| Major Depressive Disorder
Rexulti vs Aplenzin
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Rexulti vs Aplenzin 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 signalsAplenzin has a higher rate of injection site reactions vs Rexulti based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Aplenzin but not Rexulti, including UnitedHealthcare
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Category
Rexulti
Aplenzin
At A Glance
Oral
Once daily
Atypical antipsychotic
Oral
Once daily
Norepinephrine-dopamine reuptake inhibitor
Indications
- Major Depressive Disorder
- Schizophrenia
- Agitation in Dementia
- Major Depressive Disorder
- Seasonal Affective Disorder
Dosing
Major Depressive Disorder Start 0.5 mg or 1 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
Schizophrenia Adults: start 1 mg once daily, titrate to target 2-4 mg once daily (max 4 mg); pediatric patients 13-17 years: start 0.5 mg once daily, titrate to target 2-4 mg once daily (max 4 mg).
Agitation in Dementia Start 0.5 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
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.
Contraindications
- Known hypersensitivity to brexpiprazole or any excipient (reactions include rash, facial swelling, urticaria, and anaphylaxis)
- 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
Adverse Reactions
Most common (>=5%) weight increased, akathisia, headache, somnolence, insomnia
Serious neuroleptic malignant syndrome, tardive dyskinesia, metabolic changes, leukopenia, neutropenia, agranulocytosis, orthostatic hypotension, falls, seizures, body temperature dysregulation
Postmarketing neuroleptic malignant syndrome
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.
Pharmacology
Brexpiprazole is an atypical antipsychotic whose efficacy may be mediated through partial agonist activity at serotonin 5-HT1A and dopamine D2 receptors combined with antagonist activity at serotonin 5-HT2A receptors; the exact mechanism of action in the approved indications is unknown.
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.
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Most Common Insurance
Anthem BCBS
Rexulti
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (11/12)
Aplenzin
- Covered on 5 commercial plans
- PA (4/12) · Step Therapy (10/12) · Qty limit (9/12)
UnitedHealthcare
Rexulti
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (6/8)
Aplenzin
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Rexulti
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Aplenzin
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Cancer-Related Behavioral Health
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
$100/momo
Aplenzin Copay Savings Program - Non-covered benefitCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.