| Major Depressive Disorder
Abilify vs Spravato
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Abilify vs Spravato 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 signalsSpravato has a higher rate of injection site reactions vs Abilify based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Spravato but not Abilify, including UnitedHealthcare
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Category
Abilify
Spravato
At A Glance
Oral
Once daily
Atypical antipsychotic
Intranasal
Twice weekly to every 2 weeks
NMDA receptor antagonist
Indications
- Schizophrenia
- Bipolar I disorder
- Major Depressive Disorder
- Autistic Disorder
- Gilles de la Tourette syndrome
- Depressive Disorder, Treatment-Resistant
- Major Depressive Disorder
Dosing
Schizophrenia - adults Starting dose 10-15 mg/day, target 10-15 mg/day, max 30 mg/day, once daily without regard to meals.
Schizophrenia - adolescents (13-17 yrs) Starting dose 2 mg/day, titrated to 5 mg after 2 days and target of 10 mg/day after 2 additional days, max 30 mg/day, once daily.
Bipolar I disorder - adults, monotherapy Starting dose 15 mg/day, target 15 mg/day, up to 30 mg/day based on clinical response, once daily.
Bipolar I disorder - adults, adjunct to lithium or valproate Starting dose 10-15 mg/day, target 15 mg/day, max 30 mg/day, once daily.
Bipolar I disorder - pediatric (10-17 yrs) Starting dose 2 mg/day, titrated to 5 mg/day after 2 days and target of 10 mg/day after 2 additional days, max 30 mg/day, once daily.
Major Depressive Disorder - adults, adjunct to antidepressants Starting dose 2-5 mg/day, recommended range 2-15 mg/day, max 15 mg/day, once daily.
Autistic Disorder - pediatric (6-17 yrs), irritability Starting dose 2 mg/day, target 5-10 mg/day, max 15 mg/day, once daily.
Gilles de la Tourette syndrome - pediatric (6-18 yrs) Starting dose 2 mg/day; target 5 mg/day for patients <50 kg (max 10 mg/day) or 10 mg/day for patients >=50 kg (max 20 mg/day), once daily.
Depressive Disorder, Treatment-Resistant Induction (Weeks 1-4): 56 mg or 84 mg intranasally twice weekly; Maintenance (Weeks 5-8): 56 mg or 84 mg once weekly; Week 9 and after: 56 mg or 84 mg every 2 weeks or once weekly, individualized to the least frequent dosing to maintain remission/response.
Major Depressive Disorder 84 mg intranasally twice weekly for 4 weeks in conjunction with an oral antidepressant; dose may be reduced to 56 mg twice weekly based on tolerability.
Contraindications
- History of hypersensitivity reaction to aripiprazole (reactions have ranged from pruritus/urticaria to anaphylaxis)
- Aneurysmal vascular disease (including thoracic and abdominal aorta, intracranial, and peripheral arterial vessels) or arteriovenous malformation
- History of intracerebral hemorrhage
- Hypersensitivity to esketamine, ketamine, or any excipient
Adverse Reactions
Most common (>=10%) - adults nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, insomnia, restlessness
Most common (>=10%) - pediatric somnolence, headache, vomiting, extrapyramidal disorder, fatigue, increased appetite, insomnia, nausea, nasopharyngitis, weight increased
Serious NMS, tardive dyskinesia, metabolic changes, pathological gambling, orthostatic hypotension, leukopenia, neutropenia, agranulocytosis, seizures, cerebrovascular adverse events, suicidal thoughts and behaviors
Postmarketing anaphylactic reaction, angioedema, DRESS, blood glucose fluctuation, hiccups, oculogyric crisis, pathological gambling, fecal incontinence
Most common (>=5%) dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, blood pressure increased, vomiting, feeling drunk
Serious sedation, dissociation, respiratory depression, blood pressure increase, cognitive impairment, impaired ability to drive and operate machinery, ulcerative or interstitial cystitis, embryo-fetal toxicity
Postmarketing bradycardia, respiratory depression (including respiratory arrest), hypotension
Pharmacology
Aripiprazole is an atypical antipsychotic whose efficacy may be mediated through a combination of partial agonist activity at D2 and 5-HT1A receptors and antagonist activity at 5-HT2A receptors; it also exhibits high affinity for D3, moderate affinity for D4, 5-HT2C, 5-HT7, alpha1-adrenergic, and H1 receptors.
Esketamine is the S-enantiomer of racemic ketamine and a non-selective, non-competitive NMDA receptor antagonist; the mechanism by which it exerts its antidepressant effect is unknown.
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Most Common Insurance
Anthem BCBS
Abilify
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
Spravato
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
UnitedHealthcare
Abilify
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Spravato
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (6/8) · Qty limit (3/8)
Humana
Abilify
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (1/3)
Spravato
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (1/3) · Qty limit (1/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Abilify.
$10/fillfill
Spravato with Me Savings ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.