| Schizophrenia
Cobenfy vs Invega Sustenna
Side-by-side clinical, coverage, and cost comparison for schizophrenia.Deep comparison between: Cobenfy vs Invega Sustenna 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 signalsInvega Sustenna has a higher rate of injection site reactions vs Cobenfy based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Invega Sustenna but not Cobenfy, including UnitedHealthcare
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Category
Cobenfy
Invega Sustenna
At A Glance
Oral
Twice daily
Muscarinic agonist/antagonist combination
IM injection
Every 4 weeks
D2/5HT2A antagonist
Indications
- Schizophrenia
- Schizophrenia
- Schizoaffective Disorder
Dosing
Schizophrenia Starting dose 50 mg/20 mg orally twice daily for at least 2 days, then 100 mg/20 mg twice daily for at least 5 days; may increase to 125 mg/30 mg twice daily based on tolerability and response (maximum dose); take at least 1 hour before or 2 hours after a meal; do not open capsules. Geriatric patients: start at 50 mg/20 mg twice daily, maximum 100 mg/20 mg twice daily.
Schizophrenia Initiation: 234 mg deltoid on Day 1, 156 mg deltoid on Day 8; recommended monthly maintenance 117 mg (range 39-234 mg) in deltoid or gluteal muscle; maximum monthly dose 234 mg.
Schizoaffective Disorder Initiation: 234 mg deltoid on Day 1, 156 mg deltoid on Day 8; monthly maintenance 78-234 mg adjusted for tolerability and/or efficacy in deltoid or gluteal muscle; maximum monthly dose 234 mg.
Mild renal impairment (creatinine clearance >=50 mL/min) Initiation: 156 mg deltoid on Day 1, 117 mg deltoid on Day 8; monthly maintenance 39-156 mg; maximum monthly dose 156 mg.
Contraindications
- Urinary retention
- Moderate (Child-Pugh Class B) or severe (Child-Pugh Class C) hepatic impairment
- Gastric retention
- History of hypersensitivity to COBENFY or trospium chloride
- Untreated narrow-angle glaucoma
- Known hypersensitivity to paliperidone, risperidone, or any excipient in the INVEGA SUSTENNA formulation
Adverse Reactions
Most common (>=5%) Nausea, dyspepsia, constipation, vomiting, hypertension, abdominal pain, diarrhea, tachycardia, dizziness, gastroesophageal reflux disease
Serious Urinary retention, liver enzyme elevations, increases in heart rate, angioedema
Postmarketing Chest pain, hypertensive crisis, palpitations, supraventricular tachycardia, syncope, gastritis, rash, rhabdomyolysis, confusion, delirium, hallucinations, somnolence, vision abnormal, angioedema, anaphylactic reaction, Stevens-Johnson syndrome (reported with trospium chloride component)
Most common (>=5%) Injection site reactions, somnolence/sedation, dizziness, akathisia, extrapyramidal disorder
Serious Increased mortality in elderly patients with dementia-related psychosis, cerebrovascular adverse reactions, neuroleptic malignant syndrome, QT prolongation, tardive dyskinesia, metabolic changes, orthostatic hypotension and syncope, leukopenia/neutropenia/agranulocytosis, hyperprolactinemia, seizures
Postmarketing Angioedema, anaphylactic reaction, catatonia, ileus, somnambulism, swollen tongue, thrombotic thrombocytopenic purpura, urinary incontinence, urinary retention
Pharmacology
Xanomeline is a muscarinic agonist with preferential activity at M1 and M4 receptors in the central nervous system, where its efficacy in schizophrenia is thought to arise; trospium chloride is a peripheral muscarinic antagonist included to reduce cholinergic adverse effects.
Paliperidone palmitate is hydrolyzed to paliperidone, the major active metabolite of risperidone; its therapeutic effect in schizophrenia may be mediated through a combination of central dopamine Type 2 (D2) and serotonin Type 2 (5HT2A) receptor antagonism, with additional antagonist activity at histamine H1 and alpha-1/alpha-2 adrenergic receptors.
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Most Common Insurance
Anthem BCBS
Cobenfy
- Covered on 5 commercial plans
- PA (12/12) · Step Therapy (8/12) · Qty limit (11/12)
Invega Sustenna
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (4/12) · Qty limit (11/12)
UnitedHealthcare
Cobenfy
- Covered on 4 commercial plans
- PA (8/8) · Step Therapy (8/8) · Qty limit (2/8)
Invega Sustenna
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Cobenfy
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (2/3) · Qty limit (3/3)
Invega Sustenna
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (0/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
$0/fillfill
Cobenfy Copay Assistance ProgramCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
Cost estimate not availableHealthWell: Cancer-Related Behavioral Health
Commercial or private insurance
Medicare, Medicaid, VA, TRICARE
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.