| Major Depressive Disorder
Trintellix vs Vraylar
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Trintellix 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 Trintellix based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Vraylar but not Trintellix, including UnitedHealthcare
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Category
Trintellix
Vraylar
At A Glance
Oral
Once daily
Antidepressant
Oral
Daily
Atypical antipsychotic
Indications
- Major Depressive Disorder
- Schizophrenia
- Manic Disorder
- Depression, Bipolar
- Major Depressive Disorder
Dosing
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.
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
- 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
- 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% 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
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
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.
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
Trintellix
- Covered on 5 commercial plans
- PA (3/12) · Step Therapy (3/12) · Qty limit (11/12)
Vraylar
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (3/12)
UnitedHealthcare
Trintellix
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (4/8) · Qty limit (5/8)
Vraylar
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (8/8)
Humana
Trintellix
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (3/3) · Qty limit (2/3)
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
$10/fillfill
Trintellix Savings CardCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
Final cost depends on formulary coverage
$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.