Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Xanomeline-Trospium(click to collapse)
1/4 selected
Xanomeline-Trospium
Cobenfy
Muscarinic M1/M4 Agonist + Peripheral Antagonist
FDA-approved indications
- Schizophrenia in adults — the ONLY non-dopaminergic antipsychotic FDA-approved
MechanismXanomeline: CNS muscarinic M1/M4 agonist; Trospium: peripheral muscarinic antagonist
Half-lifeXanomeline: ~5 hours; Trospium: ~6 hours
Decision GuideWhen to pick each / when to consider an alternative
Xanomeline-Trospium
Consider when
- First-episode schizophrenia with EPS, akathisia, or tardive dyskinesia concerns — no D2 blockade eliminates EPS, TD, akathisia, and prolactin elevation
- Schizophrenia with metabolic comorbidity or weight gain history — no metabolic syndrome, no weight gain, no glucose or lipid effects
- Baseline QT prolongation or concomitant QT-prolonging drugs — zero QT effect at therapeutic dose, unlike lumateperone (4.9 ms), aripiprazole, and most SGAs
- Patient prioritizing sexual function or with prior D2-mediated sexual dysfunction — no prolactin elevation, no D2-mediated sexual side effects
- +1 more
Consider an alternative when
- Cannot reliably fast (≥1 h before meals or ≥2 h after) — food reduces trospium AUC 85–90%, causing subtherapeutic exposure and worsening GI effects
- Anticholinergic contraindication present: urinary retention, BPH, gastric retention, untreated narrow-angle glaucoma — absolute contraindications from trospium component
- Moderate–severe hepatic impairment (Child-Pugh B/C) or eGFR <60 mL/min — xanomeline AUC ≥7-fold elevated; both components accumulate; not recommended
- GI intolerance, gastroparesis, or significant GERD — cholinergic adverse effects (nausea 19%, vomiting 15%, dyspepsia 18%) are dose-limiting
- +1 more
| Axis | Xanomeline-Trospium muscarinic-agonist |
|---|---|
| CNS | |
Dizziness | |
| Autonomic | |
Anticholinergic burden | |
Urinary retention / hesitancy | |
| Cardiac | |
Blood pressure elevation | |
Heart rate / tachycardia | |
| GI | |
Constipation / GI hypomotility | |
| Hepatic | |
Liver enzymes / hepatotoxicity | |