| Schizophrenia
Igalmi vs Invega Sustenna
Side-by-side clinical, coverage, and cost comparison for schizophrenia.Deep comparison between: Igalmi 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 Igalmi based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Invega Sustenna but not Igalmi, including UnitedHealthcare
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Category
Igalmi
Invega Sustenna
At A Glance
Sublingual or buccal film
As needed (acute use)
Alpha-2 adrenergic receptor agonist
IM injection
Every 4 weeks
D2/5HT2A antagonist
Indications
- Schizophrenia
- Bipolar I disorder
- Bipolar Disorder Type 2
- Schizophrenia
- Schizoaffective Disorder
Dosing
Schizophrenia, Bipolar I disorder, Bipolar Disorder Type 2 - Adults Mild or moderate agitation: 120 mcg initial dose SL or buccal; severe agitation: 180 mcg initial; up to 2 additional doses (60-90 mcg) at least 2 hours apart; maximum 240-360 mcg/day.
Mild or Moderate Hepatic Impairment Mild or moderate agitation: 90 mcg initial; severe agitation: 120 mcg initial; optional additional doses of 60 mcg at least 2 hours apart; maximum 210-240 mcg/day.
Severe Hepatic Impairment Mild or moderate agitation: 60 mcg initial; severe agitation: 90 mcg initial; optional additional doses of 60 mcg at least 2 hours apart; maximum 180-210 mcg/day.
Geriatric Patients (>=65 years) 120 mcg initial dose regardless of agitation severity; optional additional doses of 60 mcg at least 2 hours apart; maximum 240 mcg/day.
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
—
- Known hypersensitivity to paliperidone, risperidone, or any excipient in the INVEGA SUSTENNA formulation
Adverse Reactions
Most common (>=5%) Somnolence, oral paresthesia or oral hypoesthesia, dizziness, dry mouth, hypotension, orthostatic hypotension.
Serious Hypotension, orthostatic hypotension, bradycardia, QT interval prolongation, somnolence, withdrawal reactions, tolerance and tachyphylaxis.
Postmarketing Arrhythmia, atrial fibrillation, cardiac arrest, bradycardia, convulsion, apnea, bronchospasm, agitation, delirium, hallucination, hypertension, rash, urticaria.
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
Dexmedetomidine is an alpha-2 adrenergic receptor agonist whose mechanism of action in acute agitation is thought to involve activation of presynaptic alpha-2 adrenergic receptors; it also exhibits concentration-dependent QT prolongation.
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
Igalmi
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (1/12) · Qty limit (11/12)
Invega Sustenna
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (4/12) · Qty limit (11/12)
UnitedHealthcare
Igalmi
- Covered on 4 commercial plans
- PA (2/8) · Step Therapy (1/8) · Qty limit (0/8)
Invega Sustenna
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Igalmi
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (0/3) · Qty limit (1/3)
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
No savings programs available for Igalmi.
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.