Risperdal vs. Saphris for Bipolar Disorder and Schizophrenia: Important Differences and Potential Risks.

Key takeaways

Risperidone (Risperdal) and asenapine (Saphris) are both atypical antipsychotics used to treat schizophrenia and bipolar disorder, but they have some key differences. Risperidone is available in generic form and can be taken as a pill, dissolvable tablet, or liquid, while asenapine is only available as a dissolvable tablet that you place under your tongue. Risperidone is typically taken once or twice daily, whereas asenapine needs to be taken twice daily. Risperidone can be used for irritability associated with autism in children, but asenapine is not approved for this use. Asenapine tends to be more expensive and is not suitable for people with severe liver problems. Both medications can cause weight gain and sleepiness, but risperidone has a higher risk of movement problems and changes in sleep patterns. Additionally, both medications can interact with many different medications.

Risperidone

(Risperdal)

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Asenapine

(Saphris)

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Summary for Risperdal

Prescription only

Risperidone (Risperdal) is an atypical antipsychotic that's used to improve mood, thoughts, and behaviors in people with schizophrenia, bipolar disorder, and autism. It's taken by mouth, typically once or twice daily. Common side effects of risperidone (Risperdal) include sleepiness, movement problems, and weight gain. Risperidone (Risperdal) can interact with some medications, such as certain antidepressants or blood pressure medications. Taking these medications together can make certain side effects worse.

Indications for Risperdal

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

Pros and Cons for Risperdal

Pros

Taken by mouth
Available as a pill, dissolving tablet, and liquid
Can be used in both adults and children
Available as a lower-cost generic

Cons

Higher risk of sexual problems, compared to other atypical antipsychotics
Can cause weight gain
Can cause changes to sleep or movement problems
Shouldn't be mixed with alcohol

Common Side Effects for Risperdal

Adults:

Muscle stiffness, muscle tightening, difficulty with movement (25%)
Extreme sleepiness (11%)
Restlessness, trouble remaining still (9%)
Tremor (6%)
Dizziness (6%)
Nausea (5%)
Repetitive movements, abnormal postures (5%)

Children:

Extreme sleepiness (up to 56%)
Dizziness (up to 16%)
Nausea or vomiting (up to 16%)
Stomach pain (up to 16%)
Muscle stiffness, muscle tightening, difficulty with movement (up to 12%)
Heartburn (up to 10%)
Sore throat (up to 10%)

Warnings for Risperdal

Higher risk of death in older adults with dementia-related psychosis
Neuroleptic malignant syndrome
Difficulty controlling muscle movements (tardive dyskinesia)
Weight gain, higher blood sugar, and higher cholesterol levels
High prolactin levels
Changes in blood pressure and higher risk of falls
Risk of infection (from low white blood cell count)
Difficulty concentrating and extreme sleepiness
Seizures
Prolonged and painful erection
Caution use in people with phenylketonuria (PKU) - orally disintegrating tablets only

Summary for Saphris

Prescription only

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.

Indications for Saphris

Schizophrenia in adults
Bipolar I disorder in adults and children ages 10 years and older

Pros and Cons for Saphris

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)

Cons

Can cause drowsiness or trouble sleeping
Taken twice a day
Can't be taken by people who have severe liver problems

Common Side Effects for Saphris

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.