcelona, Spain, in early July 2014, and at the Festival d'Avignon in France later that month. The play appeared at the Odéon-Théâtre de l'Europe in Paris in November 2016, and at the LG Arts Center in Seoul from March 31 to April 2, 2017. The play had its first American production at the Brooklyn Academy of Music's Next Wave Festival, where it ran from November 28 to December 2, 2017.
The Festival d'Avignon production received several positive notices, including reviews from the French newspapers La Croix, Les Échos, and Le Monde, as well as from the English newspaper The Guardian, whose reviewer described it as "electrifying theatre". The French magazine Télérama gave the Avignon production a negative review, calling the source material inferior and complaining about the use of video screens on the set, while another French magazine, La Terrasse, complimented the staging and acting of the Odéon production. American critics gave mostly negative reviews of the Next Wave Festival production. Helen Shaw's review for The Village Voice said the adaptation was unwatchable because it portrayed Rand's characters and views seriously without undercutting them. In a mixed review for The New York Times, critic Ben Brantley complimented Hove for capturing Rand's "sheer pulp appeal", but described the material as "hokum with a whole lot of ponderous speeches". A review for The Huffington Post complimented van Hove's ability to portray Rand's message, but said the play was an hour too long.
The novel was adapted in Urdu for the Pakistan Television Network in the 1970s, under the title Teesra Kinara. The serial starred Rahat Kazmi, who also wrote the adaptation. Kazmi's wife, Sahira Kazmi, played Dominique.
The novel was also parodied in an episode of the animated adventure series Mighty Mouse: The New Adventures and in season 20 of the animated sitcom The Simpsons, in the last part of the episode "Four Great Women and a Manicure".
In 1944, Omnibook Magazine produced an abridged edition of the novel that was sold to members of the United States Armed Forces. Rand was annoyed that Bobbs-Merrill allowed the edited version to be published without her approval of the text. King Features Syndicate approached Rand the following year about creating a condensed, illustrated version of the novel for syndication in newspapers. Rand agreed, provided that she could oversee the editing and approve the proposed illustrations of her characters, which were provided by Frank Godwin. The 30-part series began on December 24, 1945, and ran in over 35 newspapers. Rand biographer Anne Heller complimented the adaptation, calling it "handsomely illustrated".