Genetic Engineering & Biotechnology News recently ran a brief article entitled “EU Sanctions Merck & Co.’s Sublingual Bipolar Disorder Drug Sycrest.” Sycrest was first approved in the U.S. in 2009 where Merck markets it as Saphris. Sycrest/Saphris is a “sublingual asenapine drug for treating moderate to severe manic episodes in adult patients with bipolar I disorder” and for treating schizophrenia. When used in treating bipolar disorder mania, it is most effective when used with other anti-manic medications, including lithium and Depakote.

Saphris/asenapine is the newest member of the class of drugs called atypical antipsychotics. It works in the same general manner – affecting primarily dopamine receptors. It also carries the same potential risks that we describe in our initial post on atypical antipsychotics. It is approved for use in schizophrenia and Bipolar I disorder for acute mania. It comes in a sublingual form (under the tongue), which some patients prefer, but which many people don’t like.

I have only had the opportunity to try it in one patient and she experienced severe sedation and stopped it. It was otherwise well tolerated. My thoughts at this point are that because this is a new medicine, with unknown safety profile in longer term use, it is probably going to be used primarily in individuals who have not responded to anything else for their condition.

The primary reason for using Saphris instead of one of the other atypical antipsychotics would be if Saphris were less prone than the others to cause weight gain. Unfortunately, Saphris has not proven much better than other atypical antipsychotics at avoiding this bothersome side effect.