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Tips for tapering off asenapine (Saphris)


Altostrata

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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

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 9 months later...
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?

Zoloft, started and stopped with no problem.


Paxil made me very uncomfortable within the first few days and I discontinued immediately with no ill effects.


Lexapro - I've been on it before and stopped with no problems but I plan to stay on it now as it very clearly helps my depression and anxiety, it was like a light switch when I started taking it again, like a blanket lifted off my brain. The only thing I don't like is the sexual side effects, but at 10mg it's low enough that, before the saphris effect, I had perfectly acceptable sexual function. It's the saphris that really killed me in bed. 


Effexor XR - Stopped with no problems


Clomipramine - Made me uncomfortable within the first few days, stopped immediately with no problems


Abilify - Made me unconfortable within the first few days, stopped immediately with no problems.


Current mix:


Wellbutrin 300mg


Lexapro: 10mg


Saphris 5mg as of May 8

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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

Started ADs back around 1995 after bad break-up, starting with Prozac.  Switched to Wellbutrin, and then to Effexor in 2002
Effexor XR 2002-2014 up to 225 mg at one point, down to 37.5 mg towards end but back up to 75 mg in 2014; now realize I had W/D as I dropped down, memory very poor about history.  Extreme emotions, poor concentration as I stepped back down, didn't connect the dots!
Summer 2014 reduced to 0 very quickly, was sick of anhedonia/sexual dysfunction due to meds, depression never controlled if not worse. Didn't recognize WD since symptoms built slowly (thought I had ADD! and menopausal on top of it), starting with severe sweats, very bad cog-fog and memory issues, culminating in weight loss, severe anxiety and depression, panic, severe apathy and insomnia by eight months off.  Saw p-doc who put me on Remeron, increased from 7.5 mg/day to 37.5 mg by May 22, 2015; still doing very badly though able to sleep.

June 1. 2015 Reinstated Effexor XR 37.5 mg, Remeron dropped to 30 mg PM. Immediate relief of symptoms, like nothing had ever happened!  Joined SA and began on advice of friend who recognized it was WD all along! Began tapering in July 2015.

Been tapering both meds ever since, focusing on one more than the other or doing no more than 5% of each per month.

12 mg Effexor and 5.8 mg Remeron (mirtazapine SolTabs to make a solution with OraPlus) as of 5/4/2017 

Update 3/14/18: 2.9 mg Remeron and 6 mg Effexor; 6/10/18:  2.6 mg Remeron and 4.9 mg Effexor

 

My intro: http://survivingantidepressants.org/index.php?/topic/9313-squirrellygirl-effexor-withdrawal-etc/page-2#entry196679

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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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).

Zoloft, started and stopped with no problem.


Paxil made me very uncomfortable within the first few days and I discontinued immediately with no ill effects.


Lexapro - I've been on it before and stopped with no problems but I plan to stay on it now as it very clearly helps my depression and anxiety, it was like a light switch when I started taking it again, like a blanket lifted off my brain. The only thing I don't like is the sexual side effects, but at 10mg it's low enough that, before the saphris effect, I had perfectly acceptable sexual function. It's the saphris that really killed me in bed. 


Effexor XR - Stopped with no problems


Clomipramine - Made me uncomfortable within the first few days, stopped immediately with no problems


Abilify - Made me unconfortable within the first few days, stopped immediately with no problems.


Current mix:


Wellbutrin 300mg


Lexapro: 10mg


Saphris 5mg as of May 8

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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

Started ADs back around 1995 after bad break-up, starting with Prozac.  Switched to Wellbutrin, and then to Effexor in 2002
Effexor XR 2002-2014 up to 225 mg at one point, down to 37.5 mg towards end but back up to 75 mg in 2014; now realize I had W/D as I dropped down, memory very poor about history.  Extreme emotions, poor concentration as I stepped back down, didn't connect the dots!
Summer 2014 reduced to 0 very quickly, was sick of anhedonia/sexual dysfunction due to meds, depression never controlled if not worse. Didn't recognize WD since symptoms built slowly (thought I had ADD! and menopausal on top of it), starting with severe sweats, very bad cog-fog and memory issues, culminating in weight loss, severe anxiety and depression, panic, severe apathy and insomnia by eight months off.  Saw p-doc who put me on Remeron, increased from 7.5 mg/day to 37.5 mg by May 22, 2015; still doing very badly though able to sleep.

June 1. 2015 Reinstated Effexor XR 37.5 mg, Remeron dropped to 30 mg PM. Immediate relief of symptoms, like nothing had ever happened!  Joined SA and began on advice of friend who recognized it was WD all along! Began tapering in July 2015.

Been tapering both meds ever since, focusing on one more than the other or doing no more than 5% of each per month.

12 mg Effexor and 5.8 mg Remeron (mirtazapine SolTabs to make a solution with OraPlus) as of 5/4/2017 

Update 3/14/18: 2.9 mg Remeron and 6 mg Effexor; 6/10/18:  2.6 mg Remeron and 4.9 mg Effexor

 

My intro: http://survivingantidepressants.org/index.php?/topic/9313-squirrellygirl-effexor-withdrawal-etc/page-2#entry196679

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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  • 1 year later...

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

2001- Klonopin 0.125 mg.  2011- increase to 1 mg.  2018- increase to 1.5 mg

2010- Trials of SSRI's, several.

2011- Saphris 5 mg. CT. 6/2017- retry Saphris 5 mg sublingual, begin taper August 2020 10% taper with scale, and final taper liquid sublingual, August 2019- taper complete!

2011- Geodon 20 mg. Begin taper Sept 2019. 10% liquid taper, 2020 December-5 mg.

2011- Gabapentin 300 mg to present- 2020.

2014- Vyvanse 20 mg, 2020- Vyvanse 5 mg.

2016- Lithium 300 mg, June 2016 - FT.

2017- Cogentin 0.5 mg. June-August 2019- off Cogentin.

Omeprazole 20 mg and holding, Omega 3's/fish oil, Magnesium

Omeprazole 20 mg and holding, Omega 3's/fish oil, Magnesium

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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.

Zoloft, started and stopped with no problem.


Paxil made me very uncomfortable within the first few days and I discontinued immediately with no ill effects.


Lexapro - I've been on it before and stopped with no problems but I plan to stay on it now as it very clearly helps my depression and anxiety, it was like a light switch when I started taking it again, like a blanket lifted off my brain. The only thing I don't like is the sexual side effects, but at 10mg it's low enough that, before the saphris effect, I had perfectly acceptable sexual function. It's the saphris that really killed me in bed. 


Effexor XR - Stopped with no problems


Clomipramine - Made me uncomfortable within the first few days, stopped immediately with no problems


Abilify - Made me unconfortable within the first few days, stopped immediately with no problems.


Current mix:


Wellbutrin 300mg


Lexapro: 10mg


Saphris 5mg as of May 8

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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

"Easy, easy - just go easy and you'll finish." - Hawaiian Kapuna

 

Holding is hard work, holding is a blessing. Give your brain time to heal before you try again.

 

My suggestions are not medical advice, you are in charge of your own medical choices.

 

A lifetime of being prescribed antidepressants that caused problems (30 years in total). At age 35 flipped to "bipolar," but was not diagnosed for 5 years. Started my journey in Midwest United States. Crossed the Pacific for love and hope; currently living in Australia.   CT Seroquel 25 mg some time in 2013.   Tapered Reboxetine 4 mg Oct 2013 to Sept 2014 = GONE (3 years on Reboxetine).     Tapered Lithium 900 to 475 MG (alternating with the SNRI) Jan 2014 - Nov 2014, tapered Lithium 475 mg Jan 2015 -  Feb 2016 = GONE (10 years  on Lithium).  Many mistakes in dry cutting dosages were made.


The tedious thread (my intro):  JanCarol ☼ Reboxetine first, then Lithium

The happy thread (my success story):  JanCarol - Undiagnosed  Off all bipolar drugs

My own blog:  https://shamanexplorations.com/shamans-blog/

 

 

I have been psych drug FREE since 1 Feb 2016!

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  • 2 months later...

Hi @JanCarol and @IHateSaphris

My wife is on a similar journey. For the last year she has been tapering off Saphris.

She found if she tapers too fast she gets terrible insomnia. So she was doign well at 1/8th of a 5MG tablet.. then went to 1/10th (hard to do any more precise as Im sure you know with those darn crumbly tablets)... despite being on 1/8 for several months at 1/10th she cant sleep well. Also she now has developed tardive dyskenisia.   She has been on Saphris for about 8 years.   Would love any advice. thx!

 

The only other med she is on is an SSRI she is also tapering off of.. she is down to 90 MG of Effexor which she has also been tapering off of about 10% per month for about a year. 

 

 

Edited by ChessieCat
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  • Moderator Emeritus

Hi Howard and welcome to SA,

 

It's wonderful to see a spouse wanting to support their partner.

 

It would be better for your wife to join as a member and create an Introduction topic for herself so that we can assist her directly.  It is difficult for SA to work through a 3rd person.  Having her own Intro topic will also mean that she can be supported by other members who understand what she is going through.

 

You are welcome to create a topic in the Relationships section of the forum so that you can be supported by other members.

NEW!!!     INTERVIEW with Altostrata, SA's founder    NEW!!! 

 

Plodding along inch by inch:  12" = 1',  3' =  36 " or 1 yard,  1760 yards  = 63,360" or 1 mile

Current from 17 Apr 2021:  Pristiq 0.2665mg  now holding each dose for 3 weeks

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering Oct 2015 

My tapering program   My Intro (goes to my tapering graph)  My website

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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