Asenapine: a new antipsychotic option

Asenapine is a new psychopharmacologic agent approved for the acute and maintenance treatment of schizophrenia and the acute and maintenance treatment of manic and mixed episodes associated with bipolar I disorder. The efficacy of asenapine in treating schizophrenia was evaluated in four 6-week studies in which placebo and active controls (risperidone, olanzapine, and haloperidol) were used. Two 3-week placebo-controlled trials examined the efficacy of asenapine and active control (olanzapine) in the treatment of bipolar I disorder. Asenapine demonstrated efficacy in relation to placebo for 2 of the acute schizophrenia trials and both trials examining the acute treatment of bipolar I disorder. Several factors should be examined when considering asenapine therapy in relation to other antipsychotics including efficacy, atypicality of receptor binding, obstacles to administration and compliance, and finally cost. No efficacy advantage is evident with asenapine over other antipsychotic agents. Barriers to achieving compliance with asenapine include the recommendations of twice daily dosing, the need to avoid food and liquids for at least 10 minutes postadministration, the need for patient cooperation with sublingual administration, and the low bioavailability of the tablet if swallowed. Finally, no cost advantage is evident for using asenapine in comparison to the already available generic risperidone or other soon-to-be generic atypical antipsychotics.