What is the Cobenfy?

Cobenfy is the first new medication for schizophrenia in many decades.   

Medications for schizophrenia are known as antipsychotics.

It is an exciting development as compared to existing antipsychotics:

• it can treat more symptoms, and
• it has fewer side effects.

The United States Food and Drug Administration (FDA) have approved Cobenfy, for the treatment of schizophrenia in the United States. 

But the drug is not yet licenced for use in the England, and we are not sure when it will be. But we wanted to keep you up to date with this new development.

For more information see below - When will Cobenfy be available for use in England?

Cobenfy was formerly known as KarXT or xanomeline-trospium.

You can find out more about how it was developed in this article by the Wellcome Trust. They helped fund research into Cobenfy.

How does Cobenfy work?

Current antipsychotics work by blocking some of the dopamine receptors in the brain. This can lead to side effects. These side effects can:

• have a bad effect on the quality of people's lives, or
• mean some people stop taking the medication, causing them to experience symptoms again. This is known as ‘relapse’. 

Current antipsychotics do not help treat symptoms for about 3 or 4 in 10 people who try them. 

Cobenfy does not work by blocking some of the dopamine receptors in the brain. 

Cobenfy works in a new way. It stimulates muscarinic receptors.  This is complicated. But you can find out more here and from this explainer video. 

The video is by John H. Krystal, Chair of the department of psychiatry at the Yale School of Medicine in the United States. 

Cobenfy combines 2 different drugs into one treatment: 

• Xanomeline – this reduces schizophrenia symptoms. 
• Trospium chloride – this helps counter side effects caused by xanomeline.

Does Cobenfy have any side effects or warnings?

Like a lot of medications, Cobenfy can have potential side effects.

The most common side effects are nausea, indigestion, constipation, vomiting, hypertension, abdominal pain, diarrhoea, increased heartbeat, dizziness and gastroesophageal reflux disease.

It can also cause other issues such as urinary retention, increased heart rate, decreased gastric movement or swelling beneath the skin of the face and lips.

So, some people: 

• may respond better than others to the medication, and
• will not be able to take it at all. 

You can read more in this US Food and Drug administration news release.  

Why is Cobenfy important?

Current antipsychotics:

• can treat what are known as ‘positive symptoms’, like hallucinations and delusions, but
• do not treat what are known as ‘negative symptoms’, like lack of motivation or social withdrawal, and
• usually have troubling side-effects.

See our page on Antipsychotics for more information.

Trials in the US show patients who took Cobenfy showed improvements in:

• both negative and positive symptoms, and
• cognitive symptoms, like memory or concentration problems, and
• side effects that current antipsychotics cause, such as sleepiness, weight gain and unusual body movements.

It is hoped that if people are experiencing fewer side effects, they will be more likely to take the medication.

Because of the way it works, Cobenfy may improve symptoms for those who do not respond to existing antipsychotics.

Some elements of the drug to do with cognitive improvements still need to be researched further.

When will Cobenfy be licensed for use in England?  

Cobenfy has been licensed for use in United States. But it will not be widely available there for around a year from September 2024. 

Before Cobenfy is available to be widely prescribed in England, it must go through a number of steps, including: 

• Lab testing and clinical trials,
• Approval by The Medicines and Healthcare products Regulatory Agency (MHRA), and
• Approval by The National Institute for Health and Care Excellence (NICE)

So, it is unclear when Cobenfy will be available to be widely prescribed in England.

These steps are needed to make sure the medication is safe and is affordable. 

There are likely to be different ongoing trials of the medication. One study will look at Cobenfy’s use as an add-on treatment for those who do not respond well to existing antipsychotics. 

The University of Oxford says it will be doing the first UK trial of Cobenfy in 2025. 

We will update this page when we have more information about when Cobenfy might be available in England.

What can I do if I am having issues with my antipsychotics?  

You might be having issues with your antipsychotics or their side effects. Speak to your psychiatrist as soon as you can. 

You might having issues seeing your psychiatrist. Speak to someone at your NHS mental health team, your GP, or a pharmacist.

It is important that you do not stop taking your medication without getting advice first.

You can get more advice and information in our webpage on Medication - Choice and managing problems.

Want a fully referenced, printable PDF version? 

You can download a fully referenced, printable PDF version of this information by using the link at the top of this page.

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© Rethink Mental Illness 2024

First published October 2024
Next update October, 2025, subject to any changes

Version number 1