Provider Briefing: Imipramine Availability in 2026

As a prescriber, you may have received calls from patients unable to fill their Imipramine prescriptions. While Imipramine (Tofranil) is not on the FDA's or ASHP's official drug shortage list, the practical reality for many patients is that the drug can be difficult to locate — particularly certain strengths and the pamoate capsule formulation.

This briefing provides an overview of the current availability landscape, prescribing implications, cost considerations, and tools you can use to help your patients maintain access to their medication.

Timeline: How We Got Here

Imipramine, a first-generation tricyclic antidepressant approved in the late 1950s, has been available as an inexpensive generic for decades. As prescribing patterns shifted toward SSRIs and SNRIs in the 1990s and 2000s, demand for TCAs like Imipramine declined. Several manufacturers discontinued production, leaving a shrinking number of suppliers.

Key developments:

• Brand discontinuation: The original brand Tofranil has been largely discontinued in the U.S. market, with generic versions replacing it.
• Manufacturer consolidation: Fewer generic manufacturers continue to produce Imipramine, particularly the pamoate capsule form (formerly Tofranil-PM).
• No formal shortage: As of early 2026, Imipramine does not appear on FDA or ASHP shortage databases. However, intermittent supply disruptions at the pharmacy level are well-documented.

Prescribing Implications

For providers with patients currently taking Imipramine, the availability challenges present several practical considerations:

Formulation Awareness

Imipramine is available in two salt forms:

• Imipramine Hydrochloride tablets: 10 mg, 25 mg, 50 mg — more widely available and significantly less expensive
• Imipramine Pamoate capsules: 75 mg, 100 mg, 125 mg, 150 mg — fewer manufacturers, higher cost ($90-$460 retail), more difficult to source

If a patient on the pamoate formulation reports difficulty filling their prescription, consider whether a switch to hydrochloride tablets at an equivalent daily dose is clinically appropriate. The two formulations are not interchangeable on a milligram-per-milligram basis due to differences in salt form and release characteristics.

Strength Substitution

When a specific tablet strength is unavailable, dose splitting or combining available strengths may be an option. For example, if 50 mg tablets are unavailable, prescribing two 25 mg tablets achieves the same daily dose. Document the clinical rationale and communicate the change clearly to the patient and pharmacy.

Therapeutic Drug Monitoring

For patients on stable Imipramine therapy, maintain awareness that any formulation or manufacturer change may result in subtle bioavailability differences. While FDA-approved generics are required to meet bioequivalence standards, patients sensitive to TCAs may report subjective differences. Consider monitoring plasma levels (imipramine + desipramine) if clinical response changes following a switch.

Current Availability Picture

The availability of Imipramine in 2026 can be characterized as follows:

• Imipramine HCl tablets: Generally available through major wholesalers, though individual pharmacy stock varies by region. Most patients can obtain the drug with persistence or by trying alternative pharmacies.
• Imipramine Pamoate capsules: Significantly more difficult to source. Fewer manufacturers produce this formulation, and wholesale allocation limits may restrict pharmacy ordering.
• Regional variation: Availability is not uniform across the country. Urban areas with more pharmacy options tend to have better access than rural regions.

Cost and Access Considerations

Cost should not be a significant barrier for most patients taking generic Imipramine HCl tablets:

• With insurance: Tier 1 or Tier 2 generic; copay typically $0-$15. No prior authorization generally required.
• Without insurance: Cash price $25-$38 for 30 tablets (25 mg). With discount coupons (GoodRx, SingleCare), as low as $8-$16.
• Pamoate capsules: Substantially more expensive at $90-$460 retail. Coupon prices start around $97.

For uninsured patients, NeedyMeds (needymeds.org) and RxAssist (rxassist.org) maintain directories of patient assistance programs that may cover generic medications.

Tools and Resources for Your Practice

Several tools can help streamline the process of ensuring your patients get their Imipramine filled:

Medfinder for Providers

Medfinder for Providers enables real-time pharmacy inventory checks for Imipramine and other medications. You or your staff can verify availability before sending a prescription to a specific pharmacy, saving patients the frustration of showing up only to be told the drug is out of stock.

Prescribing Best Practices

• Specify "DAW 0" (substitution permitted) to give pharmacies maximum flexibility to dispense whatever manufacturer's product is available.
• Include alternate pharmacies in your e-prescribing notes when you know a patient has had difficulty filling previously.
• Proactive refill management: Encourage patients to request refills 7-10 days before their supply runs out, giving pharmacies time to order if needed.

Alternative Medications to Consider

When Imipramine is truly unavailable and a switch is warranted, consider these TCA alternatives based on the clinical indication:

• Depression: Nortriptyline (better side effect profile), Amitriptyline (widely available, more sedating)
• Neuropathic pain: Amitriptyline (strongest evidence), Nortriptyline (better tolerated in elderly)
• Panic disorder: Clomipramine (strong serotonergic profile), or consider SSRI/SNRI class
• Enuresis: Desmopressin (DDAVP) — non-TCA option FDA-approved for nocturnal enuresis

For a patient-facing overview of alternatives, you can share: Alternatives to Imipramine.

Looking Ahead

The structural factors driving Imipramine availability challenges — limited manufacturers, low margins, and declining but persistent demand — are unlikely to change dramatically in the near term. Providers who proactively manage their patients' access, leverage tools like Medfinder for Providers, and maintain familiarity with TCA alternatives will be best positioned to navigate these ongoing supply dynamics.

Key actions for your practice:

1. Educate patients about proactive refill timing
2. Use Medfinder for Providers to verify pharmacy stock before prescribing
3. Document a backup medication plan for patients who have experienced filling difficulties
4. Consider switching pamoate patients to hydrochloride tablets where clinically appropriate

Final Thoughts

Imipramine remains a clinically valuable medication for a subset of patients who benefit from TCA therapy. While it is not in a formal shortage, the practical challenges of filling this prescription are real. By staying informed, leveraging available tools, and maintaining open communication with patients and pharmacies, you can help ensure continuity of care.

For additional provider resources, see our guide on how to help your patients find Imipramine in stock and how to help patients save money on Imipramine.