Asenapine (Saphris, Secuado): Uses, Dosage, Side Effects, Interactions, and Safety

Q: What is asenapine used for?

To treat schizophrenia in adults and bipolar I disorder (acute manic/mixed episodes) in adults; pediatric labeling exists for bipolar I ages 10–17 (sublingual).

Q: How do you take Saphris sublingual tablets correctly?

Place the tablet under your tongue until it dissolves fully; don’t eat or drink for 10 minutes after the dose.

Q: What’s the starting dose for schizophrenia?

Adults commonly start at 5 mg twice daily , with some needing 10 mg twice daily depending on response and tolerability.

Q: What’s the pediatric dose for bipolar I?

2.5 mg twice daily to start (ages 10–17 ), increasing to 5 mg BID after 3 days and 10 mg BID after 3 more days if needed.

Q: Does asenapine cause weight gain or metabolic issues?

Yes, weight gain and changes in blood sugar/lipids can occur; regular monitoring is recommended.

Q: Why does my mouth feel numb after Saphris?

Oral hypoesthesia (numbness/tingling) is a known, usually short-lived effect after sublingual dosing.

Q: What is the Secuado patch and who is it for?

A daily transdermal asenapine patch for adult schizophrenia ; strengths are 3.8/5.7/7.6 mg per 24 hours .

Q: Does asenapine prolong the QT interval?

It can increase QT ; avoid combining with other QT-prolonging drugs and use caution in at-risk patients.

Q: Can I drink alcohol on asenapine?

Alcohol can worsen drowsiness and dizziness ; most guidance recommends avoiding or minimizing use.

Q: Which drugs interact with asenapine?

Strong CYP1A2 inhibitors (e.g., fluvoxamine ) may raise levels; clinicians may adjust doses. Discuss all meds/supplements with your prescriber.

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What is Asenapine?

Asenapine is a second-generation (atypical) antipsychotic used to treat schizophrenia and bipolar I disorder (acute manic or mixed episodes). In the U.S., it’s available as sublingual tablets (brand Saphris) and a transdermal patch(brand Secuado) for adults; pediatric labeling exists for bipolar I acute mania (10–17 years) with sublingual tablets.

Asenapine’s mechanism involves dopamine and serotonin receptor effects that help stabilize mood, reduce agitation, and improve thought organization.

Who Asenapine May Help

Schizophrenia (adults) — improves positive and negative symptoms when taken as prescribed.
Bipolar I disorder — for acute manic or mixed episodes as monotherapy or adjunct to lithium/valproate; pediatric monotherapy labeling covers ages 10–17. Some references also note use as maintenance in adult bipolar I per prior labeling/clinical guidance.

Always follow your prescriber’s recommendation. This page is informational and not a substitute for medical advice.

Forms and Brands: Sublingual vs. Transdermal

Saphris® (sublingual tablets)

How taken: Place the tablet under the tongue and let it fully dissolve. Do not eat or drink for 10 minutes afterward—this protects absorption. Tablets dissolve within seconds.
Strengths: 5 mg and 10 mg sublingual tablets.

Secuado® (transdermal patch)

Indication: Adults with schizophrenia.
Strengths: 3.8 mg/24 h, 5.7 mg/24 h, 7.6 mg/24 h patch.
Key cautions: Contraindicated in severe hepatic impairment; rotate sites; follow 24-hour wear time; avoid swimming/bathing (showering allowed).

How Asenapine Works

Asenapine acts on multiple receptors—including dopamine D2 and serotonin 5-HT2A—to rebalance signaling involved in mood, perception, and behavior. That “stabilizer” effect can reduce hallucinations/delusions and smooth out manic agitation.

Dosing & Titration (Evidence-Based Ranges)

Never change your dose without medical guidance. Below are label-based examples.

Schizophrenia (adults: sublingual)

Typical 5 mg twice daily; some patients use 10 mg twice daily depending on response and tolerability. Continue the no food/drink for 10 minutes rule after each dose.

Bipolar I Disorder (adults: sublingual)

Monotherapy: 5–10 mg twice daily; if tolerated and needed, increase after about 1 week (do not exceed 10 mg twice daily in studies).
Adjunct to lithium/valproate: commonly 5 mg twice daily, may increase to 10 mg twice daily as tolerated.

Pediatric Bipolar I (10–17 years: sublingual)

Start 2.5 mg twice daily → increase to 5 mg twice daily after 3 days, then 10 mg twice daily after another 3 days if needed. Dystonia risk is higher if escalation isn’t followed.

Secuado® Patch (adults: schizophrenia)

Typical initial 3.8 mg/24 h; titrate within 3.8–7.6 mg/24 h based on response. Apply one patch every 24 hours to recommended sites (e.g., upper arm/hip/abdomen/back), rotating sites.

Administration Tips That Improve Outcomes

Sublingual: Dry hands, don’t push the tablet through the blister. Place under the tongue until fully dissolved—no splitting or swallowing—and avoid food/drink for 10 minutes. If you’re taking other meds at the same time, asenapine is often taken last to protect absorption.
Transdermal: Apply to clean, dry, hairless skin; wear for 24 hours and replace; don’t cut patches; avoid baths/swimming; rotate sites to reduce irritation.

Side Effects & Safety

Common effects

Oral hypoesthesia/paresthesia (mouth/tongue numbness) shortly after sublingual dosing—usually resolves within an hour.
Somnolence, dizziness, akathisia/restlessness, insomnia, weight gain, and metabolic changes can occur.

QT prolongation (heart rhythm)

Asenapine can increase the QT interval; caution with other QT-prolonging drugs and in patients with risk factors for torsades. Clinicians weigh risks if combining with other QT-prolongers.

Boxed warnings & serious risks

ncreased mortality in elderly patients with dementia-related psychosis; not approved for this population.
Risks include cerebrovascular events in elderly with dementia, NMS, tardive dyskinesia, hyperprolactinemia, seizures, orthostatic hypotension/falls, leukopenia/neutropenia, and hypersensitivity (including anaphylaxis/angioedema). Seek urgent care for severe symptoms.

Drug & Food Interactions

CYP1A2 inhibitors (e.g., fluvoxamine) may increase asenapine levels—clinicians may adjust dosing.
CYP2D6 interactions (e.g., paroxetine) and combined inhibitors can alter exposure; coadministration is approached cautiously.
Alcohol can worsen sedation/dizziness and impair judgment.
Discuss cannabis, nicotine, caffeine, and grapefruit use with your prescriber; a full medication/supplement list helps prevent problems.

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Asenapine vs. Other Options in Practice

Sublingual advantages: fast dissolve; helpful for people who prefer not to swallow tablets; unique but benign mouth numbness can occur.
Transdermal (Secuado): daily patch avoids swallowing and GI first-pass metabolism; can help with adherence and steady exposure; site-care and 24-hour wear schedule are essential; QT and other warnings align with the class.

Cost & Access

Generic asenapine sublingual is widely available; Secuado patches are typically handled as specialty products with prior authorization and copay programs via manufacturer portals. Work with your prescriber and pharmacy to determine coverage.

When to Call Your Prescriber

Persistent restlessness/akathisia, severe mouth irritation, or disruptive insomnia
Symptoms of high blood sugar (excessive thirst/urination) or rapid weight gain
Signs of allergic reaction, heart rhythm changes (palpitations, fainting), or uncontrolled movements

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