Comprehensive medication guide to Cobenfy including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$50 copay with commercial insurance or Medicare Part D; prior authorization typically required; Tier 4–5 specialty tier on most formularies.
Estimated Cash Pricing
$1,850–$1,887 per month retail (brand only, no generic available); BMS copay assistance program may reduce cost to $0 for eligible commercially insured patients.
Medfinder Findability Score
62/100
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Cobenfy (xanomeline and trospium chloride) is a first-in-class oral prescription medication approved by the FDA on September 26, 2024 for the treatment of schizophrenia in adults. It represents the first new mechanism of action for schizophrenia in over 30 years and the first antipsychotic to work without blocking dopamine D2 receptors.
Cobenfy combines xanomeline, a muscarinic M1/M4 receptor agonist, with trospium chloride, a peripherally acting muscarinic antagonist that prevents the GI and other peripheral side effects of xanomeline without interfering with its brain effects. Developed originally as KarXT by Karuna Therapeutics, Cobenfy is now marketed by Bristol Myers Squibb following a $14 billion acquisition in 2024. Clinical trials (EMERGENT-2 and EMERGENT-3) demonstrated significant reductions in both positive and negative schizophrenia symptoms versus placebo.
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Cobenfy works through a completely different mechanism than traditional antipsychotics. While conventional medications block dopamine D2 receptors to reduce psychotic symptoms, Cobenfy activates muscarinic M1 and M4 receptors in the brain. This muscarinic agonist approach represents the first new mechanism of action for schizophrenia treatment in over 30 years.
The active component, xanomeline, targets muscarinic receptors that play key roles in cognition, memory, and the regulation of psychosis. By working through these receptors rather than dopamine pathways, Cobenfy avoids many of the side effects that cause patients to stop taking traditional antipsychotics, including significant weight gain, extrapyramidal symptoms (EPS), and tardive dyskinesia.
The second component, trospium chloride, is an anticholinergic that does not cross the blood-brain barrier. Its role is to block muscarinic receptors in the peripheral nervous system, reducing side effects like excessive salivation and gastrointestinal distress that xanomeline would otherwise cause outside the brain. This combination allows the central benefits of muscarinic agonism while minimizing peripheral cholinergic effects.
50 mg/20 mg — capsule
Starting dose: take twice daily for at least 2 days on empty stomach
100 mg/20 mg — capsule
Intermediate and maintenance dose: take twice daily for at least 5 days, then may increase
125 mg/30 mg — capsule
Target maintenance dose: take twice daily; maximum dose 250mg/60mg per day; max 100mg/20mg BID in elderly
As a newly launched specialty medication, Cobenfy can be challenging to find in stock at local pharmacies. Not all pharmacies carry it, and supply constraints have caused intermittent availability issues since its launch in late 2024. Patients may need to check multiple pharmacies or turn to specialty pharmacies for more reliable access.
To save time, use MedFinder to check real-time Cobenfy availability at pharmacies near you. Rather than calling pharmacies one by one, MedFinder shows which locations currently have Cobenfy in stock so you can go directly to a pharmacy that can fill your prescription.
Specialty pharmacies tend to be the most reliable source for Cobenfy, as they are equipped to handle high-cost specialty medications and often maintain more consistent inventory. Many also offer home delivery, which can simplify the process for patients.
Cobenfy does not require any special certifications, REMS enrollment, or DEA scheduling to prescribe. Any licensed healthcare provider with prescriptive authority can write a prescription for Cobenfy, including:
Telehealth providers can also prescribe Cobenfy since it is not a controlled substance. This can be especially helpful for patients in areas without local psychiatrists or specialists experienced with this medication.
No, Cobenfy is not a controlled substance and is not scheduled by the DEA. It does not have abuse potential and does not require a Risk Evaluation and Mitigation Strategy (REMS) program. Any licensed prescriber, including psychiatrists, primary care physicians, nurse practitioners, and physician assistants, can prescribe Cobenfy without any special certifications or registrations.
Most common side effects (≥5% and at least twice placebo rate): nausea (19%), dyspepsia, constipation, vomiting (15%), hypertension, abdominal pain, diarrhea, tachycardia, dizziness, and GERD. GI side effects are most prominent during the titration phase and often improve over time. Serious side effects include urinary retention, angioedema (potentially life-threatening), liver injury, and decreased GI motility. Unlike traditional antipsychotics, Cobenfy does not have a black box warning and is not associated with weight gain, extrapyramidal symptoms, or prolactin elevation.
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Aripiprazole (Abilify)
Atypical antipsychotic; D2/D3 partial agonist; available as generic for under $30/month; good tolerability profile; available as long-acting injectable
Risperidone (Risperdal)
Widely used atypical antipsychotic; generic available from $10-20/month; effective for positive and negative symptoms; available as long-acting injectable
Quetiapine (Seroquel)
Atypical antipsychotic; generic available; sedating — useful for patients with sleep disruption; lower EPS risk
Olanzapine (Zyprexa)
Highly effective atypical antipsychotic; generic available; associated with significant weight gain and metabolic effects
Clozapine (Clozaril)
Gold standard for treatment-resistant schizophrenia; requires mandatory blood monitoring (REMS); generic available
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Antimuscarinic drugs (oxybutynin, tolterodine, diphenhydramine, TCAs)
moderateAdditive anticholinergic effects: increased risk of constipation, urinary retention, dry mouth
Strong CYP2D6 inhibitors (fluoxetine, paroxetine, bupropion)
moderateMay increase xanomeline blood levels, increasing risk of Cobenfy-related adverse reactions
Drugs eliminated by active tubular secretion
moderateCompetition for renal elimination may increase drug levels of both Cobenfy and concomitant drug
Sensitive CYP3A4 or P-glycoprotein substrates
moderateCobenfy may alter absorption/levels of concomitant drugs; monitor for increased adverse effects
Potassium tablets/capsules
moderateIncreased GI irritation risk due to reduced gut motility from anticholinergic effects
Pramlintide
moderateCombined slowing of GI motility may worsen GI effects and affect absorption of other oral drugs
CNS depressants (opioids, benzodiazepines, sleep medications)
moderateAdditive CNS depression — increased sedation, dizziness, and impaired thinking
Alcohol
minorMay worsen GI side effects; caution advised with trospium-containing medications
Cobenfy represents a significant advancement in schizophrenia treatment as the first medication to move beyond dopamine blockade. Its muscarinic M1/M4 agonist mechanism offers a new option for patients who struggle with the side effects of traditional antipsychotics, particularly weight gain, movement disorders, and metabolic complications.
While access challenges remain due to its newness, high cost, and supply constraints, programs from Bristol Myers Squibb can significantly reduce out-of-pocket costs for eligible patients. As manufacturing scales up throughout 2026, availability is expected to improve.
If you have been prescribed Cobenfy, visit MedFinder to check which pharmacies near you have it in stock and get your prescription filled as quickly as possible.
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