Asenapine for the treatment of manic and mixed episodes associated with bipolar I disorder: from clinical research to clinical practice

Expert Opin Pharmacother. 2013 Mar;14(4):489-504. doi: 10.1517/14656566.2013.765859. Epub 2013 Jan 29.

Abstract

Introduction: Asenapine is a sublingually administered second-generation antipsychotic with proven efficacy for the treatment of moderate to severe manic episodes associated with bipolar I disorder in adults. Its relatively favorable weight and metabolic profile, as well as the lack of appreciable activity at muscarinic cholinergic receptors and the sublingual administration are of clinical interest.

Areas covered: This paper comprises a review and commentary regarding the use of sublingual asenapine in the treatment of acute manic and mixed episodes of bipolar disorder. Basic principles in dosing, switching, management of side effects and co-administration with other medications are provided.

Expert opinion: Asenapine displays quick and reliable effects on manic symptoms, very low risk of depressive switches, efficacy on depressive symptoms during manic and mixed episodes, usually good tolerability and continued longer-term efficacy on residual and subthreshold symptoms. The fast-dissolving sublingual route of administration may favor those who have difficulties in swallowing medications. Also, the sublingual administration reduces the risk of overdose when more than the prescribed tablets are swallowed. The relatively low metabolic risk and the lack of anticholinergic side effects contribute to making this medication a useful tool for the treatment of patients with bipolar disorder.

Publication types

  • Review

MeSH terms

  • Administration, Sublingual
  • Antipsychotic Agents / administration & dosage
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / pharmacokinetics
  • Antipsychotic Agents / therapeutic use*
  • Biological Availability
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / metabolism
  • Bipolar Disorder / psychology*
  • Clinical Trials as Topic
  • Dibenzocycloheptenes
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Heterocyclic Compounds, 4 or More Rings / administration & dosage
  • Heterocyclic Compounds, 4 or More Rings / adverse effects
  • Heterocyclic Compounds, 4 or More Rings / pharmacokinetics
  • Heterocyclic Compounds, 4 or More Rings / therapeutic use*
  • Humans
  • Metabolic Clearance Rate
  • Weight Gain / drug effects

Substances

  • Antipsychotic Agents
  • Dibenzocycloheptenes
  • Heterocyclic Compounds, 4 or More Rings
  • asenapine