| Postherpetic neuralgia
Gralise vs Horizant
Side-by-side clinical, coverage, and cost comparison for postherpetic neuralgia.Deep comparison between: Gralise vs Horizant 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 signalsHorizant has a higher rate of injection site reactions vs Gralise based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Horizant but not Gralise, including UnitedHealthcare
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Category
Gralise
Horizant
At A Glance
Oral
Once daily
GABA analogue
Oral
Once or twice daily
Alpha-2-delta ligand
Indications
- Postherpetic neuralgia
- Restless Legs Syndrome
- Postherpetic neuralgia
Dosing
Postherpetic neuralgia Titrate to 1,800 mg once daily orally with the evening meal over 15 days (300 mg Day 1, 600 mg Day 2, 900 mg Days 3-6, 1,200 mg Days 7-10, 1,500 mg Days 11-14, 1,800 mg Day 15); swallow tablets whole, do not crush, split, or chew; if discontinuing, taper over at least 1 week.
Renal impairment Adjust dose for CrCl 30-60 mL/min (600-1,800 mg once daily); do not use in patients with CrCl <30 mL/min or on hemodialysis.
Restless Legs Syndrome 600 mg orally once daily at about 5 PM; dose adjustments required based on creatinine clearance in renal impairment; not recommended for patients on hemodialysis.
Postherpetic neuralgia Initiated at 600 mg orally in the morning for 3 days, then increased to 600 mg twice daily (1,200 mg/day); dose adjustments required based on creatinine clearance in renal impairment.
Contraindications
- Demonstrated hypersensitivity to gabapentin or any excipient of GRALISE
—
Adverse Reactions
Most common (>=1%) Dizziness, somnolence, headache, peripheral edema, diarrhea, dry mouth, nasopharyngitis, weight increased, pain in extremity, back pain, urinary tract infection, constipation, dyspepsia, vertigo, pain, lethargy
Serious Suicidal behavior and ideation, respiratory depression, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/multiorgan hypersensitivity, adverse reactions with abrupt or rapid discontinuation
Postmarketing Angioedema, bullous pemphigoid, erythema multiforme, Stevens-Johnson syndrome, hyponatremia, jaundice, movement disorder, elevated liver function tests, elevated creatine kinase, withdrawal symptoms (seizures, depression, suicidal ideation and behavior, agitation, confusion), life-threatening or fatal respiratory depression (with opioids or CNS depressants)
Most common (>=5%) Somnolence/sedation, dizziness, headache, fatigue, nausea, irritability
Serious Suicidal behavior and ideation, seizures with abrupt or rapid discontinuation, respiratory depression, drug reaction with eosinophilia and systemic symptoms (DRESS)/multiorgan hypersensitivity
Postmarketing Breast enlargement, gynecomastia, elevated creatine kinase, bullous pemphigoid, life-threatening or fatal respiratory depression (with opioids or CNS depressants or underlying respiratory impairment), withdrawal symptoms including seizures, depression, anxiety, insomnia, and nausea
Pharmacology
Gabapentin is a GABA analogue whose analgesic mechanism of action is unknown; in animal models it prevents allodynia and hyperalgesia, does not modify GABA receptor binding or GABA metabolism, and is hypothesized to antagonize thrombospondin binding to the alpha-2-delta-1 subunit of voltage-activated calcium channels involved in excitatory synapse formation.
Gabapentin enacarbil is a prodrug of gabapentin that undergoes extensive first-pass hydrolysis after oral absorption; gabapentin binds with high affinity to the alpha-2-delta subunit of voltage-activated calcium channels, though its precise mechanism of action in RLS and PHN is unknown.
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Most Common Insurance
Anthem BCBS
Gralise
- Covered on 5 commercial plans
- PA (9/12) · Step Therapy (0/12) · Qty limit (0/12)
Horizant
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (9/12) · Qty limit (9/12)
UnitedHealthcare
Gralise
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Horizant
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Gralise
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (2/3) · Qty limit (2/3)
Horizant
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Gralise.
No savings programs available for Horizant.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.