Asenapine
Generic: asenapine maleate · Brand: Saphris® · Class: 2nd Gen Antipsychotic
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How It Works
Asenapine is a second-generation (atypical) antipsychotic with a unique multi-receptor profile blocking dopamine, serotonin, norepinephrine, and histamine receptors. Its most distinctive feature is its sublingual (under-the-tongue) administration — the tablet dissolves under the tongue and must not be swallowed, chewed, or taken with food or water for 10 minutes. This route bypasses the digestive system and provides more consistent absorption. It is available in both 5 mg and 10 mg black cherry-flavored tablets.
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What It Treats
SchizophreniaFDA-approved for adults
Bipolar I DisorderFDA-approved for acute manic or mixed episodes in adults and children 10+
Bipolar MaintenanceUsed as adjunct to lithium or valproate
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Dosing Overview
| Population | Start | Typical Range | Max |
|---|---|---|---|
| Adults Schizophrenia | 5 mg twice daily | 5–10 mg twice daily | 20 mg/day |
| Adults Bipolar Mania | 10 mg twice daily | 5–10 mg twice daily | 20 mg/day |
| Children 10+ Bipolar Mania | 2.5 mg twice daily | 2.5–10 mg twice daily | 20 mg/day |
Placed UNDER the tongue and allowed to dissolve completely. Do not swallow, chew, or crush. Do not eat or drink for 10 minutes after taking. Available in black cherry flavor. Hands must be dry when handling.
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Side Effects
Common
- Sedation
- Dizziness
- Oral numbness or tingling
- Weight gain (moderate)
- Dry mouth
- Constipation
- Akathisia
- Nausea
Call us if you notice
- Tardive dyskinesia (involuntary movements)
- Neuroleptic malignant syndrome (NMS)
- Significant weight gain or metabolic changes
- High blood sugar or new diabetes
- Severe restlessness (akathisia)
- Muscle stiffness or rigidity
- Oral hypoesthesia (numbness under tongue)
- Allergic reactions including anaphylaxis
Oral numbness and tingling under the tongue are common and usually temporary. The sublingual route means no food or water for 10 minutes after dosing — this is important for proper absorption.
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Tips for Success
Same Time DailyTake at the same time each day for consistent levels in your system.
With FoodTaking with food reduces nausea and stomach upset.
Don't Stop AbruptlyAlways taper with your provider guidance — stopping suddenly can cause rebound symptoms.
Avoid AlcoholAlcohol increases sedation and side effects significantly.
Tell All ProvidersLet other prescribers know what you are taking — interactions matter.
Track Your MoodNote any changes in mood, movement, or weight and share with your provider.
Sublingual OnlyPlace under tongue and let dissolve completely. Never swallow whole. No eating or drinking for 10 minutes after.
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Important Safety Information
Tardive Dyskinesia: Long-term use of antipsychotics can cause involuntary repetitive movements of the face, tongue, or limbs. Report any unusual movements to your provider immediately.
Elderly Patients with Dementia: Antipsychotics carry a black box warning for increased risk of death in elderly patients with dementia-related psychosis. These medications are not approved for this use.
Metabolic Effects: Many antipsychotics can cause weight gain, elevated blood sugar, and increased cholesterol. Your provider will monitor these regularly.
Pregnancy & Breastfeeding: Discuss risks and benefits with your provider. Do not stop without consultation.
Drug Interactions: Antipsychotics interact with many medications including other CNS depressants, blood pressure medications, and QT-prolonging drugs. Always share your full medication list.
Hypersensitivity Reactions: Rare but serious allergic reactions including anaphylaxis have been reported. Seek emergency care immediately for difficulty breathing, swelling of face or throat, or severe rash.
Questions? I am here.
Reach me between appointments if you have concerns about side effects, notice mood changes, or have questions about your medication.
360-389-3712
info@rootedmindspsychiatry.com