Cobenfy for Schizophrenia: A New Pathway and Its Tradeoffs

For decades, every schizophrenia medicine approved in the United States worked on the same brain target. That target is the dopamine D2 receptor. In September 2024, Cobenfy changed that.12 It works mainly through a different signaling system, and it brings its own set of side effects and rules.

That difference is real and worth knowing about. It does not make Cobenfy the right choice for everyone. This guide covers what the trials found, what the FDA label requires, and what is still unknown, so you can have a clearer conversation with your prescriber.

Key takeaways

• Cobenfy (xanomeline and trospium chloride) is FDA-approved to treat schizophrenia in adults. It was approved on September 26, 2024.13
• It does not directly block dopamine D2 receptors. Its benefit is thought to come from turning on M1 and M4 muscarinic receptors in the brain.3
• In three five-week hospital trials, symptoms improved more than with placebo. About one extra person responded for every five people treated.2456
• The most common side effects were nausea, indigestion, constipation, vomiting, high blood pressure, stomach pain, diarrhea, a fast heartbeat, dizziness, and heartburn.3
• Weight gain, movement side effects, and sleepiness were uncommon in the trials.7 In trial comparisons, though, people stopped Cobenfy for any reason more often than they stopped risperidone or olanzapine.8
• Each capsule is taken twice a day, at least 1 hour before or 2 hours after a meal.3
• Do not start, stop, or switch a schizophrenia medicine without a plan from your prescriber.

What Cobenfy is

Cobenfy is one capsule that holds two medicines.3

• Xanomeline turns on muscarinic receptors. These receptors respond to acetylcholine, a chemical messenger in the brain and body.
• Trospium chloride blocks muscarinic receptors, mostly in the body outside the brain.3

Xanomeline does its main work in the brain. It also reaches the gut and other organs, where it can cause nausea and similar effects. Trospium is added to block many of those body effects while staying mostly out of the brain.4 The pairing is a trade. Trospium’s own blocking action can cause dry mouth, constipation, and trouble passing urine.3

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How does Cobenfy work?

The exact way Cobenfy treats schizophrenia is not known. The FDA label says its benefit is thought to come from xanomeline turning on M1 and M4 muscarinic receptors in the brain.3 Xanomeline attaches to all five muscarinic receptor types, M1 through M5. It switches on M1 and M4 more strongly than the rest.3

Researchers describe this as acting “upstream” of the dopamine system. Cobenfy may change dopamine signaling indirectly instead of blocking the dopamine receptor itself.9 The NP FADY essay on acetylcholine, linked at the end, explains these receptors in more depth.

What did the main studies find?

The FDA based its approval on two identical five-week studies, EMERGENT-2 and EMERGENT-3.3 Everyone in them was an adult whose psychosis had recently worsened enough to need a hospital stay.25 Researchers tracked symptoms with the PANSS, a 30-item rating scale. Scores run from 30 to 210, and a lower score means milder illness.3 The PANSS measures symptoms. It does not directly measure work, relationships, or quality of life.

These numbers come from the published trials.245 When the three trials were pooled, Cobenfy lowered the score by 9.9 more points than placebo on average.10 Another way to see it: for every five people treated with Cobenfy instead of placebo, about one extra person had at least a 30 percent drop in symptoms.6 Averages cannot predict how any one person will do.

In EMERGENT-3, the difference from placebo was already clear at week 2, the first symptom check.5

Positive and negative symptoms

Positive symptoms, such as hearing voices or holding fixed false beliefs, improved more than with placebo in all three trials.245

Negative symptoms, such as low drive, less emotion, and pulling away from people, improved in EMERGENT-1 and EMERGENT-2. In EMERGENT-3, the negative-symptom score did not reach statistical significance at week 5, though it did at week 4.245 All three trials enrolled people in an acute episode. None was built for people whose main problem is lasting negative symptoms.

Thinking and memory

When researchers pooled the two phase 3 trials, Cobenfy did not improve thinking scores in the full group. In a smaller group who started with clear thinking problems, it did better than placebo. The authors say a trial in stable patients with thinking problems is still needed to confirm this.11

Longer-term use

Two 52-week studies gave Cobenfy to everyone, with no placebo group. In EMERGENT-4, 156 people enrolled and 34 finished the year. In EMERGENT-5, 566 stable adults switched from their previous antipsychotic, and 277 finished.1213 Symptoms improved on average, and no new kind of safety problem appeared. EMERGENT-4 found no meaningful movement symptoms, prolactin rise, weight gain, or metabolic changes.12 Many people left early, and there was no comparison group. So these studies add safety information. They cannot show that Cobenfy prevents relapse better than another medicine.

Adding Cobenfy to another antipsychotic

The ARISE trial added Cobenfy or placebo for adults whose symptoms were not well controlled on an atypical antipsychotic. At week 6, the Cobenfy group improved by 2.0 more points, which was not statistically significant.14 Adding Cobenfy to another antipsychotic is not a proven strategy.

How is Cobenfy different from other antipsychotics?

No completed trial has compared Cobenfy directly with a named antipsychotic. A 2026 review of 438 trials in The Lancet called for exactly those comparisons.9 Until they exist, comparisons come from analyses that link separate trials together.

Those analyses point in a consistent direction. An independent 2024 analysis compared Cobenfy with aripiprazole, risperidone, and olanzapine. Symptom benefit was similar across all four. Cobenfy was the least likely to cause weight gain. But more people stopped Cobenfy, for any reason, than stopped risperidone or olanzapine.8 A 2026 analysis paid for by the manufacturer found the same pattern. People stopped Cobenfy more often than most of the medicines it was compared with.15 The 2026 Lancet review concluded that Cobenfy avoids the side effects of dopamine-blocking drugs but causes its own.9

The side-effect patterns for older medicines come from large trial reviews and FDA labels.16171819202122

Cobenfy is not a proven replacement for clozapine. The American Psychiatric Association recommends clozapine when schizophrenia has not improved enough after at least two full medicine trials. It also recommends clozapine when suicide risk stays high despite other care.23 Cobenfy also has no long-acting injection. For someone who has trouble taking daily pills, a shot may fit better.

Who might talk with a prescriber about Cobenfy?

A conversation may make sense for an adult with schizophrenia who:

• had weight gain, blood sugar or cholesterol changes, prolactin effects, stiffness, or severe restlessness on another medicine;
• did not get enough relief from an earlier medicine;
• would like to try a medicine that does not directly block dopamine;
• can keep a steady twice-daily routine timed away from meals.

Tell your prescriber first if you have any of the following, because they may rule Cobenfy out or call for extra care:3

• trouble emptying your bladder, an enlarged prostate, or bladder problems from diabetes;
• slow stomach emptying, a bowel blockage, ulcerative colitis, or myasthenia gravis;
• liver disease, gallstones that cause symptoms, or other active bile-duct disease;
• reduced kidney function;
• narrow-angle glaucoma.

Dosing and the empty-stomach rule

Cobenfy is started low and raised in steps. Every step is one capsule twice a day.3

The highest dose is 125 mg / 30 mg twice a day. In the main trials, the plan was to move everyone up to that dose on day 8 unless they could not tolerate it, and anyone could step back down.3

Older adults start at the same low dose and may go up more slowly. Their top dose is 100 mg / 20 mg twice a day, because they face a higher risk of urinary retention. The controlled trials did not include anyone older than 65.3

Why the meal timing matters. Take each dose at least 1 hour before a meal or at least 2 hours after one.3 A meal cuts the trospium your body absorbs by about 85 to 90 percent. Trospium is the part that blocks many of xanomeline’s body effects.3 Do not open the capsules.3

A practical tip is to pair each dose with a fixed daily event that stays clear of meals, such as right after waking and at least 2 hours after dinner.

Missed doses. The FDA label does not give missed-dose instructions.3 Ask your pharmacist or prescriber for a plan ahead of time, and do not take extra to make up a dose unless they tell you to.

Common side effects

In the two five-week phase 3 trials, 6 percent of people on Cobenfy stopped because of a side effect, compared with 4 percent on placebo. Nausea and vomiting were the most common reasons.3

These rates come from the FDA label.3 Some effects showed up in 2 percent of people on Cobenfy. These were extra saliva, a drop in blood pressure on standing, cough, and some movement symptoms.3 Across the short trials, most common side effects were mild or moderate and faded with time.7

Handling early side effects

• Tell your prescriber early instead of waiting for the next visit.
• Ask whether staying longer at a lower step could help.
• Keep the meal-timing rule.
• Ask for a plan for nausea or constipation before it starts.
• Check every over-the-counter medicine with a pharmacist, because some add to Cobenfy’s side effects.

Serious risks and warning signs

Urinary retention

Cobenfy can make it hard to empty the bladder. In the five-week trials this happened in 0.8 percent of people on Cobenfy. In the long-term studies it was reported in 3.5 percent. It was more common in men, in older adults, and at the highest dose. Urinary retention also raises the risk of urinary tract infections.3

Report a weak stream, trouble starting, pain when urinating, or a feeling that your bladder has not emptied. Get medical help right away if you cannot urinate.3

Liver and bile-duct problems

In the five-week trials, liver enzymes rose to at least three times the normal limit in 2.8 percent of people on Cobenfy, compared with 0.4 percent on placebo. Most rises happened in the first month and settled.3 Some short-lived rises looked like the effects of a passing gallstone.3

Your prescriber should check liver tests before you start.3 Report yellow skin or eyes, dark urine, itchy skin, or belly pain or swelling. Also mention indigestion, nausea, vomiting, or upper belly pain. These can be signs of a gallbladder, bile-duct, or pancreas problem.3

Slowed stomach and bowel

Trospium can slow the gut, and Cobenfy must not be used by people whose stomach already empties too slowly.3 Get urgent care for severe or worsening belly pain, a swollen belly, repeated vomiting, or no stool or gas.

Narrow-angle glaucoma

Cobenfy can widen the pupils. In eyes with narrow angles, that can set off a sudden glaucoma attack.3 Get urgent eye care for sudden eye pain, a red eye, blurred vision, or halos around lights.

Serious allergic swelling

Swelling of the face, lips, tongue, or throat has been reported with Cobenfy and with trospium. Swelling that affects breathing can be life-threatening.3 Call 911 for trouble breathing or throat swelling.

Heart rate and blood pressure

Cobenfy raises heart rate. In an 8-week study, 24-hour heart rate rose by an average of 9.8 beats per minute. In the placebo-controlled trials, heart rate at week 5 was up 11.4 beats per minute on Cobenfy and 5.5 on placebo.3 High blood pressure occurred in 11 percent of people on Cobenfy.3 Get urgent help for chest pain, fainting, or a racing heart that does not settle.

Confusion, sleepiness, and driving

Trospium can cause dizziness, confusion, hallucinations, and sleepiness. Delirium has also been reported.3 Do not drive or use heavy machinery until you know how Cobenfy affects you.3

When mental health symptoms become an emergency

Get help right away for thoughts of suicide, thoughts of harming someone, behavior that feels out of control, or being unable to meet basic needs. Crisis lines are listed at the end of this page.

Who should not take Cobenfy?

The FDA label says Cobenfy must not be used by people with:3

• urinary retention;
• moderate or severe liver impairment;
• gastric retention, meaning the stomach empties too slowly;
• a past allergic reaction to Cobenfy or trospium;
• untreated narrow-angle glaucoma.

The label also advises against it for people with:3

• mild liver impairment;
• active bile-duct disease, such as gallstones that cause symptoms;
• lower kidney function, meaning an eGFR below 60, because it raises trospium levels in the blood.

Cobenfy is approved only for adults. Its safety and effectiveness in children have not been established.3

What checks are needed?

The liver and heart-rate checks come from the label.3 Routine body-health checks come from the American Psychiatric Association guideline.23 Cobenfy does not need the regular blood-count checks that clozapine requires.322

Medicines, alcohol, and cannabis

Give your care team a full list of medicines, supplements, and substances. The label flags these groups:3

• Strong CYP2D6 blockers, which can raise xanomeline levels. The FDA lists bupropion, fluoxetine, and paroxetine among them.24
• Medicines cleared by active kidney secretion, which can compete with trospium and raise levels of either drug.
• Oral medicines that are sensitive to CYP3A4 or P-glycoprotein. Xanomeline briefly blocks these pathways in the gut, which can raise blood levels of those medicines.
• Other anticholinergic medicines, which can add to dry mouth, constipation, and other blocking side effects.

Because Cobenfy slows the gut, it can also change how other medicines are absorbed.3 In one study, metformin 500 mg twice a day lowered trospium levels by about 29 percent while metformin levels stayed about the same. Higher metformin doses were not studied.3

The label does not list interactions with alcohol or cannabis.3 Because Cobenfy itself can cause dizziness, confusion, and sleepiness, ask your prescriber how either one could affect you.

Pregnancy and breastfeeding

There are no data on Cobenfy use in pregnant women. Stopping treatment has risks too. Untreated schizophrenia during pregnancy raises the risk of relapse, a hospital stay, and suicide.3 Do not stop on your own. Plan with your prescriber, ideally before pregnancy.

A pregnancy registry follows outcomes in women who take psychiatric medicines, including Cobenfy. The number is 1-866-961-2388.3

There are no data on Cobenfy in human breast milk. Both ingredients show up in animal milk. Weigh the benefits of breastfeeding against your treatment needs and possible effects on the baby.3

Switching, stopping, and when it is not working

There is no single switching schedule that fits every medicine. In EMERGENT-5, stable adults switched to Cobenfy from their previous antipsychotic under close study care.13 That study does not show which switching method is safest for everyone. Ask for a written plan.

If relief is poor, review the dose, meal timing, missed doses, substance use, other health problems, and how long you have been on it. If two adequate medicine trials have not worked, ask about clozapine.23

Cost, coverage, and practical details

Cobenfy is brand-only. As of September 15, 2026, the FDA’s drug database listed no generic version.25

The manufacturer’s coverage page lists a price of $1,887 for people without drug coverage, plus any pharmacy charges. What you pay depends on your coverage.26

• Commercial insurance: eligible people may pay as little as $0 per 30-day supply through the co-pay program. The program cannot be used with Medicare, Medicaid, TRICARE, VA, or other state or federal plans.27
• Medicaid: some people pay as little as $0 per month.26
• Medicare: people with limited income may qualify for the Social Security Extra Help program.26
• Questions: the manufacturer’s Cobenfy Cares program answers coverage questions. Its phone number is on the COBENFY coverage page.26

Before your first fill, ask the pharmacy four things. Is prior authorization needed? What will my copay be? Is the starter pack in stock? What do I do if a refill is late? A starter pack combines first-step and second-step capsules.3

Store capsules at room temperature, 68 to 77°F, and keep them out of reach of children.3

Questions to ask your prescriber

1. Which symptoms are we trying to improve, and how will we measure progress?
2. Why does Cobenfy fit my history better or worse than my other options?
3. Do any of my bladder, prostate, liver, gallbladder, kidney, eye, bowel, or heart conditions change the decision?
4. Do any of my current medicines interact with it?
5. What is my exact dosing plan, and what should I do if I miss a dose or vomit after one?
6. Which side effects are expected early, and which need urgent help?
7. How will we switch from my current medicine?
8. When will we decide whether it is working?
9. Which lab tests and heart-rate or blood pressure checks do I need?
10. What will it cost me after insurance?

What we still do not know

• How Cobenfy compares with any named antipsychotic in a direct trial.9
• How well it works in controlled trials longer than five weeks.1213
• How it works in adults older than 65 or in children.3
• Whether it helps treatment-resistant schizophrenia, lowers suicide risk, or treats lasting negative symptoms or thinking problems.
• How often people miss doses in everyday life and what that does to results.

The manufacturer paid for nearly all of the Cobenfy trials, and many authors worked for the company.21012 Independent research will matter.

Bottom line

Cobenfy opens a genuinely new path in schizophrenia care. In three short trials, it eased symptoms more than placebo, and it caused little of the weight gain, stiffness, and sleepiness that come with many older medicines.

It has its own costs. Stomach upset is common. Bladder, liver, heart-rate, and blood pressure risks need watching. It must be timed away from meals twice a day, and there is no shot. It has not been proven better than any named antipsychotic, and in trial comparisons more people stopped it. The right choice brings the research together with your health, your history, your routine, and your goals.

Frequently asked questions

Is Cobenfy an antipsychotic?

Yes. The FDA calls it the first antipsychotic for schizophrenia that targets cholinergic receptors instead of dopamine receptors.1

How soon does it work?

In EMERGENT-3, the difference from placebo showed up at week 2, the first symptom check.5 One person’s response may come sooner, later, or not at all.

Does it help voices and false beliefs?

In all three short trials, positive symptoms like voices and false beliefs improved more than with placebo. Results for negative symptoms were mixed.245

Does it improve memory?

Not in the full trial group. People who started with clear thinking problems did better than placebo, but a dedicated trial is still needed.11

Does it cause weight gain?

Weight gain was uncommon in the trials and in the year-long extension study. Direct, long-term comparisons with other medicines are still missing.712

Why must I take it away from food?

A meal cuts trospium absorption by about 85 to 90 percent. Trospium is the part that blocks many of xanomeline’s body side effects.3

What if I miss a dose?

The label does not say. Ask your pharmacist or prescriber for a plan, and do not double up on your own.3

Is there a shot, or a version for children?

No to both. Cobenfy is a capsule for adults, taken twice a day.3

What should I do if someone takes too much?

Call Poison Help at 1-800-222-1222 or your prescriber, or go to the nearest emergency room right away.3

This article is for education, not personal medical advice. Do not start, stop, or change a medication without the clinician who manages it. Every numeric, regulatory, and citation claim was verified against primary labeling, federal, journal, and manufacturer sources on September 15, 2026. Drug labels, prices, and coverage rules change; confirm current details before acting on anything here.

Related reading on NP FADY

• The Chemical Behind Dry Mouth and Foggy Thinking
• Why Two Opposite Medicines Both Target Dopamine
• Rexulti (Brexpiprazole): What It Treats, Its Side Effects, and How It Compares With Abilify
• The Work Between Appointments
• Drug Interactions to Know: Antidepressants, Alcohol, CBD, and More

References

1. U.S. Food and Drug Administration. “FDA Approves Drug with New Mechanism of Action for Treatment of Schizophrenia.” Press announcement, September 26, 2024. FDA.

2. Kaul I, Sawchak S, Correll CU, et al. “Efficacy and safety of the muscarinic receptor agonist KarXT (xanomeline-trospium) in schizophrenia (EMERGENT-2) in the USA: results from a randomised, double-blind, placebo-controlled, flexible-dose phase 3 trial.” Lancet. 2024;403(10422):160–170. DOI: 10.1016/S0140-6736(23)02190-6. PMID: 38104575. 252 randomized; funded by Karuna Therapeutics. PubMed.

3. U.S. Food and Drug Administration; E.R. Squibb & Sons. “COBENFY (xanomeline and trospium chloride) capsules: full prescribing information and patient information.” Label revised January 2026; DailyMed version published August 21, 2026; accessed September 15, 2026. Indication, dosing, contraindications, warnings, adverse-reaction table, food effect, interactions, and storage. DailyMed.

4. Brannan SK, Sawchak S, Miller AC, et al. “Muscarinic Cholinergic Receptor Agonist and Peripheral Antagonist for Schizophrenia.” New England Journal of Medicine. 2021;384(8):717–726. DOI: 10.1056/NEJMoa2017015. PMID: 33626254. EMERGENT-1, phase 2; 182 randomized. PMC.

5. 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. DOI: 10.1001/jamapsychiatry.2024.0785. PMID: 38691387. EMERGENT-3; 256 randomized; separation from placebo at week 2; negative subscale not significant at week 5. PMC.

6. Citrome L, Neugebauer NM, Meli AA, Kando J. “Xanomeline and Trospium Chloride Versus Placebo for the Treatment of Schizophrenia: A Post Hoc Analysis of Number Needed to Treat, Number Needed to Harm, and Likelihood to Be Helped or Harmed.” Neuropsychiatric Disease and Treatment. 2025;21:761–773. DOI: 10.2147/NDT.S503494. PMID: 40212458. NNT 5 (95% CI 4 to 8) for at least 30% PANSS reduction. PMC.

7. Kaul I, Claxton A, Sawchak S, et al. “Safety and Tolerability of Xanomeline and Trospium Chloride in Schizophrenia: Pooled Results From the 5-Week, Randomized, Double-Blind, Placebo-Controlled EMERGENT Trials.” Journal of Clinical Psychiatry. 2025;86(1):24m15497. DOI: 10.4088/JCP.24m15497. PMID: 40047530. 683 participants; common adverse events mostly mild or moderate and transient. PubMed.

8. Wright AC, McKenna A, Tice JA, Rind DM, Agboola F. “A network meta-analysis of KarXT and commonly used pharmacological interventions for schizophrenia.” Schizophrenia Research. 2024;274:212–219. DOI: 10.1016/j.schres.2024.09.023. PMID: 39348764. Institute for Clinical and Economic Review; 33 trials, 7,193 participants. PubMed.

9. Schneider-Thoma J, Zhu Y, Qin M, et al. “Comparative efficacy and tolerability of antidopaminergic and muscarinic antipsychotics for acute schizophrenia: a network meta-analysis of randomised controlled trials indexed in international English and Chinese databases.” Lancet. 2026;407(10531):876–891. DOI: 10.1016/S0140-6736(25)02365-7. PMID: 41763745. 438 trials; publicly funded. PubMed.

10. Kaul I, Sawchak S, Claxton A, et al. “Efficacy of xanomeline and trospium chloride in schizophrenia: pooled results from three 5-week, randomized, double-blind, placebo-controlled, EMERGENT trials.” Schizophrenia (Heidelberg). 2024;10(1):102. DOI: 10.1038/s41537-024-00525-6. PMID: 39488504. Pooled difference -9.9 PANSS points. PMC.

11. Horan WP, Sauder C, Harvey PD, et al. “The Impact of Xanomeline and Trospium Chloride on Cognitive Impairment in Acute Schizophrenia: Replication in Pooled Data From Two Phase 3 Trials.” American Journal of Psychiatry. 2025;182(3):297–306. DOI: 10.1176/appi.ajp.20240076. PMID: 39659157. PubMed.

12. Kaul I, Claxton A, Sauder C, et al. “Long-Term Safety and Efficacy of Xanomeline and Trospium Chloride in Schizophrenia: A 52-Week Open-Label Extension Trial.” American Journal of Psychiatry. 2026;183(3):183–192. DOI: 10.1176/appi.ajp.20241186. PMID: 41634905. EMERGENT-4; 156 enrolled, 34 completed 52 weeks. PubMed.

13. Kaul I, Claxton A, Chaturvedi S, et al. “Long-term efficacy, safety, and tolerability of xanomeline and trospium chloride in schizophrenia: A 52-week, open-label trial (EMERGENT-5).” Schizophrenia Research. 2026;288:86–94. DOI: 10.1016/j.schres.2025.12.015. PMID: 41506001. 566 treated, 277 completed. PubMed.

14. Bristol Myers Squibb. “Bristol Myers Squibb Announces Topline Results from Phase 3 ARISE Trial Evaluating Cobenfy (xanomeline and trospium chloride) as an Adjunctive Treatment to Atypical Antipsychotics in Adults with Schizophrenia.” Press release, April 22, 2025. 2.0-point difference at week 6, P = 0.11. Company topline data; no peer-reviewed full report found in PubMed on September 15, 2026. BMS.

15. Hickey C, Sidovar MF, Garcia A, et al. “Systematic review and network meta-analysis of the efficacy, safety and tolerability of xanomeline plus trospium chloride compared with eight oral antipsychotics for the acute treatment of schizophrenia.” Journal of Comparative Effectiveness Research. 2026;15(8):e260045. DOI: 10.57264/cer-2026-0045. PMID: 42530555. Funded by Bristol Myers Squibb; higher odds of all-cause discontinuation than 7 of 8 comparators. PMC.

16. Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. “Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis.” Lancet. 2019;394(10202):939–951. DOI: 10.1016/S0140-6736(19)31135-3. PMID: 31303314. Weight, prolactin, sedation, and movement-side-effect comparisons. PMC.

17. Pillinger T, McCutcheon RA, Vano L, et al. “Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis.” Lancet Psychiatry. 2020;7(1):64–77. DOI: 10.1016/S2215-0366(19)30416-X. PMID: 31860457. PMC.

18. Otsuka America Pharmaceutical. “ABILIFY (aripiprazole) tablets: prescribing information.” Warnings and Precautions 5.7, Pathological Gambling and Other Compulsive Behaviors. Accessed September 15, 2026. DailyMed.

19. Otsuka America Pharmaceutical. “REXULTI (brexpiprazole) tablets: prescribing information.” Includes a warning for pathological gambling and other compulsive behaviors. Accessed September 15, 2026. DailyMed.

20. Sumitomo Pharma America. “LATUDA (lurasidone hydrochloride) tablets: prescribing information.” Take with food (at least 350 calories). Accessed September 15, 2026. DailyMed.

21. Pfizer (Roerig). “GEODON (ziprasidone) capsules: prescribing information.” Administer with food. Accessed September 15, 2026. DailyMed.

22. HLS Therapeutics. “CLOZARIL (clozapine) tablets: prescribing information.” Label revised June 2025. Indications include reducing the risk of recurrent suicidal behavior; ANC monitoring required. Accessed September 15, 2026. DailyMed.

23. Keepers GA, Fochtmann LJ, Anzia JM, et al. “The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.” American Journal of Psychiatry. 2020;177(9):868–872. DOI: 10.1176/appi.ajp.2020.177901. Clozapine for treatment-resistant schizophrenia and for persistent substantial suicide risk. AJP.

24. U.S. Food and Drug Administration. “Healthcare Professionals: FDA’s Examples of Drugs that Interact with CYP Enzymes and Transporter Systems.” Accessed September 15, 2026. Bupropion, fluoxetine, and paroxetine listed as strong CYP2D6 inhibitors. FDA.

25. U.S. Food and Drug Administration. “Drugs@FDA: NDA 216158, COBENFY.” Approved September 26, 2024. Queried September 15, 2026 (openFDA data updated September 14, 2026); no other application for xanomeline listed. Drugs@FDA.

26. Bristol Myers Squibb. “Insurance Coverage & Cost-Saving Options.” COBENFY patient website. Accessed September 15, 2026. List price $1,887; Cobenfy Cares coverage support. COBENFY.

27. Bristol Myers Squibb. “COBENFY Co-pay Assistance Program: Terms & Conditions.” Accessed September 15, 2026. Excludes Medicare, Medicaid, TRICARE, VA, and other state or federal programs. COBENFY.

If you or someone you know is in crisis

• Call 911 or go to your nearest emergency room for any life-threatening emergency.
• 988 Suicide & Crisis Lifeline — call or text 988, or chat at 988lifeline.org, available 24/7, free and confidential. En español: marque 988 y oprima 2, o envíe AYUDA al 988. Deaf or hard of hearing: 988 videophone (ASL) or TTY 711 then 988. Veterans: 988 and press 1, or text 838255.
• Crisis Text Line — text HOME to 741741.
• The Trevor Project (crisis support for LGBTQ+ young people) — call 1-866-488-7386, or text START to 678-678.
• National Sexual Assault Hotline (RAINN) — call 1-800-656-HOPE (4673) or text HOPE to 64673; free, confidential, 24/7. Online chat at RAINN.org/hotline.
• National Domestic Violence Hotline — call 1-800-799-SAFE (7233) or text START to 88788; 24/7, help in 200+ languages. Online chat at TheHotline.org. If your phone or computer may be monitored, calling from a safer device is an option.
• Riverside County — Inland SoCal Crisis Helpline 951-686-HELP (4357), 24/7 (Inland SoCal United Way / 211+, in partnership with RUHS-BH); Community Access, Referral, Evaluation and Support (CARES) Line 800-499-3008, 24/7.
• San Bernardino County — Access Unit (Behavioral Health Helpline) 888-743-1478, 24/7; Mobile Crisis/CCRT 800-398-0018 (24/7, all ages) or text 909-420-0560. Arrowhead Regional Medical Center (ARMC) has a dedicated walk-in adolescent psychiatric ER (ages 13–17).
• Children under 13 — call 911 for immediate danger, contact your county's mobile crisis team (they respond to all ages), or go to the nearest pediatric emergency room.
• California Peer-Run Warm Line (non-crisis — someone to talk to) — call or text 1-855-600-WARM (9276); daytime and evening hours, not a 24/7 line.
• NP Fady (non-emergency) — for routine scheduling or questions, call (909) 707-6261. This line is not monitored for emergencies.