AdultPediatricGeriatricDosage Forms & Strengths sublingual tablet 2.5mg 5mg 10mg Schizophrenia 5 mg SL q12hr initially; maintenance: after 1 week, may be increased up to 10 mg PO q12hr Bipolar Disorder Manic or mixed episodes associated with bipolar I disorder, either as monotherapy or as adjunct to lithium or valproate Monotherapy: 10 mg PO q12hr initially; may be decreased to 5 mg PO q12hr on day 2 and subsequent days if warranted by adverse effects or individual tolerance (90% of patients typically remain on higher dose) Adjunct to lithium or valproate: 5 mg PO q12hr initially; may be increased to 10 mg PO q12hr if warranted If patient responds favorably, continue beyond initial acute phase (no recommendations at this time for duration of therapy) Dosage Modifications Renal impairment Dose adjustment not necessary Hepatic impairment Mild to moderate impairment (Child-Pugh class A or B): Dose adjustment not necessary Severe impairment (Child-Pugh class C): Contraindicated Dosage Forms & Strengths sublingual tablet 2.5mg 5mg 10mg Bipolar Disorder Indicated as monotherapy for acute treatment of manic or mixed episodes associated with bipolar I disorder <10 years: Safety and efficacy not established 10-17 years: 2.5 SL q12hr initially; may increase to 5 mg SL q12hr after 3 days and to 10 mg SL q12hr after 3 additional days Dosing Considerations Pediatric patients are more sensitive to dystonia with initial dosing when recommended escalation schedule not followed Safety and efficacy of doses >10 mg q12hr not establishedNot indicated for dementia-related psychosis, in view of increased risk of death as compared with placebo (see Black Box Warnings) In elderly patients with psychosis, asenapine exposure (area under curve [AUC]) was on average 40% higher than in younger adultsInteraction CheckerEnter a drug name and asenapineNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (6)amisulprideamisulpride, asenapine. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Increases risk of neuroleptic malignant syndrome.dronedaroneasenapine and dronedarone both increase QTc interval. Contraindicated.fluconazoleasenapine and fluconazole both increase QTc interval. Contraindicated.posaconazoleasenapine and posaconazole both increase QTc interval. Contraindicated.thalidomideasenapine and thalidomide both increase sedation. Contraindicated.thioridazineasenapine and thioridazine both increase QTc interval. Contraindicated.Serious - Use Alternative (141)adagrasibadagrasib, asenapine. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.alfentanilasenapine and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatealfuzosinalfuzosin and asenapine both increase QTc interval. Avoid or Use Alternate Drug.amiodaroneasenapine and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.amisulprideamisulpride and asenapine both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.anagrelideanagrelide and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.apomorphineapomorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.aripiprazolearipiprazole and asenapine both increase QTc interval. Avoid or Use Alternate Drug.arsenic trioxideasenapine and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.artemetherartemether and asenapine both increase QTc interval. Avoid or Use Alternate Drug.artemether/lumefantrineasenapine and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.atomoxetineatomoxetine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.benzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, asenapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.asenapine and benzhydrocodone/acetaminophen both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphineasenapine and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.buprenorphine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine buccalbuprenorphine buccal and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine subdermal implantbuprenorphine subdermal implant and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and buprenorphine subdermal implant both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalbuprenorphine transdermal and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and buprenorphine transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionbuprenorphine, long-acting injection and asenapine both increase QTc interval. Avoid or Use Alternate Drug.asenapine and buprenorphine, long-acting injection both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequateceritinibceritinib and asenapine both increase QTc interval. Avoid or Use Alternate Drug.chlorpromazineasenapine and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.clarithromycinclarithromycin and asenapine both increase QTc interval. Avoid or Use Alternate Drug.clozapineclozapine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.codeineasenapine and codeine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatedasatinibdasatinib and asenapine both increase QTc interval. Avoid or Use Alternate Drug.degarelixdegarelix and asenapine both increase QTc interval. Avoid or Use Alternate Drug.desfluranedesflurane and asenapine both increase QTc interval. Avoid or Use Alternate Drug.disopyramideasenapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.dofetilidedofetilide increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug.dolasetrondolasetron and asenapine both decrease QTc interval. Avoid or Use Alternate Drug.donepezildonepezil and asenapine both increase QTc interval. Avoid or Use Alternate Drug.droperidolasenapine and droperidol both increase QTc interval. Avoid or Use Alternate Drug.efavirenzefavirenz and asenapine both increase QTc interval. Avoid or Use Alternate Drug.eliglustatasenapine and eliglustat both increase QTc interval. Avoid or Use Alternate Drug.encorafenibencorafenib and asenapine both increase QTc interval. Avoid or Use Alternate Drug.entrectinibasenapine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.eribulineribulin and asenapine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.erythromycin baseasenapine and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.erythromycin ethylsuccinateasenapine and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin lactobionateasenapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.erythromycin stearateasenapine and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.escitalopramescitalopram increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug.fentanylasenapine and fentanyl both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl intranasalasenapine and fentanyl intranasal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl iontophoretic transdermal systemasenapine and fentanyl iontophoretic transdermal system both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl transdermalasenapine and fentanyl transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefentanyl transmucosalasenapine and fentanyl transmucosal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatefexinidazolefexinidazole and asenapine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval. fingolimodfingolimod and asenapine both increase QTc interval. Avoid or Use Alternate Drug.flecainideasenapine and flecainide both increase QTc interval. Avoid or Use Alternate Drug.fluvoxamineasenapine and fluvoxamine both increase QTc interval. Avoid or Use Alternate Drug.foscarnetasenapine and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.gemifloxacingemifloxacin and asenapine both increase QTc interval. Avoid or Use Alternate Drug.gilteritinibgilteritinib and asenapine both increase QTc interval. Avoid or Use Alternate Drug.glasdegibasenapine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.goserelinasenapine and goserelin both increase QTc interval. Avoid or Use Alternate Drug.granisetrongranisetron and asenapine both increase QTc interval. Avoid or Use Alternate Drug.histrelinasenapine and histrelin both increase QTc interval. Avoid or Use Alternate Drug.hydrocodonehydrocodone, asenapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.hydromorphoneasenapine and hydromorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatehydroxychloroquine sulfatehydroxychloroquine sulfate and asenapine both increase QTc interval. Avoid or Use Alternate Drug.hydroxyzinehydroxyzine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.iloperidoneasenapine and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.inotuzumabinotuzumab and asenapine both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.isofluraneisoflurane and asenapine both increase QTc interval. Avoid or Use Alternate Drug.itraconazoleitraconazole and asenapine both increase QTc interval. Avoid or Use Alternate Drug.ivosidenibivosidenib and asenapine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.lapatinibasenapine and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.lefamulinlefamulin and asenapine both increase QTc interval. Avoid or Use Alternate Drug.leuprolideasenapine and leuprolide both increase QTc interval. Avoid or Use Alternate Drug.levodopa inhaledasenapine decreases effects of levodopa inhaled by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Atypical (2nd generation) antipsychotics inhibit dopamine D2 receptors in varying degrees (clozapine and quetiapine are lower risk). .levofloxacinasenapine and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.lithiumlithium and asenapine both increase QTc interval. Avoid or Use Alternate Drug.loperamideasenapine and loperamide both increase QTc interval. Avoid or Use Alternate Drug.lopinavirasenapine and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.macimorelinmacimorelin and asenapine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.maprotilineasenapine and maprotiline both increase QTc interval. Avoid or Use Alternate Drug.mefloquinemefloquine increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.methadoneasenapine and methadone both increase QTc interval. Avoid or Use Alternate Drug.asenapine and methadone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatemetoclopramide intranasalasenapine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.asenapine increases toxicity of metoclopramide intranasal by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potential for additive effects, including increased frequency and severity of tardive dyskinesia, other extrapyramidal symptoms, and neuroleptic malignant syndrome.midostaurinasenapine and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.mirtazapinemirtazapine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.mobocertinibmobocertinib and asenapine both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.morphineasenapine and morphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatemoxifloxacinasenapine and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.nilotinibasenapine and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.octreotideasenapine and octreotide both increase QTc interval. Avoid or Use Alternate Drug.ofloxacinasenapine and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.olanzapineolanzapine and asenapine both increase QTc interval. Avoid or Use Alternate Drug.olopatadine intranasalasenapine and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime