| Major Depressive Disorder

Spravato vs Trintellix

Side-by-side clinical, coverage, and cost comparison for major depressive disorder.

Deep comparison between: Spravato vs Trintellix with Prescriber.AI

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Safety signalsTrintellix has a higher rate of injection site reactions vs Spravato based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Trintellix but not Spravato, including UnitedHealthcare

Category

Spravato

Trintellix

At A Glance

RouteIntranasal

FrequencyTwice weekly to every 2 weeks

ClassNMDA receptor antagonist

RouteOral

FrequencyOnce daily

ClassAntidepressant

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 Starting dose 10 mg once daily without regard to meals; increase to 20 mg/day as tolerated. May decrease to 5 mg/day for patients who do not tolerate higher doses. Maximum 20 mg/day (10 mg/day in CYP2D6 poor metabolizers). Taper from 15-20 mg/day to 10 mg/day for one week before discontinuation if possible.

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 vortioxetine or any component of the formulation
Use of MAOIs intended to treat psychiatric disorders concurrently or within 21 days of stopping TRINTELLIX
Use within 14 days of stopping an MAOI intended to treat psychiatric disorders
Initiation in patients being treated with linezolid or intravenous methylene blue

Drug Interactions

737View drug interactions

1318View drug interactions

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% and twice placebo) Nausea (21-32%), constipation (3-6%), vomiting (3-6%), diarrhea (7-10%), dry mouth (6-8%), dizziness (6-9%)

Serious Serotonin syndrome, increased bleeding risk, activation of mania/hypomania, angle closure glaucoma, hyponatremia, hypersensitivity reactions including anaphylaxis and angioedema

Postmarketing Hyperprolactinemia, acute pancreatitis, seizure, aggression, agitation, anger, hostility, irritability, anosmia, hyposmia, weight gain, rash, generalized rash, hyperhidrosis

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.

Vortioxetine's antidepressant effect is thought to be related to enhancement of serotonergic activity in the CNS through inhibition of serotonin reuptake, along with 5-HT3 receptor antagonism and 5-HT1A receptor agonism.

View Full FDA Information

View full FDA information

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Most Common Insurance

Anthem BCBS

Spravato