| Major Depressive Disorder
Aplenzin vs Spravato
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Aplenzin 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 Aplenzin based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Spravato but not Aplenzin, including UnitedHealthcare
Sign up to reveal the full AI analysis
Category
Aplenzin
Spravato
At A Glance
Oral
Once daily
Norepinephrine-dopamine reuptake inhibitor
Intranasal
Twice weekly to every 2 weeks
NMDA receptor antagonist
Indications
- Major Depressive Disorder
- Seasonal Affective Disorder
- Depressive Disorder, Treatment-Resistant
- 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.
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
- 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
- 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 (>=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%) 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
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.
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.
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)
Spravato
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
UnitedHealthcare
Aplenzin
- 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
Aplenzin
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
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
$100/momo
Aplenzin Copay Savings Program - Non-covered benefitCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
$10/fillfill
Spravato with Me Savings ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
Compare Other Drugs
Let us handle your prior authsJust enter your patient's info and we'll:
- Verify eligibility with the payer.
- Pull the right PA forms directly from the payer.
- Submit, track & send live updates to your dashboard.
Free to start · HIPAA compliant
Next Steps for Your Patient
AplenzinView full Aplenzin profile
SpravatoView full Spravato profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.