Administrator Altostrata Posted August 9, 2015 Administrator Share Posted August 9, 2015 (edited) 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. Very careful tapering is necessary when you have had psychotic symptoms. Withdrawal symptoms that look like psychosis can appear even in those who never had psychosis. If you have a prior diagnosis of psychosis, emergence of these symptoms from dopamine supersensitivity can cause you to become diagnosed as "relapsed" and re-medicated. Read Psychiatrist: Some patients are better off without antipsychotics... 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 Edited November 4, 2023 by Altostrata updated 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 All postings © copyrighted. Link to comment Share on other sites More sharing options...
IHateSaphris Posted May 30, 2016 Share Posted May 30, 2016 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 Link to comment Share on other sites More sharing options...
Moderator Emeritus SquirrellyGirl Posted May 30, 2016 Moderator Emeritus Share Posted May 30, 2016 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. Link to comment Share on other sites More sharing options...
IHateSaphris Posted May 31, 2016 Share Posted May 31, 2016 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 Link to comment Share on other sites More sharing options...
Moderator Emeritus SquirrellyGirl Posted May 31, 2016 Moderator Emeritus Share Posted May 31, 2016 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. Link to comment Share on other sites More sharing options...
DMV64 Posted September 15, 2017 Share Posted September 15, 2017 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. Taper 2023-2024. Taper complete! 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. 2021: Jan-4.5mg. (held Feb.for vacation). March-4mg. Apr-3.6mg. May-3.2mg. June-2.8mg. (Held July for vacation). Aug-2.4mg. Sept.- 2.2mg. Oct. 2mg. Dec 2022 - Taper complete! 2011- Gabapentin 300 mg to present- 2020. Increase 2023 to 400mg. 2014- Vyvanse 20 mg, 2020- Vyvanse 5 mg. Increase August 2022 20mg. CT (unavailable) 4/2023 2016- Lithium 300 mg, June 2016 - FT. 2017- Cogentin 0.5 mg. June-August 2019- off Cogentin. 2018- Lamictal 300mg. Holding 2021 - Hydroxyzine 30mg. Holding. 2014 Omeprazole 20 mg and holding, Omega 3's/fish oil, Magnesium Link to comment Share on other sites More sharing options...
IHateSaphris Posted September 16, 2017 Share Posted September 16, 2017 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 Link to comment Share on other sites More sharing options...
Moderator Emeritus JanCarol Posted May 26, 2018 Moderator Emeritus Share Posted May 26, 2018 (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 May 26, 2018 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! Link to comment Share on other sites More sharing options...
howardnyc Posted August 19, 2018 Share Posted August 19, 2018 (edited) 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 August 20, 2018 by ChessieCat Link to comment Share on other sites More sharing options...
Moderator Emeritus ChessieCat Posted August 20, 2018 Moderator Emeritus Share Posted August 20, 2018 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. * NO LONGER ACTIVE on SA * MISSION ACCOMPLISHED: (6 year taper) 0mg Pristiq on 13th November 2021 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 from Oct 2015 - 13 Nov 2021 LAST DOSE 0.0025mg Post 0 updates start here My tapering program My Intro (goes to tapering graph) VIDEO: Antidepressant Withdrawal Syndrome and its Management Link to comment Share on other sites More sharing options...
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