Amisulpride

Amisulpride is effective in helping symptoms such as hearing voices, loss of energy, thought disturbances, difficulties communicating with others, worry, depression, overcoming feelings of wanting to be alone as well as other symptoms of schizophrenia.

Amisulpride is a substituted benzamide. This belongs to the group of medicines known as antipsychotics.

Amisulpride: a review of its use in the management of schizophrenia

Amisulpride, a substituted benzamide derivative, is a second-generation (atypical) antipsychotic. At low doses, it enhances dopaminergic neurotransmission by preferentially blocking presynaptic dopamine D2/D3 autoreceptors. At higher doses, amisupride antagonises postsynaptic dopamine D2 and D3 receptors, preferentially in the limbic system rather than the striatum, thereby reducing dopaminergic transmission. In patients with acute exacerbations of schizophrenia, the recommended dosage of amisulpride is 400 to 800 mg/day, although dosages < or =1200 mg/day may be administered. In comparative trials, amisulpride administered within this range (400 to 1200 mg/day) was as effective as haloperidol 5 to 40 mg/day, flupenthixol 25 mg/day and risperidone 8 mg/day in patients with acute exacerbations of schizophrenia with predominantly positive symptoms.

Side Effects of Amisulpride

Insomnia, anxiety, agitation are common side effects (occurring in 5-10%). Somnolence, constipation, nausea, vomiting and dry mouth may occur in up to 2% of patients. Other side effects include weight gain, acute dystonia, extrapyramidal side effects, tardive dyskinesia, hypotension, bradycardia and QT prolongation.

Cautions and contra-indications

In the elderly amisulpride can cause hypotension and sedation. There are no systematic published data on efficacy in children less than 15.

Renal impairment significantly reduces the clearance and prolongs the elimination half-life of amisulpride and risperidone (Caccia, 2000). If there is renal insufficiency there should be a reduction in the dose of amisulpride. The dose should be halved if the creatinine clearance is between 30-60 ml/min and reduced to a third for clearances between 10-30 ml/min.

Prescription should be avoided if there is proven hypersensitivity to the drug,  a prolactin dependent tumour, phaeochromocytoma, pregnancy or lactation.

How to store Amisulpride

• Keep all medicines out of the reach of children.
• Store in a cool, dry place, away from direct heat and light.
• Never keep out of date or unwanted medicines. Discard them safely out of the reach of children or take them to your local pharmacist who will dispose of them for you.

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