| Major Depressive Disorder
Aplenzin vs Fetzima
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Aplenzin vs Fetzima 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 signalsFetzima has a higher rate of injection site reactions vs Aplenzin based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Fetzima but not Aplenzin, including UnitedHealthcare
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Category
Aplenzin
Fetzima
At A Glance
Oral
Once daily
Norepinephrine-dopamine reuptake inhibitor
Oral
Once daily
SNRI
Indications
- Major Depressive Disorder
- Seasonal Affective Disorder
- Major Depressive Disorder
Dosing
Major Depressive Disorder Starting dose 174 mg once daily in the morning; after 4 days, increase to target dose of 348 mg once daily.
Seasonal Affective Disorder Starting dose 174 mg once daily; after 7 days, increase to target dose of 348 mg once daily in the morning; initiate in autumn, continue through winter, taper and discontinue in early spring.
Hepatic Impairment Moderate to severe (Child-Pugh 7-15): maximum 174 mg every other day; mild (Child-Pugh 5-6): consider reducing dose and/or frequency.
Renal Impairment Consider reducing dose and/or frequency in patients with GFR less than 90 mL/min.
Major Depressive Disorder Initiate at 20 mg once daily for 2 days, then increase to 40 mg once daily; may increase in 40 mg increments at intervals of 2 or more days; max 120 mg once daily, oral, with or without food.
Renal Impairment Severe (CrCl 15-29 mL/min): max 40 mg once daily; moderate (CrCl 30-59 mL/min): max 80 mg once daily; ESRD: not recommended.
Contraindications
- Seizure disorder
- Current or prior diagnosis of bulimia or anorexia nervosa
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
- Concomitant use or use within 14 days of an MAOI intended to treat psychiatric disorders
- Starting APLENZIN in a patient being treated with reversible MAOIs such as linezolid or intravenous methylene blue
- Known hypersensitivity to bupropion or any ingredient of APLENZIN
- Hypersensitivity to levomilnacipran, milnacipran HCl, or any excipient in the formulation
- Concomitant use with MAOIs intended to treat psychiatric disorders, or within 7 days of stopping FETZIMA
- Use of FETZIMA within 14 days of stopping an MAOI intended to treat psychiatric disorders
- Concomitant use with linezolid or intravenous methylene blue
Adverse Reactions
Most common (>=5%) Anorexia, dry mouth, rash, sweating, tinnitus, tremor at 300 mg/day bupropion HCl SR equivalent; insomnia, headache, nausea, dizziness, constipation, anxiety also reported.
Serious Suicidal thoughts and behaviors, seizure, hypertension, activation of mania or hypomania, psychosis and other neuropsychiatric events, angle-closure glaucoma, hypersensitivity reactions including anaphylaxis and Stevens-Johnson Syndrome.
Postmarketing Stroke, complete atrioventricular block, myocardial infarction, Brugada pattern/syndrome, angioedema, DRESS, acute generalized exanthematous pustulosis, rhabdomyolysis, hepatitis, pancreatitis, aseptic meningitis.
Most common (>=5%) Nausea, constipation, hyperhidrosis, heart rate increased, erectile dysfunction, ejaculation disorder, tachycardia, vomiting, palpitations
Serious Suicidal thoughts and behaviors, serotonin syndrome, elevated blood pressure, elevated heart rate, increased risk of bleeding, angle closure glaucoma, urinary hesitation or retention, activation of mania/hypomania, seizure, discontinuation syndrome, hyponatremia, sexual dysfunction
Postmarketing Takotsubo cardiomyopathy, anosmia, hyposmia
Pharmacology
Bupropion is an aminoketone antidepressant whose action is presumed to be mediated by noradrenergic and/or dopaminergic mechanisms; it is a relatively weak inhibitor of neuronal norepinephrine and dopamine reuptake and does not inhibit MAO or serotonin reuptake.
Levomilnacipran is a potent and selective serotonin and norepinephrine reuptake inhibitor (SNRI) that potentiates serotonin and norepinephrine neurotransmission in the central nervous system through inhibition of reuptake at their respective transporters, with no significant affinity for other receptors, ion channels, or transporters.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Aplenzin
- Covered on 5 commercial plans
- PA (4/12) · Step Therapy (10/12) · Qty limit (9/12)
Fetzima
- Covered on 5 commercial plans
- PA (3/12) · Step Therapy (11/12) · Qty limit (12/12)
UnitedHealthcare
Aplenzin
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Fetzima
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (8/8) · Qty limit (6/8)
Humana
Aplenzin
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
Fetzima
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
$100/momo
Aplenzin Copay Savings Program - Non-covered benefitCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Fetzima.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.