A Clinical Challenge: Transitioning Patients to Cobenfy

Data and treatment guidance on Cobenfy is limited to its use as a monotherapy. However, in real life clinical practice, patients are typically already taking an antipsychotic. How can you best cross-taper and transition patients onto Cobenfy? Gustavo Alva, MD, FAPA, shares his insights.

Transitions should be made in a prudent manner. There are several specific points to remember:

• Cobenfy is approved by the US Food and Drug Administration for adults with schizophrenia, but only as a monotherapy. The studies all had participants who had already washed out of their previous medication before starting Cobenfy.
• Patients may be unwilling to let go of their previous medication, as they saw some improvement with it or are used to it. It is important to educate patients about other treatment options.
• Certain medicines have a heavy-duty antihistaminergic effect, such as benadryl, atypical antipsychotics, and more. If layered on Cobenfy, they can exacerbate issues like dry mouth, constipation, urinary retention, blurry vision, and more.
• Medications like olanzapine, quetiapine, and clozapine are very sedating. Abruptly stopping these medications can make a patient seem more labile or agitated.

Dr Alva is a board-certified psychiatrist, a paid consultant of Otsuka America Pharmaceutical, Inc, and Lundbeck, and Mood Disorders Section Editor for Psychiatric Times.