| Major Depressive Disorder
Rexulti vs Vraylar
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Rexulti vs Vraylar 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 signalsVraylar has a higher rate of injection site reactions vs Rexulti based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Vraylar but not Rexulti, including UnitedHealthcare
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Category
Rexulti
Vraylar
At A Glance
Oral
Once daily
Atypical antipsychotic
Oral
Daily
Atypical antipsychotic
Indications
- Major Depressive Disorder
- Schizophrenia
- Agitation in Dementia
- Schizophrenia
- Manic Disorder
- Depression, Bipolar
- 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.
Schizophrenia Adults: start 1.5 mg once daily; recommended 1.5-6 mg once daily (max 6 mg). Pediatric patients (13-17 years): start 0.5 mg once daily; recommended 1.5-4.5 mg once daily (max 4.5 mg).
Manic Disorder Adults: start 1.5 mg once daily, increase to 3 mg on Day 2; recommended 3-6 mg once daily (max 6 mg). Pediatric patients (10-17 years): start 0.5 mg once daily; recommended 3 mg or 4.5 mg once daily (max 4.5 mg).
Depression, Bipolar Adults: start 1.5 mg once daily; may increase to 3 mg on Day 15 (max 3 mg once daily).
Major Depressive Disorder Adults (adjunctive to antidepressants): start 1.5 mg once daily; may increase to 3 mg on Day 15 (max 3 mg once daily).
Contraindications
- Known hypersensitivity to brexpiprazole or any excipient (reactions include rash, facial swelling, urticaria, and anaphylaxis)
- History of hypersensitivity reaction to cariprazine, including rash, pruritus, urticaria, and reactions suggestive of angioedema (e.g., swollen tongue, lip swelling, face edema, pharyngeal edema, swelling face)
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%) Extrapyramidal symptoms, akathisia, nausea, restlessness, insomnia, somnolence, dyspepsia, vomiting
Serious Neuroleptic malignant syndrome, tardive dyskinesia, increased mortality in elderly patients with dementia-related psychosis, suicidal thoughts and behaviors, cerebrovascular adverse reactions, metabolic changes, leukopenia/neutropenia/agranulocytosis, orthostatic hypotension, seizures
Postmarketing Stevens-Johnson syndrome
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.
Cariprazine is an atypical antipsychotic that acts as a partial agonist at central dopamine D2/D3 and serotonin 5-HT1A receptors and as an antagonist at serotonin 5-HT2A receptors; its two major active metabolites, desmethylcariprazine (DCAR) and didesmethylcariprazine (DDCAR), have in vitro receptor binding profiles similar to the parent drug.
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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)
Vraylar
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (3/12)
UnitedHealthcare
Rexulti
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (6/8)
Vraylar
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (8/8)
Humana
Rexulti
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Vraylar
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Cancer-Related Behavioral Health
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
$75/fillfill
Vraylar Savings Card - 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.