
HALF-LIFE: 24 hours
STARTING DOSE: 2.5mg-5mg sublingual (SL) BID
TARGET DOSING RANGE: 2.5mg-10mg SL BID
BEST TIME TO DOSE: Any
HOW TO DOSE:
>> Initial 2.5mg-5mg SL BID and increase as needed up to 10mg SL BID
PREGNANCY: Minimal data on safety
BREASTFEEDING: Minimal data on safety
FDA INDICATIONS:
1) Schizophrenia
2) Bipolar Disorder (acute manic/mixed episodes), 10yo and older
Additional Information
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Asenapine is structurally very similar to Mirtazapine
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Sublingual (low bioavailability due to 1st pass metabolism)
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Oral Cavity surface area limits size of dose and extent of absorption
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Rapidly absorbed and has rapid peak drug levels
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Completely dissolves within 5-10 seconds after contact with sublingual mucosa
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Oral hypoesthesia (numbness/tingling) is common
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No eating or drinking for 10 minutes following administration
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Sedation is common due to antihistamine effects
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Akathisia may be dose related
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Low-moderate risk for extrapyramidal symptoms (movement disorders), Weight gain, and Prolactin elevation
References
- Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
- Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
- Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
- J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
- Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
- Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
- Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
- Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
- Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.