Saphris Side Effects

Generic name: asenapine

Medically reviewed by Drugs.com. Last updated on Mar 2, 2025.

Note: This document provides detailed information about Saphris Side Effects associated with asenapine. Some dosage forms listed on this page may not apply specifically to the brand name Saphris.

Applies to asenapine: sublingual tablet.

Other dosage forms:

• transdermal patch extended release

Important warnings This medicine can cause some serious health issues

Sublingual route (tablet)

Use of antipsychotic drugs increases the risk of death in elderly patients with dementia-related psychosis.

Asenapine is not approved for treatment of patients with dementia-related psychosis.

Serious side effects of Saphris

Along with its needed effects, asenapine (the active ingredient contained in Saphris) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking asenapine:

More common side effects

• abnormal or decreased touch sensation
• inability to move the eyes
• inability to sit still
• increase in body movements
• increased blinking or spasms of the eyelid
• lip smacking or puckering
• need to keep moving
• puffing of the cheeks
• rapid or worm-like movements of the tongue
• restlessness
• shakiness in the legs, arms, hands, or feet
• sticking out of tongue
• trembling or shaking of the hands or feet
• trouble with breathing, speaking, or swallowing
• twitching, twisting, uncontrolled repetitive movements of the tongue, lips, face, arms, or legs
• uncontrolled chewing movements
• uncontrolled twisting movements of the neck, trunk, arms, or legs
• unusual facial expressions
• weakness of the arms and legs

Less common side effects

• blurred vision
• dizziness
• headache
• nervousness
• pounding in the ears
• slow or fast heartbeat

Rare side effects

• black, tarry stools
• bleeding gums
• blood in the urine or stools
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• changes in patterns and rhythms of speech
• coma
• confusion
• convulsions
• decreased urine output
• fast, pounding, or irregular heartbeat or pulse
• increased thirst
• muscle pain or cramps
• nausea or vomiting
• pale skin
• pinpoint red spots on the skin
• slurred speech
• swelling of the face, ankles, or hands
• troubled breathing with exertion
• unusual bleeding or bruising
• unusual tiredness or weakness

Other side effects of Saphris

Some side effects of asenapine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common side effects

• constipation
• sleepiness or unusual drowsiness
• trouble sleeping
• unusually deep sleep
• unusually long duration of sleep

Less common side effects

• acid or sour stomach
• belching
• depression
• difficulty with moving
• dry mouth
• fear or nervousness
• heartburn
• increased appetite
• increased watering of the mouth
• increased weight
• indigestion
• irritability
• muscle pain or stiffness
• pain in the arms or legs
• pain in the joints
• stomach discomfort, upset, or pain
• toothache

For healthcare professionals

Applies to asenapine: sublingual tablet, transdermal film extended release.

General adverse events

The most commonly reported adverse reactions in adults included akathisia, dizziness, extra pyramidal symptoms other than akathisia, oral hypoesthesia, somnolence, and increased weight. The most commonly reported adverse reactions in pediatric patients included somnolence, dizziness, dysgeusia, oral paresthesia, nausea, increased appetite, fatigue, and increased weight.^[Ref]

Nervous system

• Very common (10% or greater): Somnolence (up to 53%), extrapyramidal symptoms (up to 25%), sedation (up to 19.2%), akathisia (up to 15%), headache (up to 11%), dizziness (up to 10.1%)
• Common (1% to 10%): Dysgeusia, dyskinesia, dystonia/acute dystonia, extrapyramidal disorder, parkinsonism, tremor
• Uncommon (0.1% to 1%): Dysarthria, restless leg syndrome, seizure, syncope
• Rare (less than 0.1%): Neuroleptic malignant syndrome
• Frequency not reported: Bradykinesia, cerebrovascular events, hyperkinesia, hypersomnia, lethargy, motor impairment, myoclonus, resting tremor, tardive dyskinesia^[Ref]

Somnolence occurred in up to 53% of patients aged 10 to 17 years given 5 mg orally 2 times a day.

Extrapyramidal symptoms occurred in 25% of patients given 10 mg, compared to 11% of patients given 5 mg.^[Ref]

Gastrointestinal

• Very common (10% or greater): Oral hypoesthesia (up to 30%), oral paresthesia (up to 11%)
• Common (1% to 10%): Abdominal pain, constipation, dry mouth, dyspepsia, glossodynia, nausea, oropharyngeal pain, salivary hypersecretion, stomach discomfort, toothache, vomiting
• Uncommon (0.1% to 1%): Dysphagia, gastroesophageal reflux disease (GERD/GORD), oromucosal lesions (ulcerations, blustering, inflammation), swollen tongue
• Postmarketing reports: Abdominal discomfort, abdominal pain lower, abdominal pain upper, oral dysesthesia, oral peeling/sloughing, oromandibular dystonia, oropharyngeal muscular dysfunction, pharyngeal edema, swallowing difficulty, swollen throat, tongue disorder, tongue protrusion^[Ref]

Oral hypoesthesia occurred in up to 30% of pediatric patients and up to 24% of adults.

Application site reactions that include oral ulcers, blisters, peeling/sloughing, and inflammation primarily in the sublingual area have led to discontinuation of therapy in many cases. Oral hypoesthesia and/or oral paraesthesia may occur directly after administration and usually resolve in 1 hour.^[Ref]

Psychiatric

• Very common (10% or greater): Insomnia (up to 16%)
• Common (1% to 10%): Agitation, anger, anxiety, bipolar disorder, bipolar I disorder, depression, depressive symptoms, irritability, mania, schizophrenia, suicidal ideation
• Frequency not reported: Cognitive impairment^[Ref]

Other

• Very common (10% or greater): Fatigue (up to 14%)
• Uncommon (0.1% to 1%): Fall
• Rare (less than 0.1%): Idiosyncratic drug reaction
• Frequency not reported: Body temperature dysregulation, neonatal drug withdrawal syndrome^[Ref]

Metabolic

• Very common (10% or greater): Weight gain of at least 7% (up to 13.1%)
• Common (1% to 10%): Dehydration, hyperinsulinemia, increased appetite, new-onset metabolic syndrome, weight increased
• Uncommon (0.1% to 1%): Hyperglycemia, hyponatremia
• Frequency not reported: Blood insulin increased, diabetes mellitus, dyslipidemia, metabolic changes^[Ref]

While all atypical antipsychotics have been associated with metabolic changes including hyperglycemia, dyslipidemia, and weight gain, the degree of metabolic change differs for each agent.

In clinical trials with this drug, changes from baseline in fasting glucose ranged from -0.6 to 3.8 mg/dL in adults and -0.45 to 1.43 mg/dL in pediatric patients treated with this drug for 3 to 6 weeks compared with -0.2 and -2.24 mg/dL in adults and pediatric patients receiving placebo, respectively. In a 52-week double-blind, comparator-controlled trial in primarily schizophrenic patients, the mean increase in fasting glucose from baseline was 2.4 mg/dL.

An increase of 7% or more in body weight occurred in 8% to 12% of adults and 4.4% to 4.8% of pediatric patients treated with this drug for 3 weeks compared with 1.1% and 1.6%, respectively in adults and pediatric patients receiving placebo. In a 52-week double-blind, comparator-controlled trial in primarily schizophrenic patients, the mean increase in weight from baseline was 0.9 kg.^[Ref]

Musculoskeletal

• Common (1% to 10%): Arthralgia, muscle rigidity, muscle strain, myalgia
• Frequency not reported: Involuntary muscle contractions, muscle spasms, muscle twitching, musculoskeletal stiffness, neck muscle spasm^[Ref]

Very common (10% or greater: Creatine kinase elevations (up to 11.1%)

Cardiovascular

• Common (1% to 10%): Edema, hypertension, orthostatic hypotension, peripheral edema, tachycardia
• Uncommon (0.1% to 1%): Bundle branch block, hypotension, QT prolongation on ECG, sinus bradycardia, sinus tachycardia, temporary bundle branch block
• Frequency not reported: Heart rate increased^[Ref]

In a dedicated QT study in patients with schizophrenia, doses of 5, 10, 15, and 20 mg twice a day were compared with placebo. QTc interval increases ranged from 2 to 5 msec. No patients had QTc increases of 60 msec or greater, nor did any patient experience a QTc of 500 msec or greater.

Orthostatic hypotension was reported in 4.1% of elderly subjects compared with 0.3% in the combined study populations.^[Ref]

Hepatic

• Common (1% to 10%): ALT increased, AST increased, angioedema, transient asymptomatic elevations in hepatic transaminases^[Ref]

Transient elevations in serum transaminases (primarily ALT) in the short-term schizophrenia and bipolar mania trials were more common in treated patients but mean changes were not clinically relevant. In short-term, placebo-controlled schizophrenia trials, the mean increase in transaminase levels for treated patients was 1.6 units/L compared to a decrease of 0.4 units/L for placebo treated patients. The proportion of patients with transaminase elevations three or more times the ULN (at the endpoint) was 0.9% for treated patients versus 1.3% for placebo treated patients. In short-term, placebo-controlled bipolar mania trials, the mean increase in transaminase levels for treated patients was 8.9 units/L compared to a decrease of 4.9 units/L in placebo treated patients. The proportion of patients with transaminase elevations three or more times the ULN (at the endpoint) was 2.5% for treated patients versus 0.6% for placebo treated patients. No cases of more severe liver injury were seen. In a 52 week, double-blind, comparator controlled trial of patients with schizophrenia and schizoaffective disorder, the mean increase from baseline of ALT was 1.7 units/L.^[Ref]

Respiratory

• Common (1% to 10%): Dyspnea, nasal congestion, nasopharyngitis
• Rare (less than 0.1%): Pulmonary embolism
• Frequency not reported: Difficulty breathing, throat tightness, upper respiratory tract infection
• Postmarketing reports: Choking, wheezing^[Ref]

Genitourinary

• Common (1% to 10%): Dysmenorrhea
• Uncommon (0.1% to 1%): Amenorrhea, enuresis, sexual dysfunction
• Rare (less than 0.1%): Galactorrhea^[Ref]

Dermatologic

• Common (1% to 10%): Rash
• Uncommon (0.1% to 1%): Photosensitivity reaction^[Ref]

Ocular

• Uncommon (0.1% to 1%): Accommodation disorder, blurred vision, diplopia
• Frequency not reported: Blepharospasm, oculogyration^[Ref]

Hematologic

• Uncommon (0.1% to 1%): Anemia
• Rare (less than 0.1%): Neutropenia, thrombocytopenia
• Frequency not reported: Agranulocytosis, leukopenia^[Ref]

Endocrine

• Uncommon (0.1% to 1%): Decreased prolactin levels
• Rare (less than 0.1%): Gynecomastia
• Frequency not reported: Hyperprolactinemia^[Ref]

Hypersensitivity

• Uncommon (0.1% to 1%): Allergic reactions
• Postmarketing reports: Anaphylactic/anaphylactoid reactions, serious hypersensitivity reactions^[Ref]

Local

• Postmarketing reports: Sublingual application site reactions^[Ref]

Further information

Saphris side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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