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asenapine (Saphris): Schizophrenia Drug Side Effects & Dosage

What is asenapine? What is asenapine used for?

Asenapine is an atypical antipsychotic used
to treat schizophrenia. Other atypical antipsychotic drugs include olanzapine
(Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), iloperidone (Fanapt) and
aripiprazole (Abilify).

Atypical antipsychotics differ from typical antipsychotics because they cause
a lesser degree of movement (extrapyramidal) side effects and constipation.

The exact mechanism of action of asenapine is not known, but, like other
anti-psychotics, it is believed that asenapine affects the way the brain works
by interfering with communication among the brain's nerves. Nerves communicate
with each other by making and releasing chemicals called neurotransmitters. The
neurotransmitters travel to other nearby nerves where they attach to receptors
on the nerves. The attachment of the neurotransmitters either stimulates or
inhibits the function of the nearby nerves. Asenapine blocks several of the
receptors on nerves including dopamine type 2, serotonin type 2, and alpha 2
adrenergic receptors.

It is believed that many psychotic illnesses are caused by abnormal
communication among nerves in the brain, and that by altering communication
through neurotransmitters, asenapine can alter the psychotic state. Asenapine
was approved by the FDA in August, 2009.

What brand names are available for asenapine?


Is asenapine available as a generic drug?


Do I need a prescription for asenapine?


What are the side effects of asenapine?

The most common side effects of asenapine are

Other side effects are

Less common but serious side effects include:

  • Neuroleptic malignant syndrome (NMS). NMS is
    a rare but serious side effects associated with the use of antipsychotics. NMS
    may result in death and must be treated in the hospital. Signs and symptoms of
    NMS may include high fever, sweating (diaphoresis), severe muscle stiffness or
    rigidity, confusion, loss of consciousness, high blood pressure, rapid
    heartbeat, and changes in your breathing.
  • Extrapyramidal side effects (EPS) including:
    • Dystonia: painful spasms of the oral, throat, or
      neck muscles that may cause problems with speech, swallowing, and stiff neck.
    • Akathisia: feelings of restlessness or difficulty
      sitting still.
    • Pseudoparkinsonis: drug induced Parkinson’s
  • Tardive dyskinesia (TD). TD usually occurs
    after long term use of antipsychotics and usually presents with movement
    problems affecting the tongue, lips, jaw, face, and extremities.
  • Metabolic changes including high blood sugar
    (hyperglycemia), diabetes mellitus, increase in blood cholesterol, and weight
  • High blood levels of prolactin. Prolactin is
    a hormone that allows the production of breast milk. High levels of prolactin
    may cause menstrual abnormalities, leakage of milk from the breast, development
    of breasts in men (gynecomastia), and erection problems in men


Schizophrenia is the most disabling mental illness.
See Answer

What is the dosage for asenapine?

  • The starting dose for treating schizophrenia in adults is 5 mg every
    12 hours. The dose may be increased to 10 mg every 12 hours after 1 week.
  • The dose for treating bipolar disorder is 5 to 10 mg every 12 hours.
  • Asenapine sublingual tablets should be placed under the tongue and left to
    dissolve completely. Tablets dissolve within seconds and should not be
    swallowed. Ingestion of food and liquids should be avoided for 10 minutes after

Which drugs or supplements interact with asenapine?

Asenapine can reduce blood pressure especially when standing up from a
sitting down or laying down position (orthostatic hypotension). Therefore,
asenapine should be used cautiously with other drugs also associated with
orthostatic hypotension.

Asenapine may increase paroxetine (Paxil) blood levels by 2-fold. The dose of
paroxetine should be reduced by half if it is used with asenapine.

Fluvoxamine (Luvox) may reduce breakdown of asenapine in the liver,
increasing blood levels of asenapine. A smaller dose of asenapine should be

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Is asenapine safe to take if I’m pregnant or breastfeeding?

Fetuses exposed to antipsychotics during the third trimester of
pregnancy are at risk for extrapyramidal and withdrawal symptoms after birth.
Symptoms reported included agitation, hypertonia, hypotonia, tremor, somnolence,
depressed breathing, and feeding disorder. Currently there is no data on the use
of asenapine during pregnancy. Asenapine should only be used during pregnancy if
the potential benefit to the mother outweighs the potential for side effects in
the unborn baby.

A pregnancy exposure registry has been established to monitor the use of
atypical antipsychotics, including asenapine, during pregnancy. All pregnant
women treated with atypical antipsychotics are advised to enroll in this
pregnancy registry and report any side effects.

Asenapine has not been evaluated in breastfeeding women.

What else should I know about asenapine?

What preparations of asenapine are available?

Sublingual Tablets: 2.5, 5, and 10 mg

How should I keep asenapine stored?

Asenapine should be stored at room temperature, between 15 C to 30C
(59 F and 86 F).

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