• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » An Antipsychotic Patch

An Antipsychotic Patch

November 15, 2019
Chris ­Aiken, MD.
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Chris ­Aiken, MD. Editor-in-Chief of The Carlat Psychiatry Report. Practicing psychiatrist, Winston-Salem, NC.

Asenapine (Saphris) is now available as a transdermal patch, Secuado. The patch showed efficacy in a large 6-week, double-blind, placebo-controlled, fixed-dose study in 616 adult patients with schizophrenia.


Transdermal medications are thought to reduce side effects by avoiding “first-pass” metabolism in the GI tract. This is unlikely to be an advantage for Secuado, however, because the sublingual form of asenapine (Saphris) already avoids the first-pass effect by absorbing through the buccal membrane. Compared to placebo, Secuado’s side effect profile looks identical to Saphris, except that it adds one more: skin irritation (15%). Still, some patients may prefer it to Saphris, which is notorious for its unpleasant taste that is not always masked by its black cherry flavoring.


The main difference between Saphris and Secuado is in their pharmacokinetics. Saphris comes on fast, peaking within an hour, while Secuado takes 12–24 hours to reach peak levels. Peak levels are associated with side effects, however, not efficacy. Some patients do better with lower levels spread out over a long time (Secuado), while others prefer the rapid up and rapid down of Saphris. In other words, Secuado is to Saphris as Seroquel XR is to Seroquel IR.


Secuado’s advantages over Saphris are dampened when Saphris is given as a single nightly dose. This minimizes fatigue by concentrating the side effects in the evening. Although it’s recommended to divide Saphris twice daily, there is little reason to do so either in schizophrenia or bipolar disorder. Antipsychotics can be given in a single daily dose without loss of efficacy, according to 4 randomized controlled trials (Takeuchi H et al, J Clin Psychiatry 2014;75(5):506–511). That is true for antipsychotics with short half-lives like perphenazine and clozapine, and makes even more sense with the 24-hour half-life of Saphris.


Secuado and Saphris have never been directly compared, but industry-sponsored papers touting the benefits of the transdermal form are already on the march (Citrome L et al, J Clin Psychiatry 2019;80(4)). Caution: These papers draw their arguments from transdermal systems designed for other diagnoses like ADHD and dementia. There the comparison is an oral medication given twice a day, not a sublingual one given all at night. Secuado may be right for patients whose side effects are tied to asenapine’s peak plasma levels. Otherwise, Saphris is the better choice, particularly after December 2020 when it is expected to go generic.



Table: Secuado Patch vs Saphris Sublingual


Table: Secuado Patch vs Saphris Sublingual


View as full-size PDF.


General Psychiatry
KEYWORDS antipsychotic asenapine news_of_note patch saphris secuado transdermal
    Chris ­Aiken, MD.

    Zuranolone for Postpartum Depression

    More from this author
    www.thecarlatreport.com
    Issue Date: November 15, 2019
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Adult ADHD, TCPR, November/December 2019
    Highlights From This Issue
    Adult-Onset ADHD
    Micronutrients in Mental Health
    Adult ADHD: What Else Could It Be?
    Stimulants as Cognitive Enhancers
    A Practical Guide to Light Therapy
    Meet the First H3 Antagonist
    An Antipsychotic Patch
    Pharmacology for GAD: Complex Choices
    Olanzapine for Anorexia Nervosa
    In Brief: Antipsychotic Update
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2603816031.jpg
      General Psychiatry

      A Scam for Every Woman, Child, and Man: Part 2

      1 in 3 Americans were victims of online scams in the past year. Even when you know your patient is being scammed, it is hard to pull them out. We speak with Cathy Wilson about...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.