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


METHODS
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.


CONCLUSIONS
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.
University of Siena, Departments of Mental Health and Molecular Medicine, Viale Bracci 1, Siena 53100, Italy. andreafagiolini@icloud.com
Andrea
A
Fagiolini
Rocco N
RN
Forgione
Benedetto
B
Morana
Mauro
M
Maccari
Arianna
A
Goracci
Letizia
L
Bossini
Francesca
F
Pellegrini
Alessandro
A
Cuomo
Francesco
F
Casamassima
D000286:Administration, Sublingual; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001682:Biological Availability; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology*; D002986:Clinical Trials as Topic; D003986:Dibenzocycloheptenes; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006576:Heterocyclic Compounds, 4 or More Rings / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D008657:Metabolic Clearance Rate; D015430:Weight Gain / Q000187:drug effects
D014150:Antipsychotic Agents; D003986:Dibenzocycloheptenes; D006576:Heterocyclic Compounds, 4 or More Rings; C522667:asenapine