asenapine transdermal (Rx)

Brand and Other Names:Secuado
  • Print

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

transdermal system

3.8mg/24hr

5.7mg/24hr

7.6mg/24hr

Schizophrenia

Atypical antipsychotic indicated for adults with schizophrenia

Apply 3.8 mg/24 hr patch initially; may increase dosage to 5.7 mg/24 hr or 7.6 mg/24 hr after 1 week

Dosage Modifications

Renal impairment

  • Mild-to-severe (GFR 15-90 mL/min): No dosage adjustment necessary
  • Patients on dialysis: Not studied
  • Effect of renal function on the excretion of other metabolites has not been studied

Hepatic impairment

  • Mild-to-moderate (Child-Pugh A or B): No dosage adjustment necessary
  • Severe (Child-Pugh C): Contraindicated

Dosing Considerations

In a short-term, placebo-controlled trial, no suggestion of added benefit was found at a dosage of 7.6 mg/24 hr; there was an increase in certain adverse reactions

Safety of doses >7.6 mg/24 hr has not been evaluated in clinical studies

Based on AUC of asenapine, asenapine transdermal 3.8 mg/24 hr corresponds to 5 mg PO BID of sublingual (SL) asenapine and asenapine transdermal 7.6 mg/24 hr corresponds to 10 mg PO BID of SL asenapine

Safety and efficacy not established

Schizophrenia

Based on a pharmacokinetic study in elderly patients with asenapine SL, dosage adjustments are not recommended based on age alone

Exposure in elderly patients is 30-40% higher as compared with adults

Not indicated for dementia-related psychosis

May increase risk of mortality in elderly patients with dementia-related psychosis

Next:

Interactions

Interaction Checker

and asenapine transdermal

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (2)

            • dronedarone

              asenapine transdermal and dronedarone both increase QTc interval. Contraindicated.

            • thioridazine

              asenapine transdermal and thioridazine both increase QTc interval. Contraindicated.

            Serious - Use Alternative (120)

            • alfuzosin

              asenapine transdermal and alfuzosin both increase QTc interval. Avoid or Use Alternate Drug.

            • amiodarone

              asenapine transdermal and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.

            • amisulpride

              asenapine transdermal and amisulpride both increase QTc interval. Avoid or Use Alternate Drug.

            • anagrelide

              asenapine transdermal and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.

            • apomorphine

              asenapine transdermal and apomorphine both increase QTc interval. Avoid or Use Alternate Drug.

            • aripiprazole

              asenapine transdermal and aripiprazole both increase QTc interval. Avoid or Use Alternate Drug.

            • arsenic trioxide

              asenapine transdermal and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              asenapine transdermal and artemether both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether/lumefantrine

              asenapine transdermal and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

            • atomoxetine

              asenapine transdermal and atomoxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine

              asenapine transdermal and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

            • ceritinib

              asenapine transdermal and ceritinib both increase QTc interval. Avoid or Use Alternate Drug.

            • chlorpromazine

              asenapine transdermal and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.

            • clarithromycin

              asenapine transdermal and clarithromycin both increase QTc interval. Avoid or Use Alternate Drug.

            • clozapine

              asenapine transdermal and clozapine both increase QTc interval. Avoid or Use Alternate Drug.

            • dasatinib

              asenapine transdermal and dasatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • degarelix

              asenapine transdermal and degarelix both increase QTc interval. Avoid or Use Alternate Drug.

            • desflurane

              asenapine transdermal and desflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • disopyramide

              asenapine transdermal and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.

            • dofetilide

              asenapine transdermal and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.

            • dolasetron

              asenapine transdermal and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • donepezil

              asenapine transdermal and donepezil both increase QTc interval. Avoid or Use Alternate Drug.

            • droperidol

              asenapine transdermal and droperidol both increase QTc interval. Avoid or Use Alternate Drug.

            • efavirenz

              asenapine transdermal and efavirenz both increase QTc interval. Avoid or Use Alternate Drug.

            • eliglustat

              asenapine transdermal and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.

            • encorafenib

              asenapine transdermal and encorafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              asenapine transdermal and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • eribulin

              asenapine transdermal and eribulin both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin base

              asenapine transdermal and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin ethylsuccinate

              asenapine transdermal and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin lactobionate

              asenapine transdermal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

            • erythromycin stearate

              asenapine transdermal and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.

            • escitalopram

              asenapine transdermal and escitalopram both increase QTc interval. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole and asenapine transdermal both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.

            • fingolimod

              asenapine transdermal and fingolimod both increase QTc interval. Avoid or Use Alternate Drug.

            • flecainide

              asenapine transdermal and flecainide both increase QTc interval. Avoid or Use Alternate Drug.

            • fluconazole

              asenapine transdermal and fluconazole both increase QTc interval. Contraindicated.

            • fluvoxamine

              asenapine transdermal and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.

            • foscarnet

              asenapine transdermal and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.

            • gemifloxacin

              asenapine transdermal and gemifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • gilteritinib

              asenapine transdermal and gilteritinib both increase QTc interval. Avoid or Use Alternate Drug.

            • glasdegib

              asenapine transdermal and glasdegib both increase QTc interval. Avoid or Use Alternate Drug.

            • goserelin

              asenapine transdermal and goserelin both increase QTc interval. Avoid or Use Alternate Drug.

            • granisetron

              asenapine transdermal and granisetron both increase QTc interval. Avoid or Use Alternate Drug.

            • histrelin

              asenapine transdermal and histrelin both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxychloroquine sulfate

              asenapine transdermal and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.

            • hydroxyzine

              asenapine transdermal and hydroxyzine both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              asenapine transdermal and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • iloperidone

              asenapine transdermal and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              asenapine transdermal and inotuzumab both increase QTc interval. Avoid or Use Alternate Drug.

            • isoflurane

              asenapine transdermal and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • itraconazole

              asenapine transdermal and itraconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • ivosidenib

              asenapine transdermal and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.

            • lapatinib

              asenapine transdermal and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.

            • lefamulin

              asenapine transdermal and lefamulin both increase QTc interval. Avoid or Use Alternate Drug.

            • leuprolide

              asenapine transdermal and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.

            • levodopa inhaled

              asenapine transdermal decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .

            • levofloxacin

              asenapine transdermal and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • lithium

              asenapine transdermal and lithium both increase QTc interval. Avoid or Use Alternate Drug.

            • loperamide

              asenapine transdermal and loperamide both increase QTc interval. Avoid or Use Alternate Drug.

            • lopinavir

              asenapine transdermal and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              asenapine transdermal and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.

            • maprotiline

              asenapine transdermal and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.

            • mefloquine

              asenapine transdermal and mefloquine both increase QTc interval. Avoid or Use Alternate Drug.

            • methadone

              asenapine transdermal and methadone both increase QTc interval. Avoid or Use Alternate Drug.

            • metoclopramide intranasal

              asenapine transdermal increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.

            • midostaurin

              asenapine transdermal and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

            • mifepristone

              asenapine transdermal and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.

            • mirtazapine

              asenapine transdermal and mirtazapine both increase QTc interval. Avoid or Use Alternate Drug.

            • mobocertinib

              mobocertinib and asenapine transdermal both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • moxifloxacin

              asenapine transdermal and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • nilotinib

              asenapine transdermal and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.

            • octreotide

              asenapine transdermal and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

            • ofloxacin

              asenapine transdermal and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.

            • ondansetron

              asenapine transdermal and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • oxaliplatin

              asenapine transdermal and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.

            • paliperidone

              asenapine transdermal and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • panobinostat

              asenapine transdermal and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

            • paroxetine

              asenapine transdermal and paroxetine both increase QTc interval. Avoid or Use Alternate Drug.

            • pazopanib

              asenapine transdermal and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.

            • pentamidine

              asenapine transdermal and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • pimavanserin

              asenapine transdermal and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

            • pimozide

              asenapine transdermal and pimozide both increase QTc interval. Contraindicated.

            • pitolisant

              asenapine transdermal and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • ponesimod

              asenapine transdermal and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

            • posaconazole

              asenapine transdermal and posaconazole both increase QTc interval. Contraindicated.

            • primaquine

              asenapine transdermal and primaquine both increase QTc interval. Avoid or Use Alternate Drug.

            • procainamide

              asenapine transdermal and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • promethazine

              asenapine transdermal and promethazine both decrease QTc interval. Avoid or Use Alternate Drug.

            • propafenone

              asenapine transdermal and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

            • quinidine

              asenapine transdermal and quinidine both increase QTc interval. Avoid or Use Alternate Drug.

            • quinine

              asenapine transdermal and quinine both increase QTc interval. Avoid or Use Alternate Drug.

            • ranolazine

              asenapine transdermal and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.

            • ribociclib

              asenapine transdermal and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.

            • risperidone

              asenapine transdermal and risperidone both increase QTc interval. Avoid or Use Alternate Drug.

            • romidepsin

              asenapine transdermal and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

            • saquinavir

              asenapine transdermal and saquinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • selinexor

              selinexor, asenapine transdermal. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sertraline

              asenapine transdermal and sertraline both increase QTc interval. Avoid or Use Alternate Drug.

            • sevoflurane

              asenapine transdermal and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • siponimod

              asenapine transdermal and siponimod both increase QTc interval. Avoid or Use Alternate Drug.

            • solifenacin

              asenapine transdermal and solifenacin both increase QTc interval. Avoid or Use Alternate Drug.

            • sotalol

              asenapine transdermal and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • sunitinib

              asenapine transdermal and sunitinib both increase QTc interval. Avoid or Use Alternate Drug.

            • tacrolimus

              asenapine transdermal and tacrolimus both increase QTc interval. Avoid or Use Alternate Drug.

            • telavancin

              asenapine transdermal and telavancin both increase QTc interval. Avoid or Use Alternate Drug.

            • tetrabenazine

              asenapine transdermal and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • thiothixene

              asenapine transdermal and thiothixene both increase QTc interval. Avoid or Use Alternate Drug.

            • toremifene

              asenapine transdermal and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

            • trazodone

              asenapine transdermal and trazodone both increase QTc interval. Avoid or Use Alternate Drug.

            • triptorelin

              asenapine transdermal and triptorelin both increase QTc interval. Avoid or Use Alternate Drug.

            • umeclidinium bromide/vilanterol inhaled

              asenapine transdermal and umeclidinium bromide/vilanterol inhaled both decrease QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated

            • vandetanib

              asenapine transdermal and vandetanib both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended

            • vardenafil

              asenapine transdermal and vardenafil both increase QTc interval. Avoid or Use Alternate Drug.

            • vemurafenib

              asenapine transdermal and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • venlafaxine

              asenapine transdermal and venlafaxine both decrease QTc interval. Avoid or Use Alternate Drug.

            • vilanterol/fluticasone furoate inhaled

              asenapine transdermal and vilanterol/fluticasone furoate inhaled both increase QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated

            • voriconazole

              asenapine transdermal and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.

            • vorinostat

              asenapine transdermal and vorinostat both increase QTc interval. Avoid or Use Alternate Drug.

            • ziprasidone

              asenapine transdermal and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

            Monitor Closely (55)

            • albuterol

              asenapine transdermal and albuterol both increase QTc interval. Use Caution/Monitor.

            • amitriptyline

              asenapine transdermal and amitriptyline both increase QTc interval. Use Caution/Monitor.

            • amoxapine

              asenapine transdermal and amoxapine both increase QTc interval. Use Caution/Monitor.

            • arformoterol

              asenapine transdermal and arformoterol both increase QTc interval. Use Caution/Monitor.

            • azithromycin

              asenapine transdermal and azithromycin both increase QTc interval. Use Caution/Monitor.

            • bedaquiline

              asenapine transdermal and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • chloroquine

              asenapine transdermal and chloroquine both increase QTc interval. Use Caution/Monitor.

            • ciprofloxacin

              asenapine transdermal and ciprofloxacin both increase QTc interval. Use Caution/Monitor.

            • citalopram

              asenapine transdermal and citalopram both increase QTc interval. Use Caution/Monitor.

            • clomipramine

              asenapine transdermal and clomipramine both increase QTc interval. Use Caution/Monitor.

            • crizotinib

              asenapine transdermal and crizotinib both increase QTc interval. Use Caution/Monitor.

            • daridorexant

              asenapine transdermal and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • desipramine

              asenapine transdermal and desipramine both increase QTc interval. Use Caution/Monitor.

            • deutetrabenazine

              asenapine transdermal and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.

            • difelikefalin

              difelikefalin and asenapine transdermal both increase sedation. Use Caution/Monitor.

            • doxepin

              asenapine transdermal and doxepin both increase QTc interval. Use Caution/Monitor.

            • ezogabine

              asenapine transdermal and ezogabine both increase QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed, particularly when dose titrated to 1200mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fenfluramine

              asenapine transdermal decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • fluoxetine

              asenapine transdermal and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluphenazine

              asenapine transdermal and fluphenazine both increase QTc interval. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine will increase the level or effect of asenapine transdermal by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Dose reduction may be necessary

            • formoterol

              asenapine transdermal and formoterol both increase QTc interval. Use Caution/Monitor.

            • fostemsavir

              asenapine transdermal and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • ganaxolone

              asenapine transdermal and ganaxolone both increase sedation. Use Caution/Monitor.

            • gemtuzumab

              asenapine transdermal and gemtuzumab both increase QTc interval. Use Caution/Monitor.

            • haloperidol

              asenapine transdermal and haloperidol both increase QTc interval. Use Caution/Monitor.

            • imipramine

              asenapine transdermal and imipramine both increase QTc interval. Use Caution/Monitor.

            • indacaterol, inhaled

              asenapine transdermal and indacaterol, inhaled both increase QTc interval. Use Caution/Monitor.

            • indapamide

              asenapine transdermal and indapamide both increase QTc interval. Use Caution/Monitor.

            • isradipine

              asenapine transdermal and isradipine both increase QTc interval. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, asenapine transdermal. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, asenapine transdermal. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • lenvatinib

              asenapine transdermal and lenvatinib both increase QTc interval. Use Caution/Monitor.

            • lofexidine

              asenapine transdermal and lofexidine both increase QTc interval. Use Caution/Monitor.

            • nortriptyline

              asenapine transdermal and nortriptyline both increase QTc interval. Use Caution/Monitor.

            • olanzapine

              asenapine transdermal and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances

            • oliceridine

              oliceridine, asenapine transdermal. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • olodaterol inhaled

              asenapine transdermal and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • osilodrostat

              asenapine transdermal and osilodrostat both increase QTc interval. Use Caution/Monitor. Dose dependent QT prolongation - avoid drugs known to prolong the QT interval

            • osimertinib

              asenapine transdermal and osimertinib both increase QTc interval. Use Caution/Monitor.

            • ozanimod

              asenapine transdermal and ozanimod both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • pasireotide

              asenapine transdermal and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • perphenazine

              asenapine transdermal and perphenazine both increase QTc interval. Use Caution/Monitor.

            • prochlorperazine

              asenapine transdermal and prochlorperazine both decrease QTc interval. Use Caution/Monitor.

            • protriptyline

              asenapine transdermal and protriptyline both increase QTc interval. Use Caution/Monitor.

            • quetiapine

              asenapine transdermal and quetiapine both increase QTc interval. Use Caution/Monitor.

            • remimazolam

              remimazolam, asenapine transdermal. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • rilpivirine

              asenapine transdermal and rilpivirine both increase QTc interval. Use Caution/Monitor.

            • selpercatinib

              asenapine transdermal and selpercatinib both increase QTc interval. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases effects of asenapine transdermal by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases effects of asenapine transdermal by unknown mechanism. Use Caution/Monitor. Closely monitor for evidence of enhanced CNS depression when using higher dose of magnesium sulfate together with a CNS depressant.

            • sorafenib

              asenapine transdermal and sorafenib both increase QTc interval. Use Caution/Monitor.

            • triclabendazole

              asenapine transdermal and triclabendazole both increase QTc interval. Use Caution/Monitor.

            • trimipramine

              asenapine transdermal and trimipramine both increase QTc interval. Use Caution/Monitor.

            • voclosporin

              voclosporin, asenapine transdermal. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            Minor (0)

              Previous
              Next:

              Adverse Effects

              >10%

              Application site reactions (14-15%)

              Extrapyramidal symptoms (8-13%)

              1-10%

              Headache (9%)

              Increased weight (4-6%)

              Constipation (4-5%)

              Akathisia (4%)

              Somnolence (3-4%)

              Increased hepatic transaminases >3x ULN (1.6-3.1%)

              Dyspepsia (1-3%)

              Diarrhea (1-3%)

              Blood glucose increased (1-3%)

              Dystonia (1-3%)

              Nasopharyngitis (1-3%)

              Upper respiratory tract infection (1-3%)

              Creatine kinase elevations ≥3 x ULN at any time (1.6-2.1%)

              Hypertension (2%)

              Vomiting (<2%)

              Dry mouth (<2%)

              Asthenia (<2%)

              Myalgia (<2%)

              Increased prolactin levels (1.3%)

              <1%

              Anemia

              Temporary bundle-branch block

              Accommodation disorder

              Swollen tongue

              Hyponatremia

              Dysarthria

              Thrombocytopenia

              Postmarketing Reports

              Choking

              Previous
              Next:

              Warnings

              Increased mortality and dementia-related psychosis

              Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death

              Not approved for treatment of dementia-related psychosis

              Contraindications

              Severe hepatic impairment (Child-Pugh C)

              Hypersensitivity to asenapine or any components of the transdermal system

              Cautions

              Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; in placebo-controlled trials, patients, especially those taking atypical antipsychotic drugs, showed an increased risk of death in treated patients (1.6-1.7x) compared with placebo patients

              Neuroleptic malignant syndrome associated with use; monitor for symptoms; discontinue if suspected, and provide intensive symptomatic treatment and monitoring

              In placebo-controlled trials in elderly subjects with dementia, patients randomized to risperidone, aripiprazole, and olanzapine had a higher incidence of stroke and transient ischemic attack, including fatal stroke

              Not approved for treatment of dementia-related psychosis

              Atypical antipsychotic drugs, including asenapine transdermal, have caused metabolic changes, including hyperglycemia, diabetes mellitus, dyslipidemia, and body weight gain

              Hypersensitivity reactions have been observed

              Atypical antipsychotics cause orthostatic hypotension and syncope; risk is greatest during initial dose titration and when increasing the dose

              May cause somnolence, postural hypotension, motor instability, and sensory instability, which may lead to falls and, consequently, fractures or other injuries; complete fall risk assessments in patients with diseases, conditions, or medications that could exacerbate these effects, when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy

              Leukopenia, neutropenia, and agranulocytosis reported with use; perform a CBC count during first few months of therapy; in such patients, consider discontinuation of therapy at first sign of clinically significant decline in WBC count in absence of other causative factors

              Possible prolongation of QTc interval; avoid in patients with history of cardiac arrhythmias or other conditions that increase risk of torsades de pointes (eg, bradycardia, hypokalemia, hypomagnesemia)

              Can elevate prolactin levels, and elevation can persist during long-term administration; hyperprolactinemia may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotropin secretion; this, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients

              Use with caution in patients with a history of seizures or with conditions that potentially lower the seizure threshold; conditions that lower the seizure threshold may be more prevalent in patients ≥65 years

              Potential disruption of body temperature regulation

              Inherent suicide risk with population treated warrants close supervision when drug therapy is changed

              Dysphagia, esophageal dysmotility, and aspiration may occur

              Both the rate and extent of absorption are increased when heat is applied to application; avoid exposing patch to direct external heat sources (eg, hair dryers, heating pads, electric blankets, heated water beds)

              Local skin reactions, such as irritation, were reported

              Tardive dyskinesia

              • Tardive dyskinesia may develop in patients treated with antipsychotic drugs, including asenapine transdermal
              • Risk appears highest among elderly patients, especially elderly women, but it is not possible to predict which patients are likely to develop the syndrome
              • Reserve long-term antipsychotic treatment for patients who have a chronic illness that is responsive to antipsychotic drugs, or in patients in whom effective alternative therapies are not available or appropriate
              • In patients who do require long-term treatment, use lowest dose and shortest duration of treatment producing a satisfactory clinical response; periodically reassess if it needs to be continued
              • If signs and symptoms of tardive dyskinesia appear, consider discontinuing treatment

              Drug interaction overview

              • Asenapine is a CYP1A2 and UGT1A4 substrate; weak CYP2D6 inhibitor
              • Coadministration of asenapine with a CYP1A2 inhibitor increases AUC and plasma levels of asenapine; reduce dose based on clinical response, if necessary
              • Owing to its alpha1-adrenergic antagonism with potential for inducing hypotension, asenapine may enhance the effects of certain antihypertensive agents; monitor blood pressure and adjust dosage of antihypertensive drug accordingly
              • Coadministration with other drugs that prolong QTc interval may result in life-threatening arrhythmias (eg, class 1A antiarrhythmics [quinidine, procainamide], class 3 antiarrhythmics [amiodarone, sotalol], antipsychotics [ziprasidone, chlorpromazine, thioridazine], and antibiotics [moxifloxacin])
              • Asenapine may enhance inhibitory effects of paroxetine on its own metabolism by CYP2D6; concomitant use with paroxetine increases paroxetine AUC and plasma levels; reduce paroxetine dose by half when used in combination with asenapine
              Previous
              Next:

              Pregnancy & Lactation

              Pregnancy

              Studies have not been conducted in pregnant women

              No human data available informing the drug-associated risk

              Animal data

              • In a pre-and post-natal study in rats, IV administration of asenapine at doses up to 0.7 times the MRHD of 10 mg of sublingual asenapine twice daily produced increases in postimplantation loss and early pup deaths, and decreases in subsequent pup survival and weight gain
              • Doses were up to 1.1x the maximum recommended human dose (MRHD) of 12.8 mg transdermal asenapine daily.
              • Advise pregnant women of the potential risk to a fetus

              Pregnancy exposure registry

              Clinical considerations

              • Extrapyramidal and/or withdrawal symptoms, including agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorder have been reported in neonates who were exposed to antipsychotic drugs during the third trimester of pregnancy
              • Symptoms have varied in severity
              • Some neonates recovered within hours or days without specific treatment; others required prolonged hospitalization; monitor neonates for extrapyramidal and/or withdrawal symptoms and manage symptoms appropriately

              Lactation

              Studies have not been conducted to assess the presence of asenapine in human milk, the effects of asenapine on the breastfed infant, or the effects of asenapine on milk production

              Asenapine is excreted in rat milk

              Consider developmental and health benefits of breastfeeding along with the mother's clinical need for asenapine transdermal and any potential adverse effects on the breastfed infant from asenapine transdermal or from the underlying maternal condition

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

              Previous
              Next:

              Pharmacology

              Mechanism of Action

              Mechanism of action is unknown

              Efficacy thought to be mediated via combined antagonist activity at dopamine D2 and serotonin type 2 (5-HT2) receptors

              Absorption

              Peak plasma time: 12-24 hr

              Steady-state plasma concentrations are achieved in ~72 hr after the first application

              Application of a heating pad on asenapine transdermal patch for 8 hr led to a faster absorption rate (median peak plasma time ~8 hr) as compared with no heating pad

              Distribution

              Protein bound: 95% (including albumin and alpha1-acid glycoprotein)

              Vd: 20-25 L/kg

              Metabolism

              Direct glucuronidation by UGT1A4

              Oxidative metabolism predominantly by CYP1A2

              Elimination

              Half-life: 30 hr

              Excretion: Urine (~50%); feces (40%)

              Previous
              Next:

              Administration

              Transdermal Administration

              Transdermal use only

              Apply patch every 24 hr; do not wear longer than 24 hr

              Apply to clean, dry, and intact skin at the selected application sites: hip, abdomen, upper arm, or upper back area

              Wear only 1 patch at any time

              Apply to a different application site each time a new patch is applied

              Do not cut open the pouch until ready to apply; do not use if the individual pouch seal is broken or appears to be damaged

              Apply whole transdermal patch; do not cut

              If patch lifts at the edges, reattach by pressing firmly and smoothing down the edges of the patch

              If patch comes off completely, apply a new one

              After use, fold used patch so that the adhesive side sticks to itself and safely discard

              If irritation or a burning sensation occurs while wearing patch, remove and apply a new patch to a new application site

              Showering is permitted, but use during swimming or taking a bath has not been evaluated

              Do not apply external heat sources (eg, heating pad) over the patch

              Storage

              Store at room temperature 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

              Previous
              Next:

              Images

              No images available for this drug.
              Previous
              Next:

              Patient Handout

              A Patient Handout is not currently available for this monograph.
              Previous
              Next:

              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
              Additional Offers
              Email to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Email Forms to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Previous
              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.