• Monitor for clinical worsening and emergence of suicidal thoughts and behaviors, especially during the first few months of drug therapy and at times of dose changes. Assess mental status (orientation, mood, behavior) before and periodically during therapy. Assess for suicidal tendencies. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yrs.
• Assess weight and BMI initially and during therapy.
• Monitor BP (sitting, standing, lying) and pulse before and periodically during therapy.
• Observe patient carefully when administering medication to ensure that medication is actually taken and not hoarded.
• Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian: difficulty speaking or swallowing, loss of balance control, pill rolling of hands, masklike face, shuffling gait, rigidity, tremors; and dystonic: muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) periodically throughout therapy. Report these symptoms.
• Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue). Notify health care professional immediately if these symptoms occur, as these side effects may be irreversible.
• Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, loss of bladder control). Discontinue asenapine and notify health care professional immediately if these symptoms occur.
• Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual dysfunction).
• Assess for falls risk. Drowsiness, orthostatic hypotension, and motor and sensory instability increase risk. Institute prevention if indicated.
• Assess patient for signs and symptoms of hypersensitivity reactions, including anaphylaxis, angioedema, hypotension, tachycardia, swollen tongue, dyspnea, itching, wheezing, and rash.
• Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities, galactorrhea, sexual dysfunction).

Lab Test Considerations:

• Obtain fasting blood glucose, lipid profile, and cholesterol levels initially and periodically during therapy.
  • Monitor CBC frequently during initial mo of therapy in patients with pre-existing or history of low WBC. May cause leukopenia, neutropenia, or agranulocytosis. Monitor patients with neutropenia for fever or other symptoms of infection and treat promptly. Discontinue therapy if ANC <1000/mm³ occurs.
  • May cause transient ↑ in serum ALT.