*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Cobenfy is a newly FDA-approved medication to treat schizophrenia in adults. The medication has specific dosing guidelines to ensure the medication works well, and to reduce the risk of side effects. Typically patients will take Cobenfy twice daily about 12 hours apart 1 hour before or 2 hours after having a meal . Additionally the dose of Cobenfy will likely be increased slowly during the first week or two of treatment.1
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Key Takeaways
Cobenfy is a new FDA-approved antipsychotic medication to treat schizophrenia in adults. It is not approved for use for children or teens under the age of 18.
Cobenfy is available as a capsule that is taken twice daily 1 hour before or 2 hours after having a meal. Your dosage of Cobenfy will likely be increased slowly during the first week or two of treatment.
If you are considering an alternative to Cobenfy, a good place to start is with an evaluation from a medical provider. Lifestance Health is a reliable online psychiatry platform offering online assessments and medication management.
What Is Cobenfy & How Is It Used?
Cobenfy is a newly FDA-approved medication to treat schizophrenia in adults and is a type of antipsychotic medication called a muscarinic agonist. FDA approval means that the FDA has determined the drug to be safe and effective when used as intended based on data from clinical trials. Cobenfy is not intended to be used by children or anyone under eighteen years old. The usual dose schedule of Cobenfy is one capsule twice daily 1 hour before or 2 hours after having a meal.1
Cobenfy is a combination of two medications called xanomeline and trospium chloride that work in the body on muscarinic receptors.1 The two medications work together to reduce all types of schizophrenia symptoms, while limiting the usual negative side effects of schizophrenia medications. In studies, patients taking Cobenfy showed a significant lessening in all symptoms of schizophrenia.1
Cobenfy Forms & Strengths
Cobenfy is available as an oral capsule in multiple strengths. Your prescriber will decide what is the best dose for you based on your age, health history, and your symptoms. When starting treatment with Cobenfy, most patients will slowly increase their dose. It is important to only change your dose at the instruction of your prescriber and take the medication exactly as they tell you. Changing doses without your provider’s direction can put you at risk of unwanted and serious side effects.1
Cobenfy is available in the following forms:1
- 50 milligram (mg) /20 mg capsules
- 100 mg/20 mg capsules
- 125 mg/30 mg capsules
Cobenfy is also available as a starter pack with two different doses. This package can be helpful for those starting treatment to slowly and effectively increase the dose. If your doctor decides to prescribe you this version, be sure to follow the package directions exactly. Always take your Cobenfy dose 1 hour before or 2 hours after a meal, and do not open the capsules. Do your best to never forget or skip doses, as this can interfere with your treatment.1
How to Take Cobenfy
For best treatment results, take Cobenfy as instructed by your provider. Cobenfy should be taken two times a day without food. To ensure this, always take Cobenfy at least 1 hour before eating or at least 2 hours after eating a meal. Do your best to take Cobenfy doses exactly 12 hours apart. Taking Cobenfy with food, or too close together in time, can cause unwanted side effects.1
It is likely your doctor will increase your dose slowly over time. Only change your dose when your doctor tells you to. Do not stop taking Cobenfy unless instructed by your prescriber. Finally, Cobenfy comes as a capsule to take by mouth. It should not be chewed, crushed, or opened.1 If you have trouble swallowing pills talk to your pharmacist for tips.
Cobenfy Dosage for Adults With Schizophrenia
Cobenfy only has one FDA-approved use, to treat schizophrenia in adult patients.1 All doses of Cobenfy are intended to be taken by mouth twice daily. Most patients will start on the lowest strength capsule twice daily and increase the dose over the course of the week. After some time, the dose can be increased again based on the response to the medication. Dose increases should only be done at the direction of your prescriber to ensure your safety.1
Here is Cobenfy dosage information for adults with schizophrenia:
- Typical starting dosage: The recommended starting dose is one 50 mg/20 mg capsule taken by mouth twice daily. This dose should be taken for at least two days before increasing the dose.
- Dosage increases: After at least two days at the starting dose, Cobenfy can be increased to the 100 mg/20 mg capsule twice daily. Patients should stay at this dose for at least five days before increasing the dose further.
- Maximum dosage: The maximum recommended dose for Cobenfy is one 125 mg/30 mg capsule taken twice daily. This dose should only be used if recommended by your prescriber based on your response to the medication.
Cobenfy Dosage Adjustments
There are many reasons your prescriber may decide to adjust your dose throughout therapy. Some of the reasons are listed below. Remember, never change your dose or stop taking Cobenfy without the direction of your provider.
Dosage for Geriatric Patients
It is recommended that elderly patients increase the dose of Cobenfy slower than other people. Patients over 65 years old will also have a maximum dose of Cobenfy of 100mg/20mg twice daily.
In elderly patients, Cobenfy can cause more severe side effects at lower doses than adults aged 18 to 65. Additionally, elderly patients are more likely to have other diseases that can be made worse by Cobenfy side effects. A reminder that Cobenfy has not been studied in geriatric patients and should be used with caution, only at the direction of a prescriber.1
Dosage for Adults With Impaired Renal Function
Studies have shown that patients with less than normal functioning kidneys, have higher amounts of Cobenfy in their body. Patients with mild kidney function impairment can take normal doses of Cobenfy. However, if you have severe renal impairment, taking Cobenfy is not recommended. Your doctor will determine how healthy your kidneys are and if Cobenfy is safe for you.1
Dosage for Patients With Liver Disease
Patients with any amount of liver disease or hepatic impairment should not take Cobenfy. A liver that is not functioning properly can cause dangerously high amounts of xanomeline in their body. This is dangerous for patients and can cause many severe side effects. If you are unsure of the health of your liver, your provider will conduct blood tests before beginning prescribing Cobenfy.
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What If I Miss a Dose of Cobenfy?
If you miss one Cobenfy dose and it is more than 8 hours before the next dose, take the missed dose right away. If you realize you have missed a dose but it is near the next dose time, skip the missed dose and take your next regularly prescribed dose. DO NOT double up on a dose to catch up or make up doses. This can cause more serious side effects than usual and is dangerous.1
If you have missed more than one dose in a row, reach out to your prescriber for direction. In some cases it may be necessary to restart Cobenfy at a lower dose and slowly increase again.1
You should never suddenly stop taking your medication. Talk with your healthcare provider if you would like to stop taking your medication. They will help you create a plan to taper (slowly reduce) the medication.
Can You Overdose on Cobenfy?
Yes, it is possible to overdose on Cobenfy. Overdose from Cobenfy is unique, however, since it is a combination of two medications, xanomeline and trospium chloride. These two medications work in opposite ways in the body. This means an overdose from Cobenfy can have a wide array of symptoms depending on the specific drug in excess. Familiarize yourself with the signs of an overdose below and always be on the lookout for these symptoms.
Signs of an overdose on Cobenfy include:1
Overdose of xanomeline:
- Seizures
- Vomiting
- Diarrhea
- Abdominal pain
- Over salivation or spit production
- Excessive sweating
- Low blood pressure or fainting
Overdose of trospium chloride:
- Delirium
- Agitation
- Garbled speech
- Dizziness
- High blood pressure
- Fast heart beat
- Dry mouth or eyes
- Blurred vision
- Urinary retention
What Should You Do If You Take Too Much Cobenfy?
Contact your provider, call 911, or call the Poison Help Line at 1-800-222-1222 if you suspect an overdose. Time is crucial and it is better to be safe and get help even if you are unsure.
How to Save Money on Cobenfy
Cobenfy is a newly approved medication and therefore is only available as a name brand medication. It will be many years before a lower cost, generic version will be available. However, there are many options for obtaining Cobenfy for a reasonable price. Several factors may impact the cost of your Cobenfy prescription, including your choice of pharmacy, and the specific dosage prescribed by your provider.
If you have insurance, work with your provider and pharmacy to ensure proper billing and approval. You can also check with your insurance company for a copay estimate before picking up your prescription. Be aware that deductibles or higher tiered copays may apply. If your copay is too high or you do not have insurance, visit the Cobenfy official website. There you can sign up for or see if you qualify for copay assistance.
Cobenfy Prices
The cost of Cobenfy currently ranges from $909-$1050 for a 30-day supply of 50 milligrams/20mg without insurance. Your Cobenfy prescription may cost much less with insurance depending on your plan and coverage. The cost of Cobenfy will also vary based on the dosage and amount prescribed. Discounts for Cobenfy may be available and may reduce your out of pocket costs.
Note: Cash prices listed are derived from multiple sources. The prices listed are an estimate only and cannot be guaranteed. For exact prices, please contact the pharmacy.
Walmart
$987
Walgreens
$975
CVS / Target
$953
RiteAid
$929
Kroger
$909
Costco
$1050
Hy-Vee
$934
Publix
$982
Albertsons
$942
Schizophrenia Treatment, Covered by Insurance Grow Therapy enables you to find a psychiatrist or psychiatric nurse practitioner who can diagnose your condition, prescribe appropriate medications, and monitor your reaction to medication. Find A Provider
Questions to Ask Your Provider
If you think Cobenfy may be a good option for you, start with an evaluation from a primary provider. You may be referred to a specialist, or may need to find a psychiatrist that is experienced in treating schizophrenia. Before starting treatment, ask lots of questions and be prepared to discuss all aspects of your health history and other medications.
Questions to ask your care team about Cobenfy dosage include:
- How long will it take for me to adjust to taking Cobenfy?
- Am I at risk for more serious side effects if I am already taking other psychiatric medications?
- What is the best dosage to ensure fewer side effects?
- Is there anything I should tell my therapist about this new medication?
- When will my dose change?
- What if I want to stop taking Cobenfy?
- What is the maximum dose I can expect?
- Can I drive while taking Cobenfy?
- When is the best time to take Cobenfy?
- When can I expect my body to adjust to the medication?
Prescriber’s Tips
Your prescriber will share important information about your Cobenfy prescription. They will explain how to take and store your medication, what to avoid when taking it, and what to do about side effects. Follow these tips for safe and effective use of Cobenfy.
- When beginning treatment follow your prescriber’s directions exactly. The dosage increases are to happen at specific times.
- Keep a note or log with symptoms you experience while taking Cobenfy. This can help your provider determine the best dose for you.
- Avoid taking Cobenfy with food. Studies show that taking a Cobenfy significantly changes the amount of medication that enters your body. This can lead to unintended effects of the medication.
- Keep track of how often you use the bathroom while on Cobenfy. Rare but serious side effects include urinary retention and slowing of the digestive tract. It is important to identify changes in bathroom use promptly and seek medical care.
Frequently Asked Questions
Is There a Maximum Dose of Cobenfy?
Yes, the maximum dose of Cobenfy is 125 mg/30 mg capsule taken twice daily. If you are over 65 years old, the recommended maximum dose is 100 mg/20 mg capsule twice daily. In other specific instances the maximum dose of Cobenfy may be different. You should never start taking Cobenfy at the maximum dose. Always start at a lower dose and increase based on your prescriber’s direction.1
Is Cobenfy Used Long-term?
Cobenfy has been studied over the long term and can be used long term if it is well tolerated. Be sure to regularly see your prescriber to monitor symptoms and side effects. Some patients may require additional regular preventative testing to ensure safe use.1
What Are the Long-term Risks of Taking Cobenfy?
Long term risks of Cobenfy mainly include risk of liver injury and risk of urinary retention. Monitoring for signs of these risks and quickly alerting your provider during treatment is very important. For liver injury look for yellowing of the skin and/or upper left stomach pain and for urinary retention look for weak stream, incomplete bladder emptying, or pain while urinating.1
Is Cobenfy Safer Than Other Schizophrenia Medications?
Safety of medications greatly depends on each patient’s specific situation. However, Cobenfy works differently than other FDA approved medications and therefore does not have the same risk for some side effects like uncontrollable movement disorders.
What Should I Avoid While Taking Cobenfy?
There are many medications, foods and substances that can affect how Cobenfy works. In general, medications and substances that cause drowsiness should be avoided as they can make the side effects of Cobenfy worse. Additionally, Cobenfy can cause other medications to work differently or have increased side effects.
Will I Need Blood Tests While Taking Cobenfy?
Depending on your overall health, some patients may require blood testing before and during treatment. Due to Cobenfy’s risk in patients with liver disease and biliary disease, it is recommended to monitor liver enzymes throughout treatment.1
How Long Does It Take for Cobenfy to Start Working?
The effects of Cobenfy should be felt within the first several weeks of taking the medication. Most patients in studies felt the full effect by the fifth week of treatment.1
Can I Open the Capsule to Take Cobenfy?
No, the drug manufacturers specifically state opening the capsule is not recommended. If you have trouble swallowing pills, work with your provider to find a solution.1
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Bristol Myers Squibb. (September, 2024). Cobenfy U.S. Prescribing Information. Retrieved from: https://packageinserts.bms.com/pi/pi_cobenfy.pdf
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