When You Can't Get Clomipramine, What Are Your Options?

If you've been taking Clomipramine for OCD and suddenly can't find it at any pharmacy, the anxiety can be overwhelming. You know this medication works for you. You know you shouldn't stop it cold turkey. And now you need a plan B.

The good news is that there are several FDA-approved alternatives for OCD that your doctor can prescribe if Clomipramine isn't available. In this guide, we'll cover what Clomipramine is, how it works, and walk through the best alternative medications — so you can have an informed conversation with your prescriber.

What Is Clomipramine?

Clomipramine (brand name: Anafranil) is a tricyclic antidepressant (TCA) and the first medication ever FDA-approved for obsessive-compulsive disorder. It was approved in 1989 for patients aged 10 and older.

While newer SSRIs are now typically prescribed first for OCD, Clomipramine remains one of the most effective medications for the condition. A major meta-analysis found that Clomipramine was more effective than Sertraline, Fluoxetine, and Fluvoxamine at reducing OCD symptoms. This is why many patients and their doctors consider it irreplaceable.

Clomipramine is available as generic capsules in 25 mg, 50 mg, and 75 mg strengths. The typical maintenance dose ranges from 100 to 250 mg per day.

How Does Clomipramine Work?

Clomipramine works primarily by blocking the reuptake of serotonin — a brain chemical involved in mood regulation and repetitive behaviors. Among all tricyclic antidepressants, Clomipramine has the strongest affinity for the serotonin transporter, which is a big part of why it's so effective for OCD.

Its active metabolite, desmethylclomipramine, also blocks norepinephrine reuptake, which may contribute to its effects on mood and pain. This dual mechanism makes Clomipramine unique among both TCAs and OCD medications.

For more details, see our post on how Clomipramine works.

Alternative Medications for OCD

If you can't find Clomipramine, these are the most commonly prescribed alternatives. All of them are SSRIs (selective serotonin reuptake inhibitors) that are FDA-approved for OCD and widely available as generics.

1. Fluvoxamine (Luvox)

Fluvoxamine was one of the first SSRIs approved specifically for OCD. It's available in immediate-release tablets (25 mg, 50 mg, 100 mg) and extended-release capsules (100 mg, 150 mg).

• Typical dose: 100–300 mg per day
• Pros: Strong evidence for OCD; available as generic; relatively few drug interactions compared to some SSRIs
• Cons: Can cause nausea and sedation; less commonly prescribed than other SSRIs, so some pharmacies may not stock it
• Availability: Generally available, though the extended-release form may sometimes be harder to find

Interestingly, some psychiatrists use Fluvoxamine together with Clomipramine for treatment-resistant OCD. Fluvoxamine inhibits the enzyme that converts Clomipramine to its less serotonergic metabolite, effectively boosting Clomipramine's OCD-fighting power.

2. Fluoxetine (Prozac)

Fluoxetine is one of the most widely prescribed antidepressants in the world and is FDA-approved for OCD in both adults and children aged 7 and older.

• Typical dose: 20–80 mg per day for OCD
• Pros: Very widely available; long half-life means missed doses are less likely to cause withdrawal; extensive safety data
• Cons: May cause insomnia, restlessness, or sexual side effects; some patients find it activating
• Availability: Excellent — one of the most commonly stocked generic medications

3. Sertraline (Zoloft)

Sertraline is another first-line SSRI for OCD, approved for adults and children aged 6 and older.

• Typical dose: 50–200 mg per day for OCD
• Pros: Well-studied for OCD; good tolerability profile; very widely available as generic
• Cons: Can cause GI side effects (nausea, diarrhea); sexual side effects are common
• Availability: Excellent — widely stocked at nearly every pharmacy

4. Paroxetine (Paxil)

Paroxetine is FDA-approved for OCD and several other anxiety disorders.

• Typical dose: 20–60 mg per day for OCD
• Pros: Effective for OCD and comorbid anxiety disorders; available as generic
• Cons: Higher risk of withdrawal symptoms if stopped abruptly compared to other SSRIs; more weight gain and sedation; sexual side effects
• Availability: Good — widely available as generic

How Do These Alternatives Compare to Clomipramine?

Here's the honest truth: Clomipramine is often more effective for OCD than any individual SSRI. Clinical studies have consistently shown that Clomipramine produces greater reductions in OCD symptom scores compared to SSRIs.

However, SSRIs have significant advantages:

• Fewer side effects: SSRIs generally cause fewer anticholinergic side effects (dry mouth, constipation, blurred vision) and are less sedating
• Lower seizure risk: Clomipramine carries a dose-dependent seizure risk, especially above 250 mg/day; SSRIs do not
• Better cardiac safety: SSRIs don't carry the same risk of QT prolongation and cardiac arrhythmias as Clomipramine
• Easier to find: SSRIs are among the most commonly stocked medications at any pharmacy

If you've been stable on Clomipramine and are switching to an SSRI due to availability issues, your doctor will likely start the SSRI while gradually tapering your Clomipramine dose. This cross-taper needs to be done carefully because both Clomipramine and SSRIs affect serotonin, and combining them increases the risk of serotonin syndrome.

Important Reminders

• Never switch medications on your own. Always work with your prescriber to transition safely.
• Don't stop Clomipramine abruptly. Sudden discontinuation can cause withdrawal symptoms.
• Keep trying to find Clomipramine. Use Medfinder to check real-time pharmacy availability. An alternative is a bridge, not necessarily a permanent replacement.
• Give alternatives time to work. SSRIs for OCD typically take 8 to 12 weeks to reach full effectiveness.

Final Thoughts

Clomipramine is a uniquely effective medication for OCD, and there's no perfect one-to-one replacement. But if you can't find it, SSRIs like Fluvoxamine, Fluoxetine, Sertraline, and Paroxetine are proven alternatives that can help manage your symptoms while supply issues are resolved.

Start by using Medfinder to search for Clomipramine in stock near you. If it's truly unavailable, bring this article to your next appointment and talk to your doctor about which alternative is the best fit for your situation.

For more on the current availability situation, read our Clomipramine shortage update for 2026.