Your Patients Need Clomipramine — Here's How to Help Them Get It

As a provider who prescribes Clomipramine, you've almost certainly heard from frustrated patients who can't get their prescriptions filled. The intermittent shortage of Clomipramine (Anafranil) has been an ongoing challenge since 2020, and in 2026, many patients are still struggling with inconsistent availability.

For patients with OCD — especially those who've tried and failed multiple SSRIs — Clomipramine isn't just another medication. It may be the only thing keeping their symptoms manageable. A supply disruption can lead to relapse, withdrawal, and significant distress.

This guide provides practical, actionable steps you can take to help your patients find Clomipramine and maintain continuity of care.

Current Availability

As of early 2026, Clomipramine remains intermittently available in the United States. Key points:

• The 25 mg capsule is generally the most consistently available strength
• The 50 mg and 75 mg capsules experience more frequent stockouts
• Availability varies significantly by region, pharmacy chain, and wholesaler
• Independent pharmacies and mail-order services often have better access than chain pharmacies

The shortage is not total — Clomipramine is being manufactured, but production volumes don't consistently meet demand across all distribution channels.

Why Your Patients Can't Find It

Several factors contribute to the ongoing difficulty:

• Few generic manufacturers: Only a small number of companies produce Clomipramine, creating vulnerability when any one has production issues
• Concentrated API supply: The active ingredient comes from limited global sources
• Increased prescribing volume: Growing OCD diagnosis rates and off-label use for depression, pain, and anxiety have increased demand
• Low margins: As an older generic, Clomipramine isn't profitable enough for manufacturers to significantly expand production
• Distributor allocation: During shortages, wholesalers may limit quantities to individual pharmacies, meaning even pharmacies that want to order more can't get it

What Providers Can Do: 5 Practical Steps

Step 1: Direct Patients to Medfinder

The single most impactful thing you can do is point patients to Medfinder. This free tool allows patients (and your staff) to search real-time pharmacy inventory for Clomipramine across chain, independent, and specialty pharmacies.

Instead of telling patients to "call around," you can give them a specific tool that shows which pharmacies near them have stock right now. Consider adding the Medfinder link to your after-visit instructions for patients on Clomipramine.

Step 2: Prescribe Flexibly

When a specific strength is unavailable, a simple dose adjustment can solve the problem:

• If 75 mg capsules are out of stock, prescribe three 25 mg capsules daily
• If 50 mg capsules are out, prescribe two 25 mg capsules daily
• Write prescriptions that specify "or equivalent combination of available strengths" when possible

Communicate these alternatives to both the patient and the pharmacy to prevent confusion and delays.

Step 3: Consider Mail-Order and Specialty Pharmacies

Mail-order pharmacies often have more consistent access to medications in shortage because they serve a wider geographic area and may have direct relationships with multiple manufacturers. If your patient's insurance includes a mail-order benefit, this can be an excellent option — and often provides 90-day supplies at lower cost.

Specialty pharmacies that focus on psychiatric medications may also maintain better stock of Clomipramine than general retail pharmacies.

Step 4: Proactively Plan for Gaps

For patients stable on Clomipramine, consider these proactive measures:

• Prescribe 90-day supplies when insurance allows, providing a larger buffer against short-term stockouts
• Discuss contingency plans at appointments — which SSRI would you switch to if Clomipramine becomes unavailable?
• Document SSRI trial history in the chart to support prior authorizations and insurance appeals if a switch is needed
• Encourage early refills — advise patients to start the refill process 7–10 days before their supply runs out

Step 5: Know When to Consider Compounding

Compounding pharmacies can prepare Clomipramine capsules from bulk active pharmaceutical ingredient when commercial products are unavailable. This option is worth considering when:

• The patient has failed or cannot tolerate SSRI alternatives
• Commercial Clomipramine is unavailable for an extended period
• The patient needs a non-standard dose or formulation

Ensure the compounding pharmacy is accredited (PCAB or equivalent) and follows USP <855> and <800> standards. Note that compounded medications may not be covered by the patient's insurance.

Alternatives to Consider

When a medication switch is necessary, these SSRIs are the most evidence-based alternatives for OCD:

• Fluvoxamine (Luvox): Strong OCD evidence; 100–300 mg/day. Also used as augmentation with Clomipramine (CYP1A2 interaction — use with caution).
• Fluoxetine (Prozac): FDA-approved for OCD; 20–80 mg/day. Long half-life minimizes discontinuation risk. CYP2D6 inhibitor — allow washout from Clomipramine.
• Sertraline (Zoloft): FDA-approved for OCD; 50–200 mg/day. Good tolerability; fewer CYP interactions.
• Paroxetine (Paxil): FDA-approved for OCD; 20–60 mg/day. Higher discontinuation syndrome risk.

For patients with treatment-resistant OCD who can't access Clomipramine, augmentation strategies (adding an atypical antipsychotic like Aripiprazole or Risperidone to an SSRI) may provide additional benefit.

For more detail, see our provider shortage briefing.

Workflow Tips for Your Practice

Integrating shortage management into your clinical workflow can reduce the burden on both you and your patients:

• Flag Clomipramine patients in your EHR: Create a registry or flag so you can proactively reach out when supply changes
• Add Medfinder to discharge/visit instructions: Include medfinder.com/providers as a standard resource for patients on medications in shortage
• Train front desk staff: Ensure your team knows how to respond when patients call about fill problems — direct them to Medfinder and schedule a provider callback if a medication change is needed
• Pre-authorize alternatives: For patients on Clomipramine, consider documenting in the chart which alternative you'd switch to if supply fails — this saves time when a crisis occurs
• Monitor shortage databases: Periodically check the FDA and ASHP shortage databases for Clomipramine updates so you can proactively communicate with affected patients

Final Thoughts

The Clomipramine shortage is a structural problem without a quick fix. But as a prescriber, you can make a significant difference in your patients' experience by being proactive, prescribing flexibly, and directing patients to tools that help them find their medication.

Medfinder for Providers is designed to support exactly this kind of workflow — helping you and your patients navigate shortages without unnecessary phone calls, delays, or treatment interruptions.

Your patients trust you to advocate for their care. During a shortage, that advocacy extends beyond the prescription pad to helping them actually get the medication in hand.