| Major Depressive Disorder
Spravato vs Fetzima
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Spravato 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 Spravato based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Fetzima but not Spravato, including UnitedHealthcare
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Category
Spravato
Fetzima
At A Glance
Intranasal
Twice weekly to every 2 weeks
NMDA receptor antagonist
Oral
Once daily
SNRI
Indications
- Depressive Disorder, Treatment-Resistant
- Major Depressive Disorder
- Major Depressive 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 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
- 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
- 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%) 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, 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
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.
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
Spravato
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (10/12) · Qty limit (0/12)
Fetzima
- Covered on 5 commercial plans
- PA (3/12) · Step Therapy (11/12) · Qty limit (12/12)
UnitedHealthcare
Spravato
- Covered on 4 commercial plans
- PA (6/8) · Step Therapy (6/8) · Qty limit (3/8)
Fetzima
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (8/8) · Qty limit (6/8)
Humana
Spravato
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (1/3) · Qty limit (1/3)
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
$10/fillfill
Spravato with Me Savings ProgramCommercial 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.