Evaluating Transdermal Asenapine in Schizophrenia

In this episode, "Evaluating Transdermal Asenapine in Schizophrenia," the expert psychiatrist Dr. John Kane explores the pharmacological and practical advantages of transdermal asenapine, currently the only antipsychotic available in a transdermal patch formulation.

Dr. Alva sets the stage by noting asenapine's evolution from a sublingual agent — which carried challenges related to dysgeusia and dietary restrictions — to the transdermal formulation now available, framing it as an important innovation for patients with specific tolerability or adherence challenges. He invites Dr. Kane to comment on how transdermal absorption addresses unmet needs by bypassing hepatic first-pass metabolism, and to share impressions of the phase three trial data supporting this formulation.

Dr. Kane affirms that transdermal asenapine represents a meaningful addition to the treatment armamentarium. He highlights several key pharmacokinetic advantages over the sublingual formulation: avoidance of first-pass metabolism, simplified once-daily dosing compared to the twice-daily sublingual regimen, and reduced peak-to-trough plasma concentration variability over the 24-hour wear period. He notes the patch can be applied to multiple sites — including the upper arm, upper back, abdomen, or hip — with rotation recommended across applications. Drawing on phase three trial data, Dr. Kane describes the formulation as both efficacious and well tolerated, potentially offering tolerability advantages over the sublingual version. He closes by emphasizing that transdermal asenapine, like many alternative delivery formats, remains underutilized, and calls for better education of clinicians, patients, and families about available options — while also noting that formulation choices may evolve over time as patients move through different stages of illness and treatment.

The next episode in this series, "Novel Mechanisms of Action in Schizophrenia Treatment," features the panelists examining the FDA approval of xanomeline/trospium chloride, detailing how its muscarinic M1/M4 agonism represents a fundamental departure from decades of dopamine-based antipsychotic treatment and its promising implications for patients with inadequate responses to existing therapies.