Provider Briefing: Meprobamate Availability in 2026

Meprobamate — a carbamate-derivative anxiolytic once marketed as Miltown and Equanil — remains FDA-approved for anxiety disorders but has become increasingly difficult for patients to obtain. While not listed on formal FDA or ASHP shortage databases, real-world availability is severely limited. This briefing provides prescribers with the information they need to manage patients currently taking Meprobamate and to make informed decisions about continuing or transitioning therapy.

Timeline: How We Got Here

Meprobamate's path to scarcity has been gradual:

• 1955: Meprobamate introduced as Miltown; becomes the first blockbuster psychotropic drug in the U.S.
• 1960s-1970s: Benzodiazepines (Diazepam, Chlordiazepoxide) begin replacing Meprobamate due to wider therapeutic index.
• 1970: Classified as Schedule IV controlled substance under the Controlled Substances Act.
• 1990s-2000s: Brand names Miltown and Equanil discontinued. Prescribing declines sharply.
• 2010s-present: Only a small number of generic manufacturers continue production. Pharmacy stocking declines as demand falls, creating a functional access gap for remaining patients.

Prescribing Implications

For providers who still have patients on Meprobamate, several factors warrant attention:

Beers Criteria Considerations

Meprobamate is listed on the American Geriatrics Society (AGS) Beers Criteria as a medication to avoid in older adults. It carries increased risk of CNS adverse effects, falls, fractures, and motor vehicle accidents in the elderly population. For patients aged 65 and older, transitioning to a safer alternative is generally recommended regardless of availability concerns.

Dependence and Withdrawal Risk

Patients who have been taking Meprobamate long-term are at risk for physical dependence. Abrupt discontinuation can precipitate withdrawal seizures, which can be life-threatening. Any transition away from Meprobamate should involve a carefully managed taper — typically reducing the dose by 10-25% per week, with close monitoring.

Limited Evidence Base

Meprobamate's evidence base is largely from mid-20th century studies that do not meet current standards for clinical trial design. Newer anxiolytics — including Buspirone, SSRIs, SNRIs, and Hydroxyzine — have substantially more robust efficacy and safety data.

Current Availability Picture

As of early 2026:

• Shortage status: Not listed on FDA or ASHP shortage databases
• Manufacturers: Limited to a small number of generic producers
• Dosage forms available: 200 mg, 400 mg, and 600 mg tablets
• Pharmacy stocking: Most chain pharmacies do not routinely stock Meprobamate; independent pharmacies may be more likely to carry it or willing to special-order
• Telehealth prescribing: Limited — as a Schedule IV controlled substance, many telehealth platforms restrict or do not support prescribing Meprobamate

Cost and Access Challenges

Patients face significant financial barriers:

• Retail cash price: $297-$671 for a 30-day supply
• Insurance coverage: Many plans do not cover Meprobamate or require prior authorization. Step therapy protocols often require trial of benzodiazepines or Buspirone first.
• Discount programs: Coupon cards from SingleCare (~$97) and GoodRx (~$158) provide meaningful savings for uninsured or underinsured patients
• Patient assistance programs: No manufacturer-sponsored programs exist (brands discontinued). General programs through NeedyMeds and RxAssist may help.

Tools and Resources for Your Practice

When patients report difficulty finding Meprobamate, consider these resources:

• Medfinder for Providers: A pharmacy availability tool that helps locate medications in stock near the patient's location. Recommend this to patients who are actively searching.
• Independent pharmacy networks: Direct patients to independent pharmacies, which often have greater ordering flexibility than chains.
• Prior authorization support: If transitioning to an alternative that requires PA, prepare documentation early to avoid treatment gaps.

Alternative Therapies to Consider

When transitioning patients off Meprobamate, the following alternatives have stronger evidence bases and broader availability:

• Buspirone: First-line for GAD; non-controlled; takes 2-4 weeks for onset; excellent safety profile
• Hydroxyzine: Non-controlled antihistamine anxiolytic; rapid onset; useful for acute situational anxiety
• Lorazepam: Benzodiazepine; Schedule IV; fast-acting; appropriate for short-term use during transitions
• SSRIs/SNRIs: Sertraline, Escitalopram, Venlafaxine — first-line pharmacotherapy for anxiety disorders per current guidelines

For a patient-facing comparison, share our article on alternatives to Meprobamate.

Looking Ahead

There are no new formulations or brand-name revivals of Meprobamate in the development pipeline. Given ongoing declines in prescribing and manufacturing interest, availability is unlikely to improve. Proactive transition planning for patients currently taking Meprobamate is recommended where clinically appropriate.

For patients who remain on Meprobamate and tolerate it well, establishing a reliable pharmacy relationship and planning refills well in advance are the most practical strategies for maintaining access.

Final Thoughts

Meprobamate's functional scarcity in 2026 presents a clinical management challenge for providers with legacy patients on this medication. A balanced approach — acknowledging the medication's limitations while respecting patient stability — is key. Leverage tools like Medfinder for Providers to help patients access their medications, and have transition plans ready for when access becomes untenable.

For additional provider resources, see our guide on how to help your patients find Meprobamate in stock.