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SAPHRIS is indicated as adjunctive therapy with either lithium or valproate for the acute treatment of manic or mixed episodes associated with bipolar I disorder. Efficacy was established in one 3-week adjunctive trial in adults [see Clinical Studies].
DOSAGE AND ADMINISTRATION
SAPHRIS is a sublingual tablet. To ensure optimal absorption, patients should be instructed to place the tablet under the tongue and allow it to dissolve completely. The tablet will dissolve in saliva within seconds. SAPHRIS sublingual tablets should not be split, crushed, chewed, or swallowed [see CLINICAL PHARMACOLOGY]. Patients should be instructed to not eat or drink for 10 minutes after administration [see CLINICAL PHARMACOLOGY and PATIENT INFORMATION].
Usual Dose for Acute Treatment in Adults
The recommended starting and target dose of SAPHRIS is 5 mg given twice daily. In short term controlled trials, there was no suggestion of added benefit with a 10 mg twice daily dose, but there was a clear increase in certain adverse reactions. The safety of doses above 10 mg twice daily has not been evaluated in clinical studies.
Efficacy was demonstrated with SAPHRIS in a maintenance trial in patients with schizophrenia. The starting dose in this study was 5 mg twice daily with an increase up to 10 mg twice daily after 1 week based on tolerability [see Clinical Studies]. While there is no body of evidence available to answer the question of how long the schizophrenic patient should remain on SAPHRIS, patients should be periodically reassessed to determine the need for maintenance treatment.
Usual Dose for Acute Treatment of Manic or Mixed Episodes Associated with Bipolar I Disorder in Adults
Monotherapy: The recommended starting dose of SAPHRIS, and the dose maintained by 90% of the patients studied, is 10 mg twice daily. The dose can be decreased to 5 mg twice daily if warranted by adverse effects or based on individual tolerability.
In controlled monotherapy trials, the starting dose for SAPHRIS was 10 mg twice daily. On the second and subsequent days of the trials, the dose could be lowered to 5 mg twice daily, based on tolerability, but less than 10% of patients had their dose reduced. The safety of doses above 10 mg twice daily has not been evaluated in clinical trials.
Adjunctive Therapy: The recommended starting dose of SAPHRIS is 5 mg twice daily when administered as adjunctive therapy with either lithium or valproate. Depending on the clinical response and tolerability in the individual patient, the dose can be increased to 10 mg twice daily. The safety of doses above 10 mg twice daily as adjunctive therapy with lithium or valproate has not been evaluated in clinical trials.
While there is no body of evidence available to answer the question of how long the bipolar patient should remain on SAPHRIS, whether used as monotherapy or as adjunctive therapy with lithium or valproate, it is generally recommended that responding patients be continued beyond the acute response. If SAPHRIS is used for extended periods in bipolar disorder, the physician should periodically re-evaluate the long-term risks and benefits of the drug for the individual patient.
Dosage In Special Populations
In a study of subjects with hepatic impairment who were treated with a single dose of SAPHRIS 5 mg, there were increases in asenapine exposures (compared to subjects with normal hepatic function), that correlated with the degree of hepatic impairment. While the results indicated that no dosage adjustments are required in patients with mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment, there was a 7-fold increase (on average) in asenapine concentrations in subjects with severe hepatic impairment (Child-Pugh C) compared to the concentrations of those in subjects with normal hepatic function. Therefore, SAPHRIS is not recommended in patients with severe hepatic impairment [see Use in Specific Populations]. Dosage adjustments are not routinely required on the basis of age, gender, race, or renal impairment status [see Use in Specific Populations and CLINICAL PHARMACOLOGY].
Switching From Other Antipsychotics
There are no systematically collected data to specifically address switching patients with schizophrenia or bipolar mania from other antipsychotics to SAPHRIS or concerning concomitant administration with other antipsychotics. While immediate discontinuation of the previous antipsychotic treatment may be acceptable for some patients with schizophrenia, more gradual discontinuation may be most appropriate for others. In all cases, the period of overlapping antipsychotic administration should be minimized.
Dosage Forms And Strengths
- SAPHRIS 5-mg tablets, black cherry flavor, are round, white to off-white sublingual tablets, with “5” on one side within a circle.
- SAPHRIS 10-mg tablets, black cherry flavor, are round, white to off-white sublingual tablets, with “10” on one side within a circle.
Storage And Handling
SAPHRIS (asenapine) sublingual tablets are supplied as:
5-mg Tablets, Black Cherry Flavor
Round, white to off-white sublingual tablets, with “5” on one side within a circle. Child-resistant packaging
Box of 60 6 blisters with 10 tablets NDC 0456-2405-60
Hospital Unit Dose
Box of 100 10 blisters with 10 tablets NDC 0456-2405-63
10-mg Tablets, Black Cherry Flavor
Round, white to off-white sublingual tablets, with “10” on one side within a circle. Child-resistant packaging
Box of 60 6 blisters with 10 tablets NDC 0456-2410-60
Hospital Unit Dose
Box of 100 10 blisters with 10 tablets NDC 0456-2410-63
Store at 15°-30°C (59°-86°F) [see USP Controlled Room Temperature].
Manufactured by: Catalent UK Swindon Zydis Ltd., Blagrove, Swindon, Wiltshire, SN5 8RU, UK. Distributed by: Forest Pharmaceuticals, Inc. Subsidiary of Forest Laboratories, LLC, St. Louis, MO 63045, USA. Revised: 11/2014
Last reviewed on RxList: 12/5/2014
This monograph has been modified to include the generic and brand name in many instances.
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