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Altostrata

Tips for tapering off asenapine (Saphris)

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Altostrata

Like other psychiatric drugs, the atypical antipsychotic asenapine must be tapered.

 

See Why taper by 10% of my dosage?

 

If you ever had symptoms labeled "psychotic," this becomes even more important. You must keep your nervous system stable while minimizing your asenapine dosage. Withdrawal can cause lots of strange symptoms. If you exhibit symptoms that might be interpreted as "psychotic," go to the hospital in a panic over withdrawal symptoms, or behave oddly in public, you probably will be hospitalized and given even more drugs.

 

If you go off asenapine or any psychiatric drug, you must be able to manage both withdrawal symptoms (if they occur) and your own emotions and behavior. Please taper Saphris carefully.

 

From http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=17209c32-56eb-4f84-954d-aed7b7a1b18d

 

Quote

2.1 Administration Instructions

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 crushed, chewed, or swallowed [see Clinical Pharmacology (12.3)]. Patients should be instructed to not eat or drink for 10 minutes after administration....

12.3 Pharmacokinetics

....Elimination of asenapine is primarily through direct glucuronidation by UGT1A4 and oxidative metabolism by cytochrome P450 isoenzymes (predominantly CYP1A2). Following an initial more rapid distribution phase, the mean terminal half-life is approximately 24 hrs. With multiple-dose twice-daily dosing, steady-state is attained within 3 days. ....

Absorption: Following sublingual administration, asenapine is rapidly absorbed with peak plasma concentrations occurring within 0.5 to 1.5 hours. ....

The intake of water several (2 or 5) minutes after asenapine administration resulted in decreased asenapine exposure. Therefore, eating and drinking should be avoided for 10 minutes after administration [see Dosage and Administration (2.1)].....

 

Like other antipsychotics, the adverse effects of asenapine are quite serious. Newborn babies whose mothers are taking asenapine may exhibit "extrapyramidal and/or withdrawal symptoms following delivery. There have been reports of agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress and feeding disorder in these neonates. These complications have varied in severity; while in some cases symptoms have been self-limited, in other cases neonates have required intensive care unit support and prolonged hospitalization. SAPHRIS (asenapine) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

 

Saphris comes in 5mg and 10mg sublingual tablets. The 5mg tablets can be dosed twice daily.

 

Tapering method

These tablets are activated by saliva and cannot be dissolved in water or any other liquid for tapering. The only way to taper Saphris is by cutting up the tablets, weighing the fragments, and putting a measured dose in your mouth to dissolve in your saliva as usual. Do not eat or drink for 10 minutes after you take your dose.

 

See Using a digital scale to measure doses

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IHateSaphris

I am currently trying to taper Saphris and am down to sub 5mg doses. The drug comes in a sublingual tablet that is absorbed through the tissue under the tongue and cant be swallowed. The only way i can create reduced doses is by cutting tablets but that makes it impossible to go by 10% at a time. I cant create a liquid either because it must be held under the tongue to be absorbed. Anyone have a technique for tapering this form of medication?

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SquirrellyGirl

I think your best bet is to get a jeweler's scale that weighs milligrams (out to three decimal points, 0.000) and weigh bits that you can then put under your tongue.  You can get these scales on Amazon or eBay very inexpensively.

 

SG

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IHateSaphris

In order to go at 10% i would have to get into sub milligram measurements. A milligram scale will only go 5,4,3,2,1mg (0.005, 0.004, 0.003, 0.002, 0.001) And i wont know if im over weight by up to .99 mg (0.00099).

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SquirrellyGirl

I think you may have not taken into account the fillers in your tablets.  The pills do not weigh what the dosage is.  For instance, if your tablets have 5 mg active ingredient, they don't weigh 5 mg - they weigh 5 mg plus the weight of fillers/binders.  My Remeron SolTabs are 15 mg active ingredient but weigh 90 mg.  This makes it a lot easier for weighing purposes, since yes, when you get down to weighing 5 mg and less, it will become difficult (but by then your active ingredient may be so small that you can jump off).

 

SG

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DMV64

Did you try doing this I hate saphris?? I am in the same boat!

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IHateSaphris
On 9/14/2017 at 7:06 PM, DMV64 said:

Did you try doing this I hate saphris?? I am in the same boat!

I replied to your DM.

 

I did successfully get off Saphris. I am better than ever.

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JanCarol
Posted (edited)
On 9/15/2017 at 9:00 PM, IHateSaphris said:

I did successfully get off Saphris. I am better than ever.

 

Hey @IHateSaphris - I know you've not been onsite for awhile - but - if you successfully got off Saphris, could you please describe your tapering method here?

 

There are others struggling with this sublingual nightmare, especially at the pointy end of the taper.

Edited by Altostrata
added name tag

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