| Major Depressive Disorder
Rexulti vs Effexor XR
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Rexulti vs Effexor 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 signalsEffexor has a higher rate of injection site reactions vs Rexulti based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Effexor but not Rexulti, including UnitedHealthcare
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Category
Rexulti
Effexor
At A Glance
Oral
Once daily
Atypical antipsychotic
Oral
Daily
SNRI
Indications
- Major Depressive Disorder
- Schizophrenia
- Agitation in Dementia
- Major Depressive Disorder
- Generalized Anxiety Disorder
- Phobia, Social
- Panic 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 37.5-75 mg/day; target 75 mg/day; max 225 mg/day; administered once daily with food.
Generalized Anxiety Disorder Starting dose 37.5-75 mg/day; target 75 mg/day; max 225 mg/day; administered once daily with food.
Phobia, Social Recommended dose 75 mg/day; administered once daily with food; no evidence that higher doses confer additional benefit.
Panic Disorder Starting dose 37.5 mg/day for 7 days, then 75 mg/day; max 225 mg/day; administered once daily with food.
Contraindications
- Known hypersensitivity to brexpiprazole or any excipient (reactions include rash, facial swelling, urticaria, and anaphylaxis)
- Known hypersensitivity to venlafaxine hydrochloride, desvenlafaxine succinate, or any excipients in the formulation
- Concomitant use with MAOIs (including linezolid and intravenous methylene blue), or within 14 days of stopping an MAOI antidepressant, due to risk of serotonin syndrome
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%) Nausea, somnolence, dry mouth, sweating, abnormal ejaculation, anorexia, constipation, impotence, decreased libido
Serious Serotonin syndrome, elevated blood pressure, increased risk of bleeding, angle-closure glaucoma, activation of mania/hypomania, discontinuation syndrome, seizure, hyponatremia, interstitial lung disease, eosinophilic pneumonia
Postmarketing Anaphylaxis, angioedema, QT prolongation, ventricular fibrillation, ventricular tachycardia (including torsade de pointes), takotsubo cardiomyopathy, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, neuroleptic malignant syndrome, rhabdomyolysis, hyponatremia, SIADH
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.
Venlafaxine is an SNRI whose antidepressant and anxiolytic effects are thought to be related to potentiation of serotonin and norepinephrine in the CNS through inhibition of their reuptake; it also weakly inhibits dopamine reuptake and has no significant affinity for muscarinic, H1-histaminergic, or alpha1-adrenergic receptors.
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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)
Effexor
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (12/12)
UnitedHealthcare
Rexulti
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (6/8)
Effexor
- 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)
Effexor
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · 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
No savings programs available for Effexor.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.