| Major Depressive Disorder
Spravato vs Effexor XR
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Spravato 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 Spravato based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Effexor but not Spravato, including UnitedHealthcare
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Category
Spravato
Effexor
At A Glance
Intranasal
Twice weekly to every 2 weeks
NMDA receptor antagonist
Oral
Daily
SNRI
Indications
- Depressive Disorder, Treatment-Resistant
- Major Depressive Disorder
- Major Depressive Disorder
- Generalized Anxiety Disorder
- Phobia, Social
- Panic Disorder
Dosing
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.
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
- 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
- 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%) 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
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
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.
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.
Enter your patient's insuranceCheck specific coverage details for your patient.
Most Common Insurance
Anthem BCBS
Spravato
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
Effexor
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (12/12)
UnitedHealthcare
Spravato
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (6/8) · Qty limit (3/8)
Effexor
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Spravato
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (1/3) · Qty limit (1/3)
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
$10/fillfill
Spravato with Me Savings ProgramCommercial 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.