What To Know About Saphris (Asenapine)

A Sublingual Medication Used to Treat Schizophrenia and Bipolar Disorder

Pill in hand

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Saphris (Asenapine) is a medication used to treat mental health disorders such as schizophrenia and bipolar disorder.

It belongs to a class of drugs known as atypical antipsychotics which help to treat conditions like schizophrenia and bipolar 1 disorder by balancing the chemical messengers in your brain. 

The exact mechanism of atypical antipsychotics is unclear. However, Saphris is believed to help alleviate positive and negative symptoms of schizophrenia, and symptoms of bipolar 1 disorder, by blocking dopamine receptors as well as certain serotonin receptors in the brain, affecting the regulation of these to control the regulation of these chemical messengers.

The hyperactivity and hypoactivity of dopamine in the brain have long been linked to psychotic disorders like schizophrenia.


Saphris is approved by the FDA for treating the following conditions: 

  • Schizophrenia: Saphris is used for both acute and maintenance treatment of schizophrenia symptoms. Research shows that it is effective in improving positive and negative symptoms of the condition.
  • Bipolar 1 disorder: Saphris is effective for treating manic episodes that occur in people who have bipolar 1 disorder. It is also used to prevent the recurrence of manic or mixed episodes.

Before Taking 

Before this medication is prescribed for you, you should disclose if you are taking any other medications, supplements, and vitamins to your doctor.

People who have a history of heart and liver diseases need to take this medication with added caution. If this applies to you, it’s important you disclose this to your doctor. 

Precautions and Contraindications 

While Saphris has been approved by the FDA to treat certain mental disorders, it is not approved for treating people who have dementia-related psychosis.

Research shows that older people with dementia-related psychosis who are treated with antipsychotic drugs like Saphris have an increased risk of dying. 

If you have a history of asenapine allergy, your doctor won’t prescribe Saphris to you.

Signs of an allergic reaction to asenapine include:

  • Difficulty breathing
  • Lightheadedness
  • Itching
  • Swelling of the face, tongue, or throat

As there are not a lot of studies on the safety of Saphris during pregnancy and breastfeeding, Saphris would only be used during pregnancy if the benefit clearly outweighs the potential risks.

Other Atypical Antipsychotics

Atypical antipsychotics are also known as second generation antipsychotic drugs. They work by blocking dopamine receptors in the brain. Unlike many first generation antipsychotics, they also bind to serotonin and other neurotransmitter receptors in the brain.

Some other common types of atypical antipsychotics include: 

  • Clozaril (clozapine): This is typically used to treat, treatment-resistant schizophrenia. 
  • Abilify (aripiprazole): This is used to treat bipolar disorder and schizophrenia. It may also be used in the treatment of major depressive disorder (MDD).
  • Invega (paliperidone): This is indicated to treat schizophrenia and schizoaffective disorder.
  • Zyprexa (olanzapine): This is used to treat mood disorders and schizophrenia.


Saphris is a prescription medication and dosage is typically recommended by your doctor.

Dosage is usually based on your medical condition, personal needs, tolerability to the drug, and other medication you might be taking. 

  • Schizophrenia: 5 milligrams of Saphris administered twice daily, is the typical recommended dosage when using this medication to treat schizophrenia. If there are no uncomfortable side effects, this dosage might be increased to 10 milligrams twice a day in certain cases.
  • Bipolar I disorder: 5 to 10 milligrams twice daily is typically prescribed for adults with this condition. 


Saphris has been approved by the FDA to treat Bipolar I disorder in children between the ages of 10 and 17.

They are typically started at a dosage of 2.5 milligrams twice daily, but this can be increased to as high as 20 milligrams daily depending on the child’s needs and response to treatment.

How to Take and Store

Saphris is a sublingual tablet, this means that it can be easily absorbed in your mouth. 

When taking this medication it’s important to put the whole pill under your tongue and let your saliva dissolve it.

Do not swallow it whole, break it up or chew it. Also, it's best to avoid eating or drinking anything for up to 10 minutes after taking this medication.

You should store the medication in a cool dry place away from children and pets. You should use dry hands when taking this medication. 

Side Effects

Most people who use Saphris do not experience any severe side effects. Before prescribing it to you, your doctor would have examined your medical and family history to determine if it’s the right medication for you and if you are at any increased risk for side effects.

More severe side effects typically occur as a result of contraindications with other medications or other underlying medical conditions.


Some of the most common side effects you might experience when using Saphris include: 

  • Sleepiness
  • Dizziness 
  • Muscle stiffness
  • Weight gain 
  • Nausea 
  • Restlessness
  • Numbing of the mouth 

Often these side effects will diminish on their own over time. However, if they persist or become more bothersome, you should speak to your doctor about it. 


People using Saphris may experience some severe side effects such as: 

  • High blood sugar 
  • Seizures
  • Difficulty swallowing 
  • Lowered blood counts

Saphris can potentially lower your blood pressure, particularly if you are on other medications that affect blood pressure.

Warnings and Interactions 

If you are already on antihypertensive drugs, Saphris may enhance some of their effects. It’s important to monitor your blood pressure if you are using both medications. 

In rare cases, some people who use Saphris might be at an increased risk of developing neuroleptic malignant syndrome (NMS).

NMS is a rare but potentially fatal reaction to antipsychotic drugs like Saphris. Symptoms of this condition include high fever, cardiac dysrhythmia, irregular blood pressure or pulse, and muscle rigidity.

If you notice any of these symptoms, you should speak to your doctor immediately. If a diagnosis of NMS is made, your doctor will immediately discontinue your use of Saphris. 

Even if you start to notice a significant improvement in your symptoms, you shouldn't stop using Saphris except if you’ve been advised to do so by your doctor.

In some people, Saphris might make it easier to become dehydrated and overheated.

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Asenapine for schizophrenia and bipolar I disorder. Current Psychiatry. 2009 December;8(12):75-85

  2. Plosker GL, Deeks ED. Asenapine: a review in schizophrenia. CNS Drugs. 2016;30(7):655-666.

  3. Asenapine (Saphris) for schizophrenia or bipolar I disorder (Acute mania or maintenance). NPS MedicineWise.

  4. Research C for DE and. FDA Drug Safety Communication: Serious allergic reactions reported with the use of Saphris (Asenapine maleate). FDA.

  5. Berman BD. Neuroleptic malignant syndrome: a review for neurohospitalists. The Neurohospitalist. 2011;1(1):41-47.

Additional Reading

By Toketemu Ohwovoriole
Toketemu has been multimedia storyteller for the last four years. Her expertise focuses primarily on mental wellness and women’s health topics.