| Bipolar I disorder
Lybalvi vs Igalmi
Side-by-side clinical, coverage, and cost comparison for bipolar i disorder.Deep comparison between: Lybalvi 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 Lybalvi based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Igalmi but not Lybalvi, including UnitedHealthcare
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Category
Lybalvi
Igalmi
At A Glance
Oral
Once daily
Atypical antipsychotic + opioid 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 Initiate at 5 or 10 mg/10 mg orally once daily; recommended dose 10, 15, or 20 mg/10 mg once daily; maximum 20 mg/10 mg once daily.
Bipolar I disorder - monotherapy (manic or mixed episodes) Initiate at 10 or 15 mg/10 mg orally once daily; recommended dose 10, 15, or 20 mg/10 mg once daily; maximum 20 mg/10 mg once daily.
Bipolar I disorder - adjunct to lithium or valproate Initiate at 10 mg/10 mg orally once daily; recommended dose 10, 15, or 20 mg/10 mg once daily; maximum 20 mg/10 mg once daily.
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
- Current opioid use
- Acute opioid withdrawal
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Adverse Reactions
Most common (>=5%) Weight increased, somnolence, dry mouth, headache
Serious Neuroleptic malignant syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS), metabolic changes (hyperglycemia, dyslipidemia, weight gain), tardive dyskinesia, orthostatic hypotension and syncope, leukopenia, neutropenia, agranulocytosis, dysphagia, seizures
Postmarketing Anaphylactoid reaction, angioedema, cholestatic or mixed liver injury, hepatitis, jaundice, diabetic coma, diabetic ketoacidosis, DRESS, fecal incontinence, hyperlipidemia, neutropenia, pancreatitis, priapism, rash, rhabdomyolysis, SIADH, somnambulism, stuttering, venous thromboembolic events
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
The efficacy of olanzapine in schizophrenia and bipolar I disorder may be mediated through combined dopamine and serotonin type 2 (5HT2) antagonism; samidorphan is an opioid antagonist whose mechanism could be mediated through mu-, kappa-, and delta-opioid receptor antagonism.
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
Lybalvi
- Covered on 5 commercial plans
- PA (1/12) · Step Therapy (6/12) · Qty limit (10/12)
Igalmi
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (1/12) · Qty limit (11/12)
UnitedHealthcare
Lybalvi
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (1/8) · Qty limit (1/8)
Igalmi
- Covered on 4 commercial plans
- PA (2/8) · Step Therapy (1/8) · Qty limit (0/8)
Humana
Lybalvi
- 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
Cost estimate not availableHealthWell: Schizophrenia - Medicare Access
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Igalmi.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.