| Schizophrenia
Invega Sustenna vs Rexulti
Side-by-side clinical, coverage, and cost comparison for schizophrenia.Deep comparison between: Invega Sustenna vs Rexulti 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 signalsRexulti has a higher rate of injection site reactions vs Invega Sustenna based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Rexulti but not Invega Sustenna, including UnitedHealthcare
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Category
Invega Sustenna
Rexulti
At A Glance
IM injection
Every 4 weeks
D2/5HT2A antagonist
Oral
Once daily
Atypical antipsychotic
Indications
- Schizophrenia
- Schizoaffective Disorder
- Major Depressive Disorder
- Schizophrenia
- Agitation in Dementia
Dosing
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.
Major Depressive Disorder Start 0.5 mg or 1 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
Schizophrenia Adults: start 1 mg once daily, titrate to target 2-4 mg once daily (max 4 mg); pediatric patients 13-17 years: start 0.5 mg once daily, titrate to target 2-4 mg once daily (max 4 mg).
Agitation in Dementia Start 0.5 mg orally once daily; titrate to target 2 mg once daily; maximum 3 mg once daily.
Contraindications
- Known hypersensitivity to paliperidone, risperidone, or any excipient in the INVEGA SUSTENNA formulation
- Known hypersensitivity to brexpiprazole or any excipient (reactions include rash, facial swelling, urticaria, and anaphylaxis)
Adverse Reactions
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
Most common (>=5%) weight increased, akathisia, headache, somnolence, insomnia
Serious neuroleptic malignant syndrome, tardive dyskinesia, metabolic changes, leukopenia, neutropenia, agranulocytosis, orthostatic hypotension, falls, seizures, body temperature dysregulation
Postmarketing neuroleptic malignant syndrome
Pharmacology
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.
Brexpiprazole is an atypical antipsychotic whose efficacy may be mediated through partial agonist activity at serotonin 5-HT1A and dopamine D2 receptors combined with antagonist activity at serotonin 5-HT2A receptors; the exact mechanism of action in the approved indications is unknown.
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Most Common Insurance
Anthem BCBS
Invega Sustenna
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (4/12) · Qty limit (11/12)
Rexulti
- Covered on 5 commercial plans
- PA (5/12) · Step Therapy (5/12) · Qty limit (11/12)
UnitedHealthcare
Invega Sustenna
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Rexulti
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (6/8)
Humana
Invega Sustenna
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (0/3) · Qty limit (3/3)
Rexulti
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
Cost estimate not availableHealthWell: Cancer-Related Behavioral Health
Commercial 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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Invega SustennaView full Invega Sustenna profile
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.