| Parkinson Disease
Apokyn vs Rytary
Side-by-side clinical, coverage, and cost comparison for parkinson disease.Deep comparison between: Apokyn vs Rytary 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 signalsRytary has a higher rate of injection site reactions vs Apokyn based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Rytary but not Apokyn, including UnitedHealthcare
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Category
Apokyn
Rytary
At A Glance
SC injection
As needed (PRN)
Dopamine agonist (non-ergoline)
Oral
Three to five times daily
Dopamine precursor/decarboxylase inhibitor combination
Indications
- Parkinson Disease
- Parkinson Disease
- Parkinson Disease, Postencephalitic
- Carbon monoxide-induced parkinsonism
- Manganese-induced parkinsonism
Dosing
Parkinson Disease Starting dose 0.1 mL (1 mg) to 0.2 mL (2 mg) SC as needed for "off" episodes; titrate in 0.1 mL (1 mg) increments every few days; maximum 0.6 mL (6 mg) per dose; doses must be separated by at least 2 hours. Reduce starting dose to 0.1 mL (1 mg) in mild or moderate renal impairment.
Parkinson Disease, Parkinson Disease Postencephalitic, Carbon monoxide-induced parkinsonism, Manganese-induced parkinsonism (levodopa-naive) Starting dose 23.75 mg/95 mg orally three times daily for 3 days; may increase to 36.25 mg/145 mg three times daily on day 4; titrate up to a maximum of 97.5 mg/390 mg three to five times daily; maximum daily dose 612.5 mg/2,450 mg.
Converting from immediate-release carbidopa-levodopa Calculate current total daily levodopa dose; initiate RYTARY at the recommended conversion dose (855 mg to 2,340 mg total daily levodopa depending on prior dose); administer in divided doses three to five times daily; maximum daily dose 612.5 mg/2,450 mg.
Contraindications
- Concomitant use of 5HT3 antagonists including antiemetics (ondansetron, granisetron, dolasetron, palonosetron) and alosetron
- Hypersensitivity or allergic reaction to apomorphine or any excipient including sodium metabisulfite
- Concurrent use of nonselective MAO inhibitors (e.g., phenelzine, tranylcypromine) or use within the preceding 2 weeks
Adverse Reactions
Most common (>=10% above placebo) Yawning, dyskinesias, drowsiness/somnolence, nausea/vomiting, dizziness/postural hypotension, rhinorrhea, hallucination/confusion, edema/swelling of extremities
Serious Nausea and vomiting, syncope/hypotension/orthostatic hypotension, falls, hallucinations/psychotic-like behavior, dyskinesias, hemolytic anemia, impulse control/compulsive behaviors, coronary events, QTc prolongation, withdrawal-emergent hyperpyrexia and confusion, hypersensitivity, fibrotic complications, priapism
Postmarketing Hemolytic anemia
Most common (>=5%) Nausea, dizziness, headache, insomnia, abnormal dreams, dry mouth, dyskinesia, anxiety, constipation, vomiting, orthostatic hypotension
Serious Falling asleep during activities of daily living, somnolence, withdrawal-emergent hyperpyrexia and confusion, cardiovascular ischemic events, hallucinations/psychosis, impulse control/compulsive behaviors, dyskinesia, vitamin B6 deficiency and seizures, peptic ulcer disease, glaucoma
Postmarketing Suicide attempt, suicidal ideation
Pharmacology
APOKYN is a non-ergoline dopamine agonist with high binding affinity for the dopamine D4 receptor and moderate affinity for D2, D3, D5, and adrenergic receptors; its therapeutic effect in Parkinson's disease is believed to result from stimulation of post-synaptic dopamine D2-type receptors within the caudate-putamen.
Carbidopa inhibits peripheral decarboxylation of levodopa, increasing the amount available to cross the blood-brain barrier, where levodopa is converted to dopamine to relieve the symptoms of Parkinson's disease.
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Most Common Insurance
Anthem BCBS
Apokyn
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (0/12) · Qty limit (9/12)
Rytary
- Covered on 5 commercial plans
- PA (6/12) · Step Therapy (5/12) · Qty limit (5/12)
UnitedHealthcare
Apokyn
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (0/8) · Qty limit (3/8)
Rytary
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (2/8) · Qty limit (0/8)
Humana
Apokyn
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (2/3)
Rytary
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (2/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableApokyn Patient Assistance Program
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
No savings programs available for Rytary.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.