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Atypical (Second-generation) Antipsychotic — Sublingual

Asenapine

Brand names: Sycrest

Asenapine is a second-generation (atypical) antipsychotic licensed for the treatment of moderate to severe manic episodes associated with bipolar disorder.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors, with activity at a range of other serotonin, adrenergic, dopamine and histamine receptors.

Prescribing in practice

  • It must be given as a sublingual tablet and patients should avoid eating or drinking for a short period afterwards, as swallowing greatly reduces absorption; oral hypoaesthesia may occur.
  • Hypersensitivity reactions, including serious allergic reactions, have been reported and warrant immediate discontinuation.
  • As with other antipsychotics, it can prolong the QT interval and is associated with extrapyramidal effects, weight gain and metabolic changes.

Monitoring

Monitor weight, blood glucose, lipids and, where indicated, ECG, along with extrapyramidal symptoms.

Counselling the patient

  • Place the tablet under the tongue and let it dissolve; do not chew or swallow it.
  • Do not eat or drink for a short while after taking the tablet.
  • Report any rash, swelling or difficulty breathing immediately.

Evidence & guidelines

Efficacy in acute bipolar mania is supported by randomised controlled trials underpinning its UK licence.

Reference: NICE CG185 (Bipolar Disorder); Sycrest SPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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