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asenapine

Generic Saphris
Used for Bipolar Disorder, Schizophrenia
Used for Bipolar Disorder, Schizophrenia

Asenapine (Saphris) is an atypical antipsychotic. It's used to treat schizophrenia in adults and bipolar I disorder in people ages 10 years and older. It comes as sublingual (under the tongue) tablets in both a brand-name and generic versions. The usual dosage is to dissolve a tablet under the tongue twice a day. Some potential side effects of this medication include sleepiness, trouble sleeping, and movement problems.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Allison Gourley, PharmD
Last reviewed on October 16, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsAlternativesLatest newsImagesReferencesPricesMedicare
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What is Asenapine (Saphris)?

What is Asenapine (Saphris) used for?

How Asenapine (Saphris) works

Asenapine (Saphris) is an atypical antipsychotic. It affects dopamine and serotonin activity in your brain, which can help regulate your thoughts, mood, and behaviors.

Are you looking for information on Secuado (asenapine) patch instead?

Drug Facts

Common BrandsSaphris
Drug ClassAtypical antipsychotic
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only

More on Asenapine (Saphris) essentials

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What are the side effects of Asenapine (Saphris)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Trouble sleeping (up to 16%)
  • Sleepiness (up to 15%)
  • Movement problems (up to 12%)
  • Restlessness (not being able to sit still, up to 11%)
  • Dizziness (up to 7%)
  • Constipation (up to 7%)
  • Vomiting (up to 7%)
  • Mouth numbness (up to 7%)
*Note: Side effects listed above were reported by adults with schizophrenia. Similar side effects are seen in adults and children with bipolar disorder.

Other Side Effects

  • Dry mouth
  • Salivating more
  • Tiredness (fatigue)
  • Feeling irritable
  • Weight gain
  • Bigger appetite
  • Stomach discomfort
  • High blood pressure

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Depression or thoughts of self-harm
  • Seizures
  • Neuroleptic malignant syndrome: high fever, sweating, confusion, stiffness, changing blood pressure
  • Serious allergic reaction: rash, hives, trouble breathing, swelling of the face, tongue, or throat
  • Changes in heartbeat

Source: DailyMed

More on Asenapine (Saphris) side effects

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The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Abnormal or decreased touch sensation

inability to move the eyes

inability to sit still

increase in body movements

increased blinking or spasms of the eyelid

lip smacking or puckering

need to keep moving

puffing of the cheeks

rapid or worm-like movements of the tongue

restlessness

shakiness in the legs, arms, hands, or feet

sticking out of tongue

trembling or shaking of the hands or feet

trouble with breathing, speaking, or swallowing

twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs

uncontrolled chewing movements

uncontrolled twisting movements of the neck, trunk, arms, or legs

unusual facial expressions

weakness of the arms and legs

Less common

Blurred vision

dizziness

headache

nervousness

pounding in the ears

slow or fast heartbeat

Rare

Black, tarry stools

bleeding gums

blood in the urine or stools

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

changes in patterns and rhythms of speech

coma

confusion

convulsions

decreased urine output

fast, pounding, or irregular heartbeat or pulse

increased thirst

muscle pain or cramps

nausea or vomiting

pale skin

pinpoint red spots on the skin

slurred speech

swelling of the face, ankles, or hands

troubled breathing with exertion

unusual bleeding or bruising

unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Constipation

sleepiness or unusual drowsiness

trouble sleeping

unusually deep sleep

unusually long duration of sleep

Less common

Acid or sour stomach

belching

depression

difficulty with moving

dry mouth

fear or nervousness

heartburn

increased appetite

increased watering of the mouth

increased weight

indigestion

irritability

muscle pain or stiffness

pain in the arms or legs

pain in the joints

stomach discomfort, upset, or pain

toothache

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Asenapine (Saphris)

thumbs-up

Pros

Dissolved under the tongue; good option for people who have a hard time swallowing tablets

Possible option for children who have bipolar I disorder

Less likely to cause weight gain than some other antipsychotic medications, like olanzapine (Zyprexa)

thumbs-down

Cons

Can cause drowsiness or trouble sleeping

Taken twice a day

Can't be taken by people who have severe liver problems

pharmacist-tips

Pharmacist tips for Asenapine (Saphris)

pharmacist

  • Each asenapine (Saphris) tablet is packaged on its own. The directions for how to remove the tablet from the packaging can differ depending on the manufacturer, so follow the instructions carefully. Don't open the package or remove the tablet until you're ready to take it. If you remove it too early, the tablet might break.

    • Make sure your hands are dry before touching the asenapine (Saphris) tablet. Otherwise, the tablet might dissolve in your hands.

      • Place asenapine (Saphris) under your tongue and let it dissolve completely. Don't crush, chew, or swallow the tablets. Otherwise, you won't get the right dose of medication.

        • Avoid placing asenapine (Saphris) on or near any mouth sores or blisters. Doing so can cause skin irritation, like swelling and pain.

          • Don't eat or drink for 10 minutes after you take asenapine (Saphris). Doing so causes your body to absorb less medication, which means that asenapine (Saphris) might not work as well to help with your condition.

            • Some people might feel a numbing or tingling sensation in their mouth after taking asenapine (Saphris). This sensation should go away after an hour.

              • Asenapine (Saphris) can make you feel sleepy or dizzy. Don't drive or do anything that requires a lot of concentration until you know how the medication affects you.

                • Asenapine (Saphris) can make it harder for your body to cool down. Drink enough water to stay hydrated during and after working out, and don't stay in the sun for too long to avoid getting overheating.

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                  faqs

                  Frequently asked questions about Asenapine (Saphris)

                  How long does it take for asenapine (Saphris) to take effect?
                  How long it takes for asenapine (Saphris) to start working can differ from person to person, and depending on what you're taking it to treat. Based on results from clinical studies, you're likely to notice improvements in your symptoms after taking asenapine (Saphris) for about 3 weeks for bipolar I disorder, and about 6 weeks for schizophrenia. Talk with your healthcare team if you're not sure whether asenapine (Saphris) is working for you.
                  Can you take asenapine (Saphris) for sleep?
                  Asenapine (Saphris) is only FDA-approved for schizophrenia and bipolar I disorder, not to help with sleep. While some people experienced sleepiness as a side effect, others have reported insomnia and restlessness. If you're having trouble sleeping, tell your primary care provider. They can talk with you about treatment options for sleep that are appropriate for you.
                  Does asenapine (Saphris) cause weight gain?
                  Taking antipsychotic medications, including asenapine (Saphris), can cause weight gain. In a one-year study, adults who took asenapine (Saphris) for schizophrenia gained an average of 2 pounds. Talk to your prescriber if you're concerned about weight gain from asenapine (Saphris). They can help you come up with a plan to minimize weight gain that includes eating a healthy diet and following an exercise routine that's appropriate for you.
                  Does asenapine (Saphris) cause withdrawal?
                  Stopping asenapine (Saphris) suddenly can lead to withdrawal symptoms, such as anxiety and lower sensitivity in the mouth. Doing so can also worsen schizophrenia or bipolar symptoms. Don't stop taking asenapine (Saphris) without first talking to your prescriber. If you want to stop this medication, your prescriber will instruct you on how to do so safely by lowering your dose slowly over time.
                  What's the difference between asenapine (Saphris) and aripiprazole (Abilify)?
                  Both asenapine (Saphris) and aripiprazole (Abilify) are atypical antipsychotics that can treat schizophrenia and bipolar I disorder. But there are some differences between them. For example, asenapine (Saphris) is only FDA-approved to treat schizophrenia in adults, while aripiprazole (Abilify) is approved in adults and children ages 13 years and older. Another difference is that asenapine (Saphris) tablet is dissolved under the tongue twice daily, while aripiprazole (Abilify) tablet is taken by mouth once daily. And while asenapine (Saphris) is only available as a dissolvable tablet, aripiprazole (Abilify) comes in multiple dosage forms, including monthly injections (Abilify Maintena). Follow up with your healthcare team to learn about additional differences between these medications.
                  What's the difference between asenapine (Saphris) and olanzapine (Zyprexa)?
                  Asenapine (Saphris) and olanzapine (Zyprexa) are both atypical antipsychotics used to treat schizophrenia and bipolar I disorder. One difference between them is that olanzapine (Zyprexa) treat schizophrenia in adults and children ages 13 years and older, but asenapine (Saphris) can only be taken by adults. Another difference is that olanzapine (Zyprexa) is also approved to help with other conditions, such as treatment-resistant depression, while asenapine (Saphris) isn't. A third difference is that olanzapine (Zyprexa) is more likely to cause weight gain as a side effect compared to asenapine (Saphris). Talk with your healthcare team if you have more questions about either of these medications.
                  Can asenapine (Saphris) be cut in half?
                  No, you shouldn't cut asenapine (Saphris) in half. This medication is designed to dissolve under your tongue within seconds. Don't try to split, crush, or chew it, because you might not get the full dose. If you're having trouble taking it as a whole tablet under your tongue, speak to your prescriber.
                  Is asenapine (Saphris) safe to take while pregnant?
                  Talk with your healthcare team if you're pregnant or thinking of becoming pregnant. There haven't been any studies that specifically look at the safety of asenapine (Saphris) during pregnancy. In general, taking antipsychotic medications during the third trimester can raise the risk for movement problems and withdrawal symptoms in newborn babies. But research suggests that antipsychotic medications aren't likely to raise the risk of birth defects. If you have schizophrenia or bipolar I disorder, it's important that you continue to receive treatment for your condition during pregnancy. Talk with your healthcare team about possible options, including non-medication therapies, during pregnancy.
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                  What are the risks and warnings for Asenapine (Saphris)?

                  Asenapine (Saphris) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                  risk-warning

                  Higher risk of death in older adults with dementia

                  • Risk factors: People over age 65 years who have dementia

                    There's higher risk of death in people over 65 years old with dementia taking medications like asenapine (Saphris) to treat psychosis. Most of the time, the causes of death were related to heart problems or infections. Asenapine (Saphris) isn't approved to treat dementia-related psychosis.

                    risk-warning

                    Neuroleptic malignant syndrome

                    Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening condition linked to antipsychotic medications. Symptoms include high fever, fast heart rate, full body stiffness, and confusion. Seek medical attention right away if you notice any of these symptoms. Your prescriber will likely recommend a different medication.

                    risk-warning

                    Difficulty controlling movements

                    • Risk factors: Taking atypical antipsychotic medications for a long time | Older females

                      Long-term use of asenapine (Saphris) has been linked to the development of tardive dyskinesia (TD). TD is a condition where you feel constantly restless and unable to sit still. Symptoms can include lip smacking, grimacing, and unusual eye blinking. Sometimes, this side effect can become permanent, even after you stop taking asenapine (Saphris). To lower your risk of TD, your healthcare team will only prescribe the lowest dose of medication needed to treat your symptoms. THey'll check in with you regularly to see if you still need to take asenapine (Saphris). Talk to your prescriber right away if you experience symptoms of TD.

                      risk-warning

                      High blood sugar, high cholesterol, and weight gain

                      Antipsychotic medications like asenapine (Saphris) can cause high blood sugar or diabetes, high cholesterol, and weight gain. These changes might raise your risk of heart disease, stroke, and other serious health issues. Talk to your prescriber about your risks and preventive measures you can take.

                      risk-warning

                      Serious allergic reactions

                      Asenapine (Saphris) can rarely cause serious allergic reactions. Get medical help right away if you experience a rash, fast heartbeat, swelling, or trouble breathing.

                      risk-warning

                      Low blood pressure and changes in heartbeat

                      • Risk factors: Older adults | History of heart or heartbeat problems | Taking blood pressure medications or other medications that can lower blood pressure | Taking medications that can affect heart rhythm

                        Asenapine (Saphris) can cause low blood pressure, especially when getting up from a sitting or lying down position. This medication can also cause changes in your heart beat. Be very careful the first few days you start taking asenapine (Saphris) when you stand up, because you might feel dizzy and possibly faint or fall. If you've had problems in the past with your heart or heart rhythm, talk to your prescriber to see if you should take something else besides asenapine (Saphris). Contact your care team if you feel faint or experience any abnormal heartbeats while using asenapine (Saphris).

                        risk-warning

                        Low white blood cell count

                        • Risk factors: Past low white blood cell count

                          Asenapine (Saphris) can lower the amount of white blood cells in your body. White blood cells help your body fight off infections and diseases. So you're at a higher risk for infection if your white blood cell count is too low. If you notice a fever or you're getting sick more easily, let your prescriber know right away. You might need to have blood tests done before you start asenapine (Saphris) and during the first few months of being on this medication to make sure that you have a healthy amount of white blood cells.

                          risk-warning

                          Seizures

                          • Risk factors: History of seizures | Health conditions that make it easier to have seizures

                            Asenapine (Saphris) can make you more likely to have seizures. Before starting this medication, let your prescriber know if you have a history of seizures or have a medical condition that puts you at risk for having seizures.

                            risk-warning

                            High prolactin levels

                            Taking asenapine (Saphris) can raise the levels of a hormone called prolactin in the body. The risk is higher if you take this medication over a longer period of time. Symptoms of too much prolactin can include changes in menstrual bleeding patterns, fertility problems, and mood problems in females. They can also include sexual problems in males. Talk with your health care team if you're concerned about higher prolactin levels.

                            risk-warning

                            Phenylketonuria

                            Some brands of asenapine (Saphris) tablets contain phenylalanine, which can be harmful in people with phenylketonuria (PKU). Make sure your prescriber knows if you have PKU.

                            dosage

                            Asenapine (Saphris) dosage forms

                            The average cost for 1 carton of 60 sublingual tablets of 10mg of Asenapine (Saphris) is $113.72 with a free GoodRx coupon. This is 89.03% off the average retail price of $1036.33.
                            bottle
                            Bottle
                            DosageQuantityPrice as low asPrice per unit
                            60 sublingual tablets of 5mg1 bottle$77.00$77.00
                            60 sublingual tablets of 10mg1 bottle$77.00$77.00
                            carton
                            Carton
                            DosageQuantityPrice as low asPrice per unit
                            60 sublingual tablets of 2.5mg1 carton$113.72$113.72
                            60 sublingual tablets of 5mg1 carton$96.56$96.56
                            100 sublingual tablets of 5mg1 carton$142.60$142.60
                            60 sublingual tablets of 10mg1 carton$113.72$113.72
                            100 sublingual tablets of 10mg1 carton$171.20$171.20

                            Typical dosing for Asenapine (Saphris)

                            • Schizophrenia: The typical dose is 5 mg under the tongue twice daily. After a week (if needed), your healthcare team might raise your dose to a maximum of 10 mg twice daily.

                            • Bipolar disorder

                              • Adults: The typical dose ranges from 5 mg to 10 mg under the tongue twice daily, with a maximum dose of 10 mg twice daily. Your dose will depend on if you're taking other medications for bipolar.

                              • Children ages 10 to 17 years old: The typical starting dose is 2.5 mg under the tongue twice daily. After 3 days, your child's pediatrician might raise their dose to 5 mg twice daily. The maximum dose is 10 mg twice daily.

                            interactions

                            Interactions between Asenapine (Saphris) and other drugs

                            Asenapine (Saphris) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Asenapine (Saphris). Please note that only the generic name of each medication is listed below.

                            Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                            Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                            Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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                            How much does Asenapine (Saphris) cost?

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                            contraindications-icon

                            Asenapine (Saphris) contraindications

                            Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Asenapine (Saphris) will not be safe for you to take.

                            • Severe liver problems

                            alternatives

                            What are alternatives to Asenapine (Saphris)?

                            There are a number of medications that your doctor can prescribe in place of Asenapine (Saphris). Compare a few possible alternatives below.
                            Asenapine (Saphris)
                            Used for:
                            $77.00 Lowest GoodRx priceView Prices
                            Risperidone (Risperdal)
                            Used for:

                            • Schizophrenia - people ages 13 years and older

                            • Manic or mixed episodes associated with bipolar I disorder - people ages 10 years and older

                            • Irritability associated with autism - children ages 5 to 17 years old

                            $9.00 Lowest GoodRx priceView Prices
                            Aripiprazole (Abilify)
                            Used for:
                            $9.90 Lowest GoodRx priceView Prices
                            images

                            Asenapine (Saphris) images

                            White Round B And 4 - Asenapine 10mg Sublingual Tablet (Black Cherry)
                            This medicine is White, Round Carton Imprinted With "B" And "4".White Round B And 4 - Asenapine 10mg Sublingual Tablet (Black Cherry)
                            White Round 465 - Asenapine 10mg Sublingual Tablet
                            This medicine is White, Round Carton Imprinted With "465".White Round 465 - Asenapine 10mg Sublingual Tablet

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                            References

                            Best studies we found

                            Allergan, Inc. (2024). Saphris- asenapine maleate tablet [package insert]. DailyMed.

                            Gonzalez, J. M., et al. (2011). Review of the safety, efficacy, and side effect profile of asenapine in the treatment of bipolar 1 disorder. Patient Preference and Adherence.

                            Keks, N., et al. (2019). Stopping and switching antipsychotic drugs. Australian Prescriber.

                            View All References (3)

                            MedlinePlus. (2023). Phenylketonuria.

                            Vieta, E., et al. (2018). A review of asenapine in the treatment of bipolar disorder. Clinical Drug Investigation.

                            You and Your Hormones. (2023). Prolactin.

                            GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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