Provider Briefing: The Clomipramine Supply Situation in 2026

Clomipramine (Anafranil) — the only tricyclic antidepressant FDA-approved for obsessive-compulsive disorder — has been subject to intermittent supply disruptions since 2020. For providers managing patients with OCD, treatment-resistant depression, or other conditions treated off-label with Clomipramine, these shortages present meaningful clinical challenges.

This briefing covers the current supply landscape, prescribing considerations during the shortage, cost and access issues, and practical tools to help your patients find their medication.

Shortage Timeline

Clomipramine supply issues have evolved over several years:

• 2020–2021: Initial supply disruptions emerged alongside broader pharmaceutical supply chain issues. API sourcing challenges and pandemic-related manufacturing slowdowns affected multiple generic producers.
• 2022–2023: The most acute period of shortage. Several manufacturers experienced simultaneous production delays, leading to widespread stockouts of the 50 mg and 75 mg strengths. The FDA drug shortage database listed Clomipramine capsules intermittently during this period.
• 2024–2025: Gradual improvement in supply, though availability remained inconsistent. Regional variation persisted, with some areas experiencing more significant shortages than others.
• 2026 (current): Clomipramine remains intermittently available. The 25 mg capsule is generally the easiest to source. The 50 mg and 75 mg capsules continue to have sporadic availability issues depending on region and distributor.

Prescribing Implications

The shortage creates several clinical considerations for prescribers:

Continuity of Care

Clomipramine should not be discontinued abruptly. Patients who suddenly lose access risk withdrawal symptoms including dizziness, nausea, vomiting, headache, fever, and irritability. For patients on stable regimens, treatment interruptions can also lead to OCD symptom relapse, which may take weeks to months to recover from once medication is restarted.

Dose Flexibility

When a patient's usual strength is unavailable, consider prescribing an equivalent dose using available strengths. For example:

• 75 mg daily → three 25 mg capsules
• 150 mg daily → two 75 mg capsules or three 50 mg capsules
• 200 mg daily → consider combinations of available strengths

Communicate clearly with the pharmacy and patient about any dose adjustments to prevent confusion.

Cross-Tapering to Alternatives

If Clomipramine is unavailable for an extended period, transitioning to an SSRI may be necessary. Key considerations:

• Fluvoxamine (Luvox): Most commonly used SSRI augmentation partner with Clomipramine; strong OCD evidence. Note that Fluvoxamine is a potent CYP1A2 inhibitor and will significantly increase Clomipramine levels if used in combination — this interaction is sometimes used therapeutically but requires careful monitoring.
• Fluoxetine (Prozac): FDA-approved for OCD; long half-life provides a built-in taper. However, Fluoxetine is a potent CYP2D6 inhibitor and will increase Clomipramine levels — allow adequate washout during cross-taper.
• Sertraline (Zoloft): FDA-approved for OCD; generally well-tolerated with fewer CYP interactions than Fluoxetine.
• Paroxetine (Paxil): FDA-approved for OCD; also a CYP2D6 inhibitor. Higher discontinuation syndrome risk.

Cross-tapering from Clomipramine to an SSRI requires caution due to serotonin syndrome risk. A conservative approach involves tapering Clomipramine first, allowing a brief washout period, and then initiating the SSRI at a low dose.

Monitoring During Transitions

Patients transitioning off Clomipramine should be monitored for:

• Withdrawal symptoms (particularly in the first 1–2 weeks)
• OCD symptom recurrence
• Serotonin syndrome symptoms if overlapping serotonergic agents
• Suicidality (per black box warning for all antidepressants)

Current Availability Picture

Availability varies significantly across pharmacies and regions. Key patterns:

• Chain pharmacies (CVS, Walgreens, Rite Aid) share wholesalers and tend to experience stockouts simultaneously
• Independent pharmacies often source from different distributors and may have stock when chains don't
• Mail-order pharmacies may have more consistent access due to broader distribution networks
• Compounding pharmacies can prepare Clomipramine from bulk API when commercial capsules are unavailable

Medfinder for Providers offers real-time pharmacy stock checking that can help your practice quickly identify pharmacies with Clomipramine availability for your patients.

Cost and Access Considerations

Clomipramine pricing in 2026:

• Generic cash price: $30–$150 for a 30-day supply (varies by strength and pharmacy)
• With discount coupon: $15–$60 for a 30-day supply
• Insurance: Generally covered as a Tier 1 or Tier 2 generic ($5–$30 copay)

Some insurance plans require step therapy — patients must try and fail an SSRI before Clomipramine is covered. Prior authorization may be required for the brand name or for higher doses. Providers can support patients by documenting previous SSRI trials and submitting prior authorization promptly.

For patients without insurance or with high out-of-pocket costs, patient assistance programs through organizations like NeedyMeds, RxAssist, and the Patient Access Network Foundation may provide relief. Discount cards from GoodRx, SingleCare, and RxSaver can also significantly reduce costs.

Tools and Resources for Your Practice

• Medfinder for Providers: Real-time pharmacy availability search for Clomipramine and other medications in shortage
• FDA Drug Shortage Database: Official shortage status and manufacturer updates
• ASHP Drug Shortage Resource Center: Clinical guidance and alternative therapy recommendations
• State pharmacy boards: Some states have emergency dispensing provisions during shortages that allow partial fills or emergency supplies

Looking Ahead

The structural factors driving the Clomipramine shortage — limited manufacturers, thin margins on older generics, concentrated API supply chains — are unlikely to resolve quickly. Providers should:

• Proactively discuss contingency plans with patients who are stable on Clomipramine
• Document SSRI trial history to facilitate insurance coverage and prior authorization
• Consider whether new patients might be better started on an SSRI rather than Clomipramine given supply uncertainty
• Use availability tools to direct patients to pharmacies with current stock

Final Thoughts

Clomipramine remains an essential medication in the OCD treatment arsenal — particularly for patients who have not responded to SSRIs. The ongoing shortage requires providers to be proactive, flexible, and well-informed about alternatives and resources.

By leveraging tools like Medfinder for Providers, maintaining open communication with patients about backup plans, and staying current on supply developments, you can help ensure that your patients with OCD continue to receive effective treatment despite these supply challenges.

For the patient-facing version of this update, see our Clomipramine shortage update for patients.