Provider Briefing: Clobazam Supply Disruptions in 2026

For neurologists, epileptologists, and other prescribers managing patients on Clobazam, the ongoing supply challenges present real clinical concerns. Patients with Lennox-Gastaut syndrome (LGS) and other refractory epilepsies depend on consistent access to this medication — and gaps in availability can lead to breakthrough seizures, emergency department visits, and significant patient distress.

This briefing covers the current state of Clobazam availability, the timeline of supply disruptions, clinical implications for prescribing, cost and access considerations, and tools you can use to help your patients.

Timeline of Clobazam Supply Issues

Clobazam supply disruptions are not new. Here's a brief timeline:

• 2011: FDA approves Clobazam (Onfi) for adjunctive treatment of seizures associated with LGS
• 2018: Sympazan (Clobazam oral film) approved as an alternative formulation
• 2019–2020: Generic Clobazam becomes available from multiple manufacturers following patent expiration
• 2020–2022: Intermittent manufacturing disruptions begin affecting generic supply, particularly the oral suspension
• 2023–2025: Supply fluctuations continue with periodic improvements followed by new disruptions
• 2026: Availability remains inconsistent across regions and formulations

The oral suspension has been disproportionately affected, creating particular challenges for pediatric patients who cannot swallow tablets.

Prescribing Implications

The supply disruptions create several clinical considerations:

Risk of Abrupt Discontinuation

Clobazam is a Schedule IV benzodiazepine. Abrupt cessation carries significant risks:

• Rebound seizures — potentially more severe than baseline
• Benzodiazepine withdrawal syndrome — anxiety, tremor, insomnia, muscle twitching, and in severe cases, psychosis or status epilepticus
• Withdrawal timeline: Symptoms can persist for weeks to over 12 months following discontinuation

Proactive communication with patients about their supply status is essential to prevent involuntary abrupt discontinuation.

Formulation Switching

When one formulation is unavailable, consider switching to another:

• Tablets (5 mg, 10 mg, 20 mg) — most commonly available generic formulation
• Oral suspension (2.5 mg/mL) — critical for pediatric patients; most supply-constrained
• Sympazan oral film (5 mg, 10 mg, 20 mg) — alternative delivery; may have better availability

Dose equivalency is straightforward across formulations, but verify patient/caregiver comfort with the administration method.

CYP2C19 Considerations

Clobazam is extensively metabolized by CYP2C19. Approximately 2–5% of Caucasians and 15–20% of Asian populations are CYP2C19 poor metabolizers, resulting in significantly higher active metabolite levels. When initiating or adjusting therapy:

• Poor metabolizers should start at 5 mg/day regardless of body weight
• Titrate slowly with close monitoring
• Consider pharmacogenomic testing if response or side effects are unexpected

Current Availability Picture

As of early 2026, the availability landscape for Clobazam includes:

• Generic tablets: Available from multiple manufacturers, though intermittent shortages at the pharmacy level persist. Availability varies significantly by region and pharmacy type.
• Generic oral suspension: Most affected by supply disruptions. May be unavailable for extended periods at many pharmacies.
• Brand Onfi: Limited availability; largely replaced by generics in most markets.
• Sympazan oral film: Available but may require specialty pharmacy channels and prior authorization.

Independent and specialty pharmacies tend to have more consistent stock than large chain pharmacies. Medfinder for Providers offers real-time pharmacy stock search tools that can help you and your staff locate available inventory quickly.

Cost and Access Considerations

Cost remains a barrier for many patients:

• Generic Clobazam tablets: $30–$150 for a 30-day supply (cash price); $50–$90 with discount cards
• Brand Onfi: $150–$600+ per month without insurance
• Sympazan: Premium pricing; may require prior authorization even with insurance

Insurance Coverage

Most commercial and Medicaid plans cover generic Clobazam. Common access barriers include:

• Prior authorization for brand-name or Sympazan
• Step therapy requirements (though most patients will already be on generic)
• Quantity limits that may not align with prescribed doses

Patient Assistance Resources

• Lundbeck Patient Assistance Program — for uninsured/underinsured patients using Onfi
• Aquestive Therapeutics — savings programs for Sympazan
• NeedyMeds, RxAssist, Epilepsy Foundation — additional assistance resources
• Discount cards: GoodRx, SingleCare, RxSaver can reduce generic costs by 40–70%

For a patient-facing resource on cost savings, you can direct patients to: How to Save Money on Clobazam.

Tools and Resources for Providers

Medfinder for Providers

Medfinder offers a provider-focused tool that allows your team to search for Clobazam availability at nearby pharmacies in real time. This can be integrated into your workflow to proactively identify where to send prescriptions when a patient's usual pharmacy is out of stock.

Clinical Alternatives

When Clobazam is truly unavailable, the following therapeutic alternatives may be considered based on the patient's clinical picture:

1. Clonazepam (Klonopin): Closest pharmacologic alternative; more sedating; widely available at $10–$30/month
2. Valproic Acid (Depakote): Broad-spectrum AED effective in LGS; requires blood monitoring; $15–$50/month
3. Lamotrigine (Lamictal): Approved for LGS; favorable side effect profile; slow titration required; $10–$40/month
4. Rufinamide (Banzel): Specifically approved for LGS; not a controlled substance; $50–$200/month

Full clinical details on alternatives: Alternatives to Clobazam.

Looking Ahead

The Clobazam supply situation is unlikely to resolve completely in the near term. The combination of a limited patient population, few generic manufacturers, controlled substance regulations, and global supply chain pressures means intermittent disruptions will likely continue.

Proactive measures can mitigate the impact on your patients:

• Discuss supply proactively during appointments
• Document alternative plans in the chart in case of supply interruption
• Prescribe generic Clobazam by default to maximize pharmacy flexibility
• Consider Sympazan as a backup formulation, especially for patients with frequent tablet supply issues
• Educate patients on refilling early and using tools like Medfinder

Final Thoughts

Clobazam remains an important tool in the management of Lennox-Gastaut syndrome and refractory epilepsy. While supply challenges are frustrating for providers and patients alike, proactive planning, awareness of the availability landscape, and use of real-time search tools can help ensure your patients maintain seizure control.

For a step-by-step guide on helping patients find their medication, see How to Help Your Patients Find Clobazam in Stock.

Visit medfinder.com/providers to access provider tools and resources.