Invega vs Saphris

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Introduction

For individuals with schizophrenia or bipolar I disorder, certain medications that alter the concentrations of substances in the brain linked to mood and perception, called neurotransmitters, can aid in managing their symptoms. Invega and Saphris are two such drugs often prescribed for these conditions. Both impact different neurotransmitters within the brain but have similar outcomes in stabilizing patients' moods. Invega is a dopamine antagonist - it works by blocking receptors in the brains' dopamine pathways. On the other hand, Saphris has a more complex mechanism as it acts on several different types of receptors including serotonin, adrenergic and histamine receptors. It's crucial to remember that individual responses to these medications can vary significantly based on genetic factors and medical history.

What is Invega?

Paliperidone (the generic name for Invega) and Asenapine (the generic name for Saphris) both fall into the category of atypical antipsychotics. This class of medication marked a significant advancement from the first-generation conventional antipsychotics. Paliperidone was approved by the FDA in 2006, used primarily to treat schizophrenia and schizoaffective disorder. It works by restoring balance to neurotransmitters like dopamine and serotonin in the brain, thereby improving mood, thoughts, and behavior. Compared to other drugs in its class, Paliperidone has a targeted effect on these neurotransmitters with only minimal impact on others leading to fewer side effects.

On the other hand, Asenapine is prescribed not only for schizophrenia but also as an adjunctive treatment for bipolar I disorder in adults when used with either lithium or valproate. Despite their shared classification as atypical antipsychotics, patients may respond differently based on individual physiological differences thus necessitating careful consideration of each option's potential benefits versus possible side effects under expert medical advice.

What conditions is Invega approved to treat?

Invega is approved for the treatment of specific mental/mood disorders:

Schizophrenia, a chronic and severe mental disorder that affects how a person thinks, feels, and behaves
Schizoaffective disorder (in combination with mood stabilizers or antidepressants), which is characterized by symptoms of schizophrenia like hallucinations or delusions, and symptoms of a mood disorder such as mania and depression.

How does Invega help with these illnesses?

Invega works to manage symptoms of schizophrenia by adjusting the levels of dopamine and serotonin in the brain. It accomplishes this by blocking their reabsorption into the nerve cells, which allows these neurotransmitters to be available for longer periods. Dopamine and serotonin are chemical messengers that play key roles not only in mood regulation but also in cognition, motivation, reward, sleep patterns, memory processing among others. An imbalance or inadequate functioning of these neurotransmitters is thought to contribute significantly to disorders such as schizophrenia. Therefore, Invega aims at increasing their availability thus reducing psychotic symptoms and helping patients manage their condition effectively.

What is Saphris?

Saphris, also known as Asenapine, is an atypical antipsychotic that is used for the treatment of schizophrenia and bipolar disorder. It works by adjusting the activity of certain natural substances in the brain to maintain mental balance. Unlike Invega which presents itself in tablet form, Saphris is a sublingual medication meaning it dissolves under the tongue.

Approved by FDA in 2009, Saphris stands out because it does not intensify metabolic syndrome issues such as weight gain and diabetes. However, common side effects include dizziness and oral numbness or tingling sensation due to its administration route. This distinct profile makes it a viable option especially for patients who have concerns about weight gain or metabolic complications often associated with other antipsychotics like Invega.

What conditions is Saphris approved to treat?

Saphris, a second-generation antipsychotic medication, is approved by the FDA for treating:

Schizophrenia in adults and adolescents (ages 13-17)
Bipolar I disorder as either monotherapy or adjunctive therapy to lithium or valproate for acute manic or mixed episodes in adults and children (ages 10 - 17).

How does Saphris help with these illnesses?

Saphris is an atypical antipsychotic which functions by altering the activity of certain natural substances in the brain, such as dopamine and serotonin. These neurotransmitters have been implicated in various psychiatric conditions including schizophrenia and bipolar disorder. Saphris acts to normalize these neurotransmitter levels, thereby alleviating some symptoms associated with these disorders. Its effect on other neurotransmitters may also play a role in its action as an antipsychotic medication. Unlike Invega, another atypical antipsychotic, Saphris has a unique sublingual administration route that allows it to be absorbed directly into the bloodstream from under the tongue. This can make it more appealing for patients who struggle with swallowing pills or prefer this mode of delivery due to its rapid onset of action.

How effective are both Invega and Saphris?

Both paliperidone (Invega) and asenapine (Saphris) have established histories of success in treating patients with schizophrenia, and they were initially approved by the FDA only a few years apart. Since they act on different neurotransmitters, they may be prescribed under different circumstances. The effectiveness of paliperidone and asenapine in alleviating symptoms of schizophrenia was directly studied in several clinical trials; both drugs exhibited similar efficacy in managing positive and negative symptoms of schizophrenia, as well as comparable safety profiles.

A 2007 review reported that paliperidone is effective from the first week of treatment onwards, its side effect profile is favorable compared to other antipsychotics, it's well-tolerated even among elderly populations. Further studies indicate that paliperidone has become one of the frequently prescribed antipsychotic drugs globally due to its long-acting injectable formulation providing continued symptom control with less frequent dosing.

On the other hand, a 2016 review indicated that Asenapine seems to be more effective than placebo and similar in efficacy to other common antipsychotics for acute exacerbation phases. However, it tends towards being considered after or alongside initial treatments such as risperidone or olanzapine due to its sublingual administration route which some patients find inconvenient. Despite this limitation, Asenapine could be an optimal choice for those who did not respond adequately to others or prefer avoiding certain typical side effects like weight gain associated with alternatives.

abstract image of a researcher studying a bottle of drug.

At what dose is Invega typically prescribed?

Oral dosages of Invega range from 3-12 mg/day, but research suggests that 6 mg/day is adequate for treating schizophrenia in most adults. Adolescents aged 12 to 17 may be started on a lower dosage of around 1.5 mg/day. For either population, the dosage can be increased after one week if there is no response or minimal side effects are observed. However, the maximum dosage that should not exceed under any circumstances is 12 mg/day for adults and adolescents alike.

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At what dose is Saphris typically prescribed?

Saphris treatment usually begins at a dosage of 5 mg taken twice daily. The dose can then be increased to 10 mg twice daily after several days, based on the patient's response and tolerance to the medication. It is important note that doses are evenly spread out throughout the day, typically spaced around 12 hours apart. In certain cases where there is no significant improvement or response to treatment at this level within a few weeks, your healthcare provider may consider adjusting the dose further. However, dosages exceeding 20 mg per day have not been systematically evaluated and should therefore not be used without careful medical supervision.

What are the most common side effects for Invega?

Common side effects of Invega include:

Restlessness
Weight gain
Tachycardia (increased heart rate)
Hypertension (high blood pressure)
Dyspepsia (indigestion, discomfort or pain in the stomach)
Diarrhea
Nausea and vomiting
Insomnia
Somnolence (sleepiness/drowsiness)
Tremors and other extrapyramidal symptoms (EPS), such as muscle stiffness, spasms, restlessness, etc.

Meanwhile, Saphris might cause:

Dizziness
Unusual weakness or tiredness
Increased appetite leading to weight gain
Mouth sores or ulcers caused by the sublingual tablet formulation
Dry mouth
Constipation Signs of high blood sugar like confusion, feeling sleepy, more thirst and hunger than normal etc.

Remember that it's crucial to share any concerns on these potential side effects with your healthcare provider before starting treatment.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Invega?

Invega does have potential serious side effects, although they are generally rare. These may include:

Suicidal thoughts or behavior
Symptoms of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
Problems with vision including blurred vision and seeing halos around lights
Unusual changes in heart rate such as fast or irregular heartbeat
Low sodium levels leading to symptoms like headache, confusion, slurred speech, severe weakness and unsteadiness
Neuroleptic malignant syndrome (NMS) - a potentially life-threatening condition characterized by high fever, muscle rigidity and instability of autonomic nervous system functions which could manifest as rapid heartbeats or feeling lightheaded.

If you experience any signs of serotonin syndrome: agitation; hallucinations; fever; excessive sweating; shivering or shaking; fast heart rate; muscle stiffness or twitching loss of coordination and gastrointestinal upset like nausea/vomiting/diarrhea while on Invega seek immediate medical attention.

What are the most common side effects for Saphris?

Saphris, or asenapine, is a medication used to treat symptoms of schizophrenia and bipolar disorder. Some common side effects include:

Dry mouth
Nausea or upset stomach
Constipation
Increased appetite and potential weight gain
Drowsiness, fatigue, feeling tired
Distorted sense of taste
Akathisia (feeling restless)

In rare cases, some people may experience more serious side effects like dizziness upon standing up too quickly due to blood pressure changes. Other less common but severe reactions include tremors, muscle stiffness or spasms, difficulty swallowing and in extreme cases signs of tardive dyskinesia - uncontrolled movements often affecting the face such as grimacing or eye blinking. It's important to consult with your healthcare provider if you notice any unusual symptoms while taking Saphris.

Are there any potential serious side effects for Saphris?

While Saphris is generally well tolerated, it can sometimes cause serious side effects. These may include:

Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
Unusual thoughts or behavior: confusion, agitation, aggression
Increased risk for a stroke in older adults with dementia-related psychosis
High blood sugar levels leading to diabetes or worsening of pre-existing diabetes
Disturbing muscle movements including tremors and stiffness
Low white blood cell count which could lead to infections
Difficulty swallowing that can trigger pneumonia

If any of these symptoms occur while taking Saphris, it's crucial you seek immediate medical attention. It's also worth noting that discontinuing Saphris abruptly without consulting a healthcare provider is not advised due to potential withdrawal symptoms.

Contraindications for Invega and Saphris?

Both Invega and Saphris, along with most other antipsychotic medications, may worsen symptoms of depression in some people. If you notice your depression worsening, or an increase in suicidal ideation, thoughts or behavior, please seek immediate medical attention.

Neither Invega nor Saphris can be taken if you are taking medicines that interact with these drugs such as certain antibiotics and antifungal agents. Always inform your physician about the medications you are currently using; some may require a period to clear from the system to prevent harmful interactions with both Invega and Saphris.

It is also important to note that there might be an increased risk of stroke among elderly patients suffering from dementia-related psychosis while using these drugs. Both medications should be used cautiously if you have a history of seizures or cardiovascular problems.

How much do Invega and Saphris cost?

For the brand name versions of these drugs:

The price of 30 tablets of Invega (6 mg) averages around $1300, which works out to approximately $43/day.
The price for a month's supply (60 sublingual tablets) of Saphris (5mg) is about $1000, working out to roughly $33/day.

Hence, if you are on a standard dosage for Invega (i.e., 6 mg/day), then brand-name Saphris tends to be less expensive on a per-day treatment basis. It's essential to understand that costs should not be your primary consideration in determining which medication is best suited for your needs.

As far as generic versions go:

Paliperidone (the active ingredient in Invega) isn't widely available as generic at this time, so prices may still be high.
Asenapine Maleate does have some generic options; however, it’s worth noting that prices can vary significantly depending on location and insurance coverage. You could expect somewhere between $1 - $15 per day based off current market estimations and availability.

Popularity of Invega and Saphris

Paliperidone, available under the brand name Invega, is an atypical antipsychotic primarily used to treat schizophrenia and schizoaffective disorder. As of 2020, it was estimated that around 1 million prescriptions were filled for Invega in the United States, accounting for approximately 10% of atypical antipsychotic prescriptions. The use of paliperidone has been gradually increasing since its introduction in 2006.

Asenapine, sold under the brand name Saphris among others, is another atypical antipsychotic utilized to manage symptoms of schizophrenia and bipolar I disorder. Prescribed to about half a million people in the USA as per data from 2020, asenapine accounts for roughly 5% of all atypical antipsychotics prescribed within this year. Like paliperidone's trend over time, there has also been a consistent rise in prescription rates for asenapine since it first hit the market back in 2009.

Conclusion

Both Invega (paliperidone) and Saphris (asenapine) have established efficacy in managing symptoms of schizophrenia, backed by clinical studies indicating they are more effective than placebo treatments. In some scenarios, these drugs may be combined under careful medical supervision due to their different mechanisms of action. While both impact dopamine and serotonin receptors, the specific receptor subtypes they target differ which influences prescribing decisions.

Invega is often a first-line treatment option for schizophrenia, while Saphris might be considered as an adjunctive therapy to Invega or for patients who did not respond well to initial antipsychotic drug treatment or need to avoid certain side effects such as weight gain. Both drugs are available in generic form offering potential cost savings.

It's important to note that both medications require an adjustment period meaning symptom relief may not be immediate. The side effect profiles between the two medicines share similarities with common adverse reactions including sleepiness and weight gain; however, Saphris has been linked less frequently with extrapyramidal symptoms compared to other atypical antipsychotics like paliperidone.

Patients should monitor their mental health closely especially when initiating therapy and immediately report any worsening psychiatric symptoms or thoughts of self-harm or suicide to healthcare providers.