Provider Briefing: Marplan Supply in 2026

For psychiatrists and other prescribers managing patients on Marplan (Isocarboxazid), the ongoing supply challenges require proactive planning. Marplan — a non-selective, irreversible monoamine oxidase inhibitor — remains a critical option for treatment-resistant depression, but its availability in 2026 continues to be unreliable.

This article summarizes the current supply situation, prescribing implications, cost and access considerations, and tools available to help your patients maintain medication continuity.

Shortage Timeline

Marplan has experienced intermittent availability issues for several years, driven by its status as a sole-source brand medication with no approved generic equivalent. Key milestones include:

• Historical discontinuation and reintroduction: Originally developed by Roche, Marplan was temporarily discontinued before being reintroduced by Validus Pharmaceuticals LLC.
• Critical shortage and FDA importation: The most severe supply disruption prompted Validus to coordinate with the FDA for temporary importation of Marplan to the US market — an unusual regulatory step that highlights the severity of the supply gap.
• 2026 status: Marplan remains intermittently available. Some pharmacies can source it through wholesalers; others cannot. There is no published FDA resolution date for the shortage.

Prescribing Implications

The unreliable supply of Marplan creates several clinical challenges:

Continuity of Care

Patients who have achieved remission or meaningful improvement on Marplan face the risk of involuntary medication discontinuation. Abrupt cessation of an irreversible MAOI can lead to withdrawal symptoms and rapid relapse of depressive episodes. Providers should:

• Discuss supply contingencies proactively with patients currently on Marplan
• Identify an alternative MAOI in advance, so a switch can be initiated quickly if supply is interrupted
• Consider prescribing 90-day supplies when Marplan is available to create a buffer

New Prescriptions

For providers considering initiating Marplan in a new patient, the supply situation introduces an additional risk factor. Before writing a new Marplan prescription, consider:

• Whether the patient can reliably access the medication given current shortages
• Whether an alternative MAOI with more stable supply (e.g., Nardil or Parnate) might be a more practical first choice
• Using Medfinder for Providers to verify current pharmacy availability before the patient leaves the office

Washout Periods

If transitioning a patient from Marplan to another antidepressant class, standard washout periods apply. A minimum of 14 days should elapse between discontinuing Marplan and initiating an SSRI, SNRI, TCA, or other serotonergic medication. When switching between MAOIs, shorter intervals may be acceptable under close supervision, but this should be managed on a case-by-case basis.

Current Availability Picture

As of early 2026, Marplan availability can be characterized as follows:

• Chain pharmacies: Rarely stock Marplan due to low demand. May or may not be able to order from their primary wholesaler.
• Independent pharmacies: More likely to have flexible wholesaler relationships and willingness to special-order.
• Hospital outpatient pharmacies: May have access through institutional distribution channels.
• Specialty/mail-order pharmacies: Variable availability. Worth checking, particularly for 90-day supplies.

Medfinder for Providers offers a real-time view of which pharmacies in a given area currently have Marplan in stock, allowing you to direct patients to pharmacies that can actually fill their prescription.

Cost and Access

Marplan's cost is a significant barrier for many patients:

• Cash price: $577-$700 for a 30-day supply (60 tablets, 10 mg)
• No generic available: Isocarboxazid is not available in generic form in the US
• Insurance: Most plans require prior authorization. Step therapy is common — patients must demonstrate inadequate response to first-line agents
• Manufacturer co-pay card: Commercially insured patients may pay as little as $20/month (up to $100 savings per 30-day fill). Not valid for government insurance.
• Patient assistance: Prescription Hope offers Marplan at $70/month for qualifying patients. NeedyMeds and RxAssist list additional programs.

Providers should proactively discuss cost with patients and help them access savings programs. For a patient-facing resource, refer them to How to save money on Marplan.

Tools and Resources for Providers

• Medfinder for Providers: Real-time pharmacy availability tracking. Verify stock before writing prescriptions.
• Validus Pharmaceuticals: Contact at 1-866-982-5438 for supply inquiries and to report shortages.
• FDA Drug Shortage Database: Monitor official shortage status and estimated resolution dates.
• Marplan co-pay card: Available at marplan.com for eligible commercially insured patients.

Alternative MAOIs

When Marplan is unavailable, the primary alternatives within the MAOI class are:

• Nardil (Phenelzine): Non-selective, irreversible MAOI. Hydrazine class (same subclass as Isocarboxazid). Typical dose: 45-90 mg/day. Same dietary restrictions.
• Parnate (Tranylcypromine): Non-selective, irreversible MAOI. Non-hydrazine class. Typical dose: 30-60 mg/day. May be more activating. Same dietary restrictions.
• Emsam (Selegiline transdermal): Transdermal MAOI. 6/9/12 mg/24 hr patches. At 6 mg/24 hr, no dietary restrictions required. Higher doses require tyramine precautions.

Note that Nardil has also experienced supply challenges, so availability of alternative MAOIs should be verified before switching. See our patient-facing guide: Alternatives to Marplan.

Looking Ahead

There are no publicly announced plans for a generic Isocarboxazid, and the small patient population makes generic development commercially unattractive. The MAOI class as a whole faces supply vulnerability due to low volumes and limited manufacturer interest.

Providers who prescribe MAOIs should develop institutional strategies for managing supply disruptions, including maintaining awareness of cross-MAOI switching protocols and building relationships with pharmacies that reliably source these medications.

Final Thoughts

The Marplan shortage is not a transient supply blip — it's a structural challenge that reflects the economics of niche psychiatric medications. Providers play a critical role in helping patients navigate this landscape: verifying availability before prescribing, discussing contingency plans, facilitating access to savings programs, and maintaining clinical flexibility around MAOI alternatives.

Medfinder for Providers is designed to help with exactly this kind of situation. We also recommend sharing our provider's guide to helping patients find Marplan with your clinical team.