Peer perspective: learn how COBENFY, a first-in-class* M1/M4 schizophrenia treatment is thought to work2-5

Watch video: Gus Alva, MD explains the mechanism of action (MOA) of Cobenfy

Peer perspective featuring Doctor Gus Alva

Dr Gus Alva explains the mechanism of COBENFY, a first-in-class M1/M4 muscarinic agonist for the treatment of schizophrenia. COBENFY is a unique combination of xanomeline (M1M4 muscarinic agonist) and trospium chloride (muscarinic antagonist). Xanomeline is thought to work by selectively* activating M, and M, receptors. Although the mechanism of xanomeline in the treatment of schizophrenia is unclear, it is thought to work by selectively activating M, and M, receptors in the CNS. This activation is believed to help decrease dopamine in the CNS. Importantly, COBENFY does not bind to dopamine D receptors.2-5

Trospium chloride is thought to help limit muscarinic activation in the in the periphery.2

* COBENFY is a combination of xanomeline (M1/M4 muscarinic agonist) and trospium chloride (muscarinic antagonist).1

“It's been a long time coming, but I'm glad we're finally beginning to find alternate paths in the treatment of schizophrenia in adults.”

Gus Alva, MD

More videos 

COBENFY Mechanism of Action (MOA)

Learn how COBENFY is thought to work in the treatment of schizophrenia through its unique mechanism of action.

Safety and Tolerability Profile of COBENFY

Dr Jelena Kunovac and Dr Gerald Maguire review the safety and tolerability profile, which was evaluated in over 1,250 patients across 5 clinical trials.7

Getting Patients Started on COBENFY

Nurse Practitioner Hara Oyedeji shares insights on how to start COBENFY in your patients. Hara reviews recommended monitoring before and during treatment, clinical considerations such as relevant drug-drug interactions, and dose adjustments fo special populations. Additionally, Hara offers important reminders to assist in counseling new patients starting on COBENFY.

References: 

  1. Data on file. Karuna Therapeutics, Inc., a Bristol Myers Squibb company; Boston, MA.
  2. COBENFY. Prescribing Information. Bristol-Myers Squibb Company; 2024.
  3. Kaul I, Sawchak S, Walling DP, et al. Efficacy and safety of xanomeline-trospium chloride in schizophrenia: a randomized clinical trial. JAMA Psychiatry. 2024;81(8):749-756.
  4. Paul SM, Yohn SE, Popiolek M, Miller AC, Felder CC. Muscarinic acetylcholine receptor agonists as novel treatments for schizophrenia. Am J Psychiatry. 2022;179(9):611-627.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

COBENFY™ is contraindicated in patients with: urinary retention; moderate or severe (Child-Pugh Class B or C) hepatic impairment; gastric retention; history of hypersensitivity to COBENFY or trospium chloride—angioedema has been reported with COBENFY and trospium chloride; and untreated narrow-angle glaucoma.

WARNINGS AND PRECAUTIONS

Risk of Urinary Retention: COBENFY can cause urinary retention. Geriatric patients and patients with clinically significant bladder outlet obstruction and incomplete bladder emptying (e.g., patients with benign prostatic hyperplasia (BPH), diabetic cystopathy) may be at increased risk of urinary retention.

COBENFY is contraindicated in patients with pre-existing urinary retention and is not recommended in patients with moderate or severe renal impairment.

In patients taking COBENFY, monitor for symptoms of urinary retention, including urinary hesitancy, weak stream, incomplete bladder emptying, and dysuria. Instruct patients to be aware of the risk and promptly report symptoms of urinary retention to their healthcare provider. Urinary retention is a known risk factor for urinary tract infections. In patients with symptoms of urinary retention, consider reducing the dose of COBENFY, discontinuing COBENFY, or referring patients for urologic evaluation as clinically indicated.

Risk of Use in Patients with Hepatic Impairment: Patients with hepatic impairment have higher systemic exposures of xanomeline, a component of COBENFY, compared to patients with normal hepatic function, which may result in increased incidence of COBENFY-related adverse reactions.

COBENFY is contraindicated in patients with moderate or severe hepatic impairment. COBENFY is not recommended in patients with mild hepatic impairment.

Assess liver enzymes prior to initiating COBENFY and as clinically indicated during treatment.

Risk of Use in Patients with Biliary Disease: In clinical studies with COBENFY, transient increases in liver enzymes with rapid decline occurred, consistent with transient biliary obstruction due to biliary contraction and possible gallstone passage.

COBENFY is not recommended for patients with active biliary disease such as symptomatic gallstones. Assess liver enzymes and bilirubin prior to initiating COBENFY and as clinically indicated during treatment. The occurrence of symptoms such as dyspepsia, nausea, vomiting, or upper abdominal pain should prompt assessment for gallbladder disorders, biliary disorders, and pancreatitis, as clinically indicated.

Discontinue COBENFY in the presence of signs or symptoms of substantial liver injury such as jaundice, pruritus, or alanine aminotransferase levels more than five times the upper limit of normal or five times baseline values.

Decreased Gastrointestinal Motility: COBENFY contains trospium chloride. Trospium chloride, like other antimuscarinic agents, may decrease gastrointestinal motility. Administer COBENFY with caution in patients with gastrointestinal obstructive disorders because of the risk of gastric retention. Use COBENFY with caution in patients with conditions such as ulcerative colitis, intestinal atony, and myasthenia gravis.

Risk of Angioedema: Angioedema of the face, lips, tongue, and/or larynx has been reported with COBENFY and trospium chloride, a component of COBENFY. In one case, angioedema occurred after the first dose of trospium chloride. Angioedema associated with upper airway swelling may be life-threatening. If involvement of the tongue, hypopharynx, or larynx occurs, discontinue COBENFY and initiate appropriate therapy and/or measures necessary to ensure a patent airway. COBENFY is contraindicated in patients with a history of hypersensitivity to trospium chloride.

Risk of Use in Patients with Narrow-angle Glaucoma: Pupillary dilation may occur due to the anticholinergic effects of COBENFY. This may trigger an acute angle closure attack in patients with anatomically narrow angles. In patients known to have anatomically narrow angles, COBENFY should only be used if the potential benefits outweigh the risks and with careful monitoring.

Increases in Heart Rate: COBENFY can increase heart rate. Assess heart rate at baseline and as clinically indicated during treatment with COBENFY.

Anticholinergic Adverse Reactions in Patients with Renal Impairment: Trospium chloride, a component of COBENFY, is substantially excreted by the kidney. COBENFY is not recommended in patients with moderate or severe renal impairment (estimated glomerular filtration rate (eGFR) <60 mL/min). Systemic exposure of trospium chloride is higher in patients with moderate and severe renal impairment. Therefore, anticholinergic adverse reactions (including dry mouth, constipation, dyspepsia, urinary tract infection, and urinary retention) are expected to be greater in patients with moderate and severe renal impairment.

Central Nervous System Effects: Trospium chloride, a component of COBENFY, is associated with anticholinergic central nervous system (CNS) effects. A variety of CNS anticholinergic effects have been reported with trospium chloride, including dizziness, confusion, hallucinations, and somnolence. Monitor patients for signs of anticholinergic CNS effects, particularly after beginning treatment or increasing the dose. Advise patients not to drive or operate heavy machinery until they know how COBENFY affects them. If a patient experiences anticholinergic CNS effects, consider dose reduction or drug discontinuation.

Most Common Adverse Reactions (≥5% and at least twice placebo): nausea, dyspepsia, constipation, vomiting, hypertension, abdominal pain, diarrhea, tachycardia, dizziness, and gastroesophageal reflux disease.

Use in Specific Populations:

 
  • Moderate or Severe Renal Impairment: Not recommended
  • Mild Hepatic Impairment: Not recommended

COBENFY (xanomeline and trospium chloride) is available in 50mg/20mg, 100mg/20mg, and 125mg/30mg capsules.

INDICATION

COBENFY™ is indicated for the treatment of schizophrenia in adults.

Please see U.S. Full Prescribing Information, including Patient Information.

1629-US-2400833 02/25

Cobenfy, Cobenfy Cares, and the Cobenfy logo are trademarks of Karuna Therapeutics, Inc., a Bristol Myers Squibb company.
© 2025 Bristol-Myers Squibb Company. 1629-US-2400140 02/25

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