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Secuado

asenapine
Used for Schizophrenia
Used for Schizophrenia

Secuado (asenapine) is a patch that's applied on the skin. It's used for treating adults with schizophrenia. This medication is an atypical antipsychotic that helps balance thoughts, mood, and behaviors. The patches come in 3 different strengths. The typical dose is to apply 1 patch onto the skin once a day. Your wear the patch for 24 hours before replacing it with a new one. Common side effects include skin irritation(s) and uncontrollable muscle movements. Secuado (asenapine) is a brand-name medication; it doesn't have a generic version yet.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Allison Gourley, PharmD
Last reviewed on February 6, 2025
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsAlternativesReferencesPricesMedicare
basics-icon

What is Secuado (asenapine)?

What is Secuado (asenapine) used for?

How Secuado (asenapine) works

Secuado (asenapine) is an atypical antipsychotic. It affects the activity of dopamine and serotonin in the brain. This helps regulate thoughts, mood, and behaviors in people with schizophrenia.

Are you looking for information on asenapine sublingual tablet (Saphris) instead?
When does Secuado (asenapine) start working?
Time passed since treatment started:
HOURS
DAYS
WEEKS
MONTHS
Full effect

Drug Facts

Common BrandsSecuado
Drug ClassAtypical antipsychotic
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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Avg retail price
$1672.46(save 20.83%)
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$1324.13
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What are the side effects of Secuado (asenapine)?

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

  • Reaction at the application site (e.g., itchy, redness, irritation, pain; 14-15%)
  • Uncontrollable muscle movements (8-13%)
  • Headache (9%)
  • Weight gain (4-6%)

Other Side Effects

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Neuroleptic malignant syndrome: high fever, sweating, confusion, stiffness, changing blood pressure
  • Uncontrolled muscle movements (tardive dyskinesia): involuntarily sticking out your tongue, puffing out your cheeks, puckering your mouth, lip smacking, chewing, or foot tapping
  • Serious allergic reaction: hives, swelling in the face or throat, trouble breathing

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
  • High blood sugar (hyperglycemia)—increased thirst or amount of urine, unusual weakness or fatigue, blurry vision
  • High fever, stiff muscles, increased sweating, fast or irregular heartbeat, and confusion, which may be signs of neuroleptic malignant syndrome
  • High prolactin level—unexpected breast tissue growth, discharge from the nipple, change in sex drive or performance, irregular menstrual cycle
  • Infection—fever, chills, cough, or sore throat
  • Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
  • Pain or trouble swallowing
  • Seizures
  • Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
  • Uncontrolled and repetitive body movements, muscle stiffness or spasms, tremors or shaking, loss of balance or coordination, restlessness, shuffling walk, which may be signs of extrapyramidal symptoms (EPS)

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

  • Drowsiness
  • Headache
  • Irritation at application site
  • Weight gain
pros-and-cons

Pros and cons of Secuado (asenapine)

thumbs-up

Pros

An easy-to-use patch that's placed on the skin

Applied once each day

Good option for people who don't want to take medications by mouth or through injections

thumbs-down

Cons

Can cause skin irritation, like redness, itchiness, and discomfort

Not a good option for people with severe liver problems

Not approved for children younger than 18 years of age

pharmacist-tips

Pharmacist tips for Secuado (asenapine)

pharmacist

  • Don't open the pouch that contains the Secuado (asenapine) patch until you're ready to place it on the skin. Don't use the patch if it's cut or damaged or if the seal on the pouch is broken. Also never cut the patch to make it smaller for any reason because it can affect how the medication works for you.

    • Apply only one Secuado (asenapine) patch every 24 hours. Don't wear the patch longer than 24 hours because it can cause more skin irritation and it might not be safe. Be sure to remove the used patch before you put on a new one.

      • Place the Secuado (asenapine) patch on an area of clean, dry skin on either the hip, belly area, upper arm, or upper back area. Change where you apply each new patch. It'll help lower the risk for skin irritation around the patch and under the patch.

        • Don't apply the patch on damaged, injured, cut, or burned skin and avoid areas with rashes, redness, and other skin problems. Avoid areas of skin that have oils, lotions, or powders on it. Make sure the area isn't very hairy; use scissors to clip the hair as close to the skin as possible instead of shaving to prevent skin damage.

          • Don't put the Secuado (asenapine) patch onto areas of skin where you wear tight clothing, like waistbands, bras, or tank top straps. Tight clothing can irritate the skin where you've placed the patch.

            • Skin irritation, such as redness, itching, bumpy skin, discomfort, pain, and swelling, are common side effects of Secuado (asenapine). If your skin starts to feel irritated while you're wearing the patch, take off that patch. Then, put on a new patch to a different spot. Let your prescriber know if you continue to have skin irritation.

              • Secuado (asenapine) can make it harder for your body to cool down. Drink enough water to stay hydrated during and after exercise. Don't stay in the sun for too long to avoid overheating.

                • Avoid getting the Secuado (asenapine) patch hot after it's placed on the skin. This can include heat from hair dryers, heating pads, electric blankets, or heated water beds. It can make more medication get absorbed into the body faster, which can cause more side effects.

                  • You can shower while you wear a Secuado (asenapine) patch. But avoid bathing or swimming because these activities might cause the patch to fall off.

                    • If the edges of the Secuado (asenapine) patch lift off your skin, smooth them down with your fingers and press the patch down with your palm to help it stick better.

                      • If the Secuado (asenapine) patch falls off completely, don't use the same patch again. Apply a new patch on a different area of skin. Then, change the patch when you typically do.

                        • If the Secuado (asenapine) patch is hard to remove, you can loosen up the edges with oil-based products, such as olive oil or petroleum jelly.

                          • Fold used Secuado (asenapine) patches in half with the sticky sides together before you throw them away in a trash bin. This prevents children and animals from accidentally getting exposed to the medication on the patch. Call 911 or the Poison Control Center at 1-800-222-1222 right away if you think a child or pet has accidentally chewed or eaten a Secuado (asenapine) patch.

                            faqs

                            Frequently asked questions about Secuado (asenapine)

                            Does Secuado (asenapine) cause weight gain?
                            Yes, weight gain is a side effect of many antipsychotics, including Secuado (asenapine). Studies showed that 14% to 18% of people gained 7% or more of their body weight after using this medication for 6 weeks. Talk to your prescriber if you're worried about weight gain or if you've noticed that you gained a lot of weight with Secuado (asenapine). Sometimes, switching to a different medication can help.
                            Is Secuado (asenapine) a controlled substance?
                            No, Secuado (asenapine) isn't a controlled substance. It isn't known to have a risk for addiction or problems with misuse.
                            When was Secuado (asenapine) approved?
                            Secuado (asenapine) was FDA approved in October 2019. It was approved as the first patch that's applied onto the skin for treating adults with schizophrenia.
                            Can Secuado (asenapine) cause a rash?
                            Yes, it's possible for Secuado (asenapine) to cause a rash. It's more common to see a rash where you applied the patch. But a rash can also appear in other places on your body. Tell your prescriber if you continue to get a rash where you place the patches or if the rash is severe. You might be allergic to the medication.
                            Does Secuado (asenapine) make you sleepy?
                            One of the possible side effects of Secuado (asenapine) is sleepiness. But it doesn't seem like it happens very commonly. In studies, up to 4% of people who took Secuado (asenapine) reported sleepiness as a side effect. Be care driving or performing activities that require you to be alert. Be sure you know how Secuado (asenapine) affects your ability to think clearly, make sound decisions, and coordinate movement.
                            What's the difference between Saphris and Secuado?
                            Saphris and Secuado contain the same active ingredient, asenapine. But they're taken in different ways. Secuado is a patch that you place on the skin once a day, whereas Saphris is a tablet that you dissolve under the tongue twice a day. Another difference is what they're approved to treat. Saphris and Secuado both treat adults with schizophrenia. But Saphris is also approved to treat bipolar 1 disorder in adults and certain children. Talk to your prescriber about more differences between Saphris and Secuado.
                            How long does it take for Secuado (asenapine) to work?
                            Studies showed that some people can start to have symptom improvement after 3 weeks of taking Secuado (asenapine). It can take 6 weeks or more of treatment to see the biggest improvement in symptoms from the medication. Make sure you check in with your prescriber about your schizophrenia and how well Secuado (asenapine) seems to be working for you.
                            Is Secuado (asenapine) safe to use during pregnancy?
                            Speak with your prescriber or obstetrician-gynecologist (OB-GYN) about the risks and benefits of taking Secuado (asenapine) if you're pregnant. There isn't enough information to know whether Secuado (asenapine) is safe to use during pregnancy. In general, taking antipsychotic medications during the third trimester can raise the risk for movement problems and withdrawal symptoms in the newborn baby. And if you're pregnant and you're taking Secuado (asenapine), you're encouraged to enroll in the National Pregnancy Registry for Psychiatric Medications. It keeps track of how safe certain medications are when taken during pregnancy.
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                            warings-icon

                            What are the risks and warnings for Secuado (asenapine)?

                            Secuado (asenapine) 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-related psychosis

                            Older adults with dementia sometimes have some symptoms of schizophrenia, like hallucinations and delusions. This is called dementia-related psychosis. Studies showed that people 65 years and older with dementia-related psychosis have a higher risk of death and stroke if they take antipyschotic medications like Secuado (asenapine). Most of the time, the causes of death were related to heart problems or infections.

                            Because of this risk, Secuado (asenapine) isn't approved for treating people with dementia-related psychosis. Tell your prescriber if you have dementia before you start this medication. Caregivers should tell the prescriber that the person they're caring for has dementia.

                            risk-warning

                            Neuroleptic malignant syndrome

                            Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening condition that's been linked to treatment with antipsychotic medications like Secuado (asenapine). Get medical help right away if you have a high fever, feel confused, have a fast heart rate, or your whole body feels stiff. These could be signs and symptoms of NMS. Your prescriber will probably recommend a different medication for you.

                            risk-warning

                            Difficulty controlling muscle movements (tardive dyskinesia)

                            • Risk factors: Older adults | Female and 65 years or older | Higher-than-recommended doses of Secuado (asenapine) | Taking Secuado (asenapine) for a long time

                              Secuado (asenapine) can cause tardive dyskinesia (TD), or uncontrolled muscle movements in the tongue, face, mouth, neck, hands, arms, legs, and feet. It can look like lip smacking, grimacing, and unusual eye blinking. Sometimes, this side effect can become permanent, even after you stop taking the medication. This is more likely with long-term treatment.

                              To lower your risk of TD, you'll get prescribed the lowest dose of Secuado (asenapine) possible that's needed to treat your symptoms. Your prescriber will check in with you regularly to see whether you still need to take the medication. Talk to your prescriber right away if you experience symptoms of TD.

                              risk-warning

                              High blood sugar, high cholesterol, and weight gain

                              • Risk factors: History of diabetes | History of high cholesterol | People who are considered obese

                                Secuado (asenapine) can raise your blood sugar, sometimes to dangerous levels that can lead to serious complications or death. Your prescriber might check your blood sugar periodically during treatment. Let your prescriber know if you have symptoms of high blood sugar, such as feeling very thirsty, urinating more often, weakness, dry mouth, or fruity-smelling breath.

                                Secuado (asenapine) can also cause high cholesterol levels and weight gain. Your prescriber will check your cholesterol levels through blood testing throughout treatment. They'll also check in with you about your weight for any concerning changes.

                                It's important for your prescriber to check for changes in blood sugar levels, cholesterol levels, and weight. This is because high blood sugar levels, high cholesterol levels, and a large body size are risk factors for heart disease, stroke, and other serious health issues. Talk to your care team if you have concerns about taking Secuado (asenapine).

                                risk-warning

                                Serious allergic reactions

                                It's possible to have a serious allergic reaction to Secuado (asenapine). It can happen at any time, sometimes after the first time someone has put on the patch. Get medical help right away if you have a rash, fast heartbeat, swelling in the face or tongue, trouble breathing, wheezing, or anaphylaxis.

                                risk-warning

                                Low blood pressure (leading to risk for falls)

                                Secuado (asenapine) can make you sleepy, which can put you at risk for falls and other accidental injuries. Antipsychotic medications can also sometimes cause your blood pressure to drop when you stand up. This can make you feel dizzy or lightheaded and put you at risk for falls. Be very careful when you're getting up after sitting or lying down during the first few days you're taking Secuado (asenapine) and after any changes in dose. Stand up slowly and hold onto something stable to prevent dizziness and lower the risk for falls.

                                risk-warning

                                Low white blood cell count (leading to risk for infections)

                                • Risk factors: History of low white blood cell count | Taking other medications that lower white blood cell counts

                                  Secuado (asenapine) can lower the amount of white blood cells in your body. White blood cells help your body fight off infections. So when your white blood cell count is low, you're at risk for infection.

                                  Your prescriber might order blood tests to check your white blood cell count during the first few months of treatment. Let your prescriber know right away if you have a fever or if you notice that you're getting sick more easily while you're taking Secuado (asenapine).

                                  risk-warning

                                  Possible changes in heart rhythm

                                  • Risk factors: History of abnormal heart rhythm (arrhthymia) | Slow heart rate | Low potassium levels | Low magnesium levels | Taking other medications that can change heart rhythm

                                    It isn't clear whether Secuado (asenapine) can cause changes in heart rhythm. But this effect has happened to some people who took the sublingual tablet form of asenapine.

                                    To be safe, let your prescriber know if you have an irregular heart rhythm (arryhthmia). Also tell your pharmacist and care team about all the medications you take. It's best to avoid other medications that can cause changes in your heart rhythm while you're taking Secuado (asenapine). They can include amiodarone (Pacerone), antibiotics like ciprofloxacin (Cipro), other antipsychotics, and certain antidepressants. Your prescriber might recommend certain changes to your treatment plan to minimize your risk for abnormal heart rhythm.

                                    risk-warning

                                    Possible high prolactin levels

                                    Medications like asenapine can raise the levels of a hormone called prolactin in the body. The prolactin levels can stay high with long-term treatment. People who took Secuado (asenapine) didn't report having symptoms of high prolactin levels during clinical studies. But be aware of symptoms like changes in menstrual bleeding patterns, sexual problems, enlarge breasts in males, and milky discharge from the breast in females. Talk with your healthcare team if you're concerned about higher prolactin levels.

                                    risk-warning

                                    Use with caution in people who have seizures

                                    • Risk factors: History of seizures | Age 65 years or older | Health conditions that make it easier to have seizures

                                      Before you start Secuado (asenapine), let your prescriber know about the medical conditions you have. Tell them if you have a history of seizures. People who took this medication didn't report having a seizure during clinical studies. But a very small number of people who took the sublingual tablet form of asenapine did. To be safe, people who have a history of seizures or a medical condition that makes it more likely for them to have seizure should take Secuado (asenapine) with caution. Talk to your prescriber if you have concerns.

                                      dosage

                                      Secuado (asenapine) dosage forms

                                      The average cost for 1 package of 30 transdermal systems of 7.6mg/24 hours of Secuado (asenapine) is $1343.15 with a free GoodRx coupon. This is 19.69% off the average retail price of $1672.46.
                                      package
                                      Package
                                      DosageQuantityPrice as low asPrice per unit
                                      30 transdermal systems of 3.8mg/24 hours1 package$1341.82$1341.82
                                      30 transdermal systems of 5.7mg/24 hours1 package$1324.13$1324.13
                                      30 transdermal systems of 7.6mg/24 hours1 package$1343.15$1343.15

                                      Typical dosing for Secuado (asenapine)

                                      Secuado (asenapine) patch can be applied to either the hip, belly area, upper arm, or upper back area.

                                      The typical starting dose is to apply one Secuado (asenapine) 3.8 mg/24 hours patch on the skin each day.

                                      Your prescriber might raise the patch strength depending on your symptoms.

                                      The maximum dose is one Secuado (asenapine) 7.6 mg/24 hours patch each day.

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                                      How much does Secuado (asenapine) cost?

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                                      Secuado (brand)
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                                      contraindications-icon

                                      Secuado (asenapine) 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 Secuado (asenapine) will not be safe for you to take.
                                      alternatives

                                      What are alternatives to Secuado (asenapine)?

                                      There are a number of medications that your doctor can prescribe in place of Secuado (asenapine). Compare a few possible alternatives below.
                                      Secuado (asenapine)
                                      Used for:
                                      $1324.13 Lowest GoodRx priceView Prices
                                      Asenapine (Saphris)
                                      Used for:
                                      $115.94 Lowest GoodRx priceView Prices
                                      Aripiprazole (Abilify)
                                      Used for:
                                      $9.90 Lowest GoodRx priceView Prices

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                                      References

                                      Best studies we found

                                      Betcher, H. K., et al. (2019). Use of antipsychotic drugs during pregnancy. Current Treatment Options in Psychiatry.

                                      Dimaraki, E., et al. (2022). Hyperprolactinemia. Endocrine Society.

                                      Meyer, R., et al. (2022). Onset of action of selected second-generation antipsychotics (pines)-A systematic review and meta-analyses. Biomedicines.

                                      View All References (3)

                                      Noven Pharmaceuticals, Inc. (2019). U.S. FDA approves Secuado® (asenapine) transdermal system, the first-and-only transdermal patch for the treatment of adults with schizophrenia. 

                                      Noven Therapeutics, LLC. (2025). Secuado- asenapine film, extended release [package insert]. DailyMed.

                                      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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