| Major Depressive Disorder
Rexulti vs Fetzima
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Rexulti 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 Rexulti based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Fetzima but not Rexulti, including UnitedHealthcare
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Category
Rexulti
Fetzima
At A Glance
Oral
Once daily
Atypical antipsychotic
Oral
Once daily
SNRI
Indications
- Major Depressive Disorder
- Schizophrenia
- Agitation in Dementia
- Major Depressive 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 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
- Known hypersensitivity to brexpiprazole or any excipient (reactions include rash, facial swelling, urticaria, and anaphylaxis)
- 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%) 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, 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
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.
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
Rexulti
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (11/12)
Fetzima
- Covered on 5 commercial plans
- PA (3/12) · Step Therapy (11/12) · Qty limit (12/12)
UnitedHealthcare
Rexulti
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (6/8)
Fetzima
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (8/8) · Qty limit (6/8)
Humana
Rexulti
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
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
Cost estimate not availableHealthWell: Cancer-Related Behavioral Health
Commercial 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.