Transdermal Asenapine for Agitation and Irritability in a Child With Complete Intravenous Dependence.

Atypical antipsychotics are often effective for managing behavioral disturbances in children with neurodevelopmental disabilities; however, limited evidence-based pharmacologic therapies exist for those dependent upon intravenous and transdermal routes. Transdermal asenapine is US Food and Drug Administration (FDA) approved for adult schizophrenia, but lacks data regarding pediatric use and tolerability. To our knowledge, there are no reports of transdermal asenapine use in children.1,2 Sublingual asenapine is FDA approved for pediatric bipolar mania monotherapy (ages 10-17 years), but was found to lack efficacy for schizophrenia in adolescents.1,3-5 Reportedly, its pediatric tolerability profile resembles those of other second-generation antipsychotics, with pharmacokinetic and safety data comparable to those in adults.3,6,7 We present the case of a 5-year-old child for whom transdermal asenapine effectively and safely managed agitation and improved tolerance of medical therapies and quality of life. Our case suggests that this may be an effective, well-tolerated pharmacologic option for agitation management in a subset of children. Guardian informed consent was obtained prior to publication.