Asenapine: a new focus on the treatment of mania

Asenapine, recently marketed in United States and ready to be so in Europe, is a multimodal action second-generation antipsychotic, with high affinity for multiple dopaminergic (D2, D3 y D4), serotonergic (5HT2A, 5HT2B, 5HT2C, 5HT6 and 5HT7) and adrenergic (α1A, α2A, α2B and α2C) receptors. Asenapine has to be administered sublingually. After going through succesfully the preliminary phases of development, several clinical trials have been completed in two main indications: schizophrenia and mania. This article summarizes the available evidence on its safety and efficacy in acute mania and provides some prospect on its clinical immediate and future applications.

Asenapine is effective and generally well tolerated in the treatment of moderate-to-severe acute mania associated to bipolar I disorder. The sublingual administration may be a challenge (coadministration with food or other drugs needs to be avoided) but also an opportunity (improved treatment adherence). Due to its multimodal receptor profile, it may cause several side-effects, but most of those are relatively mild, with none being particularly outstanding. In Europe, asenapine is indicated for the treatment of acute mania only, but several trials are being conducted in schizophrenia and bipolar depression.