| Bipolar I disorder
Fanapt vs Igalmi
Side-by-side clinical, coverage, and cost comparison for bipolar i disorder.Deep comparison between: Fanapt vs Igalmi with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsIgalmi has a higher rate of injection site reactions vs Fanapt based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Igalmi but not Fanapt, including UnitedHealthcare
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Category
Fanapt
Igalmi
At A Glance
Oral
Twice daily
D2/5-HT2 antagonist
Sublingual or buccal film
As needed (acute use)
Alpha-2 adrenergic receptor agonist
Indications
- Schizophrenia
- Bipolar I disorder
- Schizophrenia
- Bipolar I disorder
- Bipolar Disorder Type 2
Dosing
Schizophrenia Titrate from 1 mg twice daily; recommended dosage 6 mg to 12 mg twice daily orally, with or without food.
Bipolar I disorder Titrate from 1 mg twice daily; recommended dosage 12 mg twice daily orally, with or without food.
Schizophrenia, Bipolar I disorder, Bipolar Disorder Type 2 - Adults Mild or moderate agitation: 120 mcg initial dose SL or buccal; severe agitation: 180 mcg initial; up to 2 additional doses (60-90 mcg) at least 2 hours apart; maximum 240-360 mcg/day.
Mild or Moderate Hepatic Impairment Mild or moderate agitation: 90 mcg initial; severe agitation: 120 mcg initial; optional additional doses of 60 mcg at least 2 hours apart; maximum 210-240 mcg/day.
Severe Hepatic Impairment Mild or moderate agitation: 60 mcg initial; severe agitation: 90 mcg initial; optional additional doses of 60 mcg at least 2 hours apart; maximum 180-210 mcg/day.
Geriatric Patients (>=65 years) 120 mcg initial dose regardless of agitation severity; optional additional doses of 60 mcg at least 2 hours apart; maximum 240 mcg/day.
Contraindications
- Known hypersensitivity reaction to iloperidone or any excipient in FANAPT
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Adverse Reactions
Most common (>=2%) Dizziness, somnolence, tachycardia, dry mouth, nasal congestion, fatigue, weight increased, nausea, orthostatic hypotension, diarrhea
Serious Increased mortality in elderly patients with dementia-related psychosis, cerebrovascular adverse reactions, QT prolongation, neuroleptic malignant syndrome, tardive dyskinesia, metabolic changes, orthostatic hypotension and syncope, falls, seizures, leukopenia/neutropenia/agranulocytosis, hyperprolactinemia
Postmarketing Retrograde ejaculation, hypersensitivity reactions including anaphylaxis, angioedema, throat tightness, urticaria, rash, and pruritus
Most common (>=5%) Somnolence, oral paresthesia or oral hypoesthesia, dizziness, dry mouth, hypotension, orthostatic hypotension.
Serious Hypotension, orthostatic hypotension, bradycardia, QT interval prolongation, somnolence, withdrawal reactions, tolerance and tachyphylaxis.
Postmarketing Arrhythmia, atrial fibrillation, cardiac arrest, bradycardia, convulsion, apnea, bronchospasm, agitation, delirium, hallucination, hypertension, rash, urticaria.
Pharmacology
Iloperidone is an atypical antipsychotic whose efficacy is believed to be mediated through combined antagonism at dopamine D2 and serotonin 5-HT2 receptors; it also has high affinity for norepinephrine NE-alpha1 receptors and forms an active metabolite, P88, with a similar receptor binding profile.
Dexmedetomidine is an alpha-2 adrenergic receptor agonist whose mechanism of action in acute agitation is thought to involve activation of presynaptic alpha-2 adrenergic receptors; it also exhibits concentration-dependent QT prolongation.
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Most Common Insurance
Anthem BCBS
Fanapt
- Covered on 5 commercial plans
- PA (8/12) · Step Therapy (8/12) · Qty limit (2/12)
Igalmi
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (1/12) · Qty limit (11/12)
UnitedHealthcare
Fanapt
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (3/8) · Qty limit (2/8)
Igalmi
- Covered on 4 commercial plans
- PA (2/8) · Step Therapy (1/8) · Qty limit (0/8)
Humana
Fanapt
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Igalmi
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (1/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Fanapt.
No savings programs available for Igalmi.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.