Saphris is dissolved under the tongue and is given twice per day in 5mg or 10mg tablets. The drug is not absorbed as well if swallowed.
How the drug works is not yet completely understood. It is thought that the drug influences certain receptors in the brain. Asenapine could be referred to as a multi-receptor neuroleptic drug, which influences both serotonin and dopamine antagonism. The literature on the drug indicates that it can have beneficial effects on cognitive function and may reduce some unwanted symptoms in patients with schizophrenia. Researchers report an exceptionally high affinity for specific receptors that may be significant, however exactly how the drug works is poorly understood.1
Comparisons from trials done showed Saphris to be only minimally effective for acute mania compared to most other antipsychotic medications.2
It is believed that antipsychotics such as Saphris deflect dopamine from binding at the D2 receptor. This is thought to correlate to the drug’s ability to reduce psychotic symptoms. However, there is a limitation to any drug’s effectiveness over time because the body adapts by building new receptors.
This adaptation can make trying to withdraw from antipsychotic medication extremely difficult, sometimes described as more challenging than benzodiazepine or heroin withdrawal.
This difficulty may be caused, at least in part, by another aspect of antipsychotic medication. Withdrawal can become hard to manage because when the drug is reduced, a significant flood of dopamine may occur; this can clinically present as a return of manic symptoms.
The patient may become, affected by this reaction, unwilling or unable to follow directions. It may be desirable at such a point to arrange hospital admission for stabilization. Once stabilized, tapering may be able to resume at a slow pace. This scenario would not occur in all cases, but the possibility may be more likely where medication has been relied on for many years. Such considerations should be discussed prior to beginning tapering. With exacting, well-planned, and compassionate protocols, it is possible in most cases to transition to being medication free, or to the lowest possible dose that still provides satisfactory quality of life.
As a general note, it is usual that a drug such as Saphris is given during a time of crisis or to control an extreme type of episode. Less attention is often given in determining whether such a crisis was a temporary situation. It may be easier to find a doctor to prescribe Saphris, or similar medication than it is to find a doctor familiar enough with correct tapering to help with the reduction or elimination of the drug when that time comes. Inpatient help may be able to answer this problem, where staff are familiar and capable of helping with Saphris withdrawal.
Many adjunct therapies are used in the programs as well, so that maximum client support is made available. Some of these include mind/body techniques like 
