How amisulpride works
Amisulpride belongs to the class of atypical antipsychotics (atypical neuroleptics) – a group of newer agents used to treat mental disorders that cause fewer to no extrapyramidal motor symptoms (EPS; movement disorders) compared to older agents and work more effectively against so-called “negative symptoms.”
Amisulpride is used to treat schizophrenia. The term refers to a group of mental disorders characterized by an alteration in perception, a disturbance in thinking, drive, and overall personality.
The result is, on the one hand, “positive symptoms”, i.e. those that arise as a result of the illness and would not normally occur, such as delusions and hallucinations. In addition, “negative symptoms” occur – symptoms that result from the absence or inadequate expression of normally present behaviors. Examples include apathy, reduced emotions, and social withdrawal.
Its effect in the central nervous system is mainly based on a blockade of the docking sites of the nerve messenger dopamine (dopamine receptors). However, the therapeutic effect only occurs after long-term use.
Unlike many other antipsychotics, amisulpride does not have a sedative effect.
Absorption, breakdown and excretion
Amisulpride is administered by mouth (orally). Only about half of the ingested drug enters the bloodstream and on to the central nervous system. About 12 hours after ingestion, half of the active ingredient has left the body (with the urine).
When is amisulpride used?
Amisulpride is used to treat acute and chronic schizophrenic disorders.
This is how amisulpride is used
Amisulpride is taken once or twice daily, independent of meals. The maximum daily dose of 1200 milligrams must not be exceeded. Regular intake is necessary to achieve the desired effect.
For patients with dysphagia, drops containing amisulpride are also available in addition to tablets.
What are the side effects of amisulpride?
Possible side effects are, for example, insomnia, anxiety, pathological restlessness with violent movements (agitation), tremor and agitation while sitting (akathisia). Extrapyramidal motor symptoms are generally a common side effect of neuroleptics, but occur less frequently with amisulpride than with other representatives of this drug group.
Possible side effects also include increased prolactin production. Prolactin is a hormone that is increasingly secreted by the body during pregnancy, for example. In women, the increased prolactin level can lead to menstrual disorders, breast pain and sexual dysfunction, among other things. In men, headaches and loss of libido are the main concerns.
Amisulpride also relieves nausea (antiemetic effect) via blockade of central dopamine docking sites.
What should be considered when taking amisulpride?
Contraindications
Amisulpride must not be used in:
- prolactin-producing tumors
- pheochromocytoma (rare tumor of the adrenal medulla)
- concomitant use of L-DOPA (Parkinson’s disease medication)
- concomitant use of drugs that also prolong the QT interval (such as quinidine, amiodarone, sotalol)
Drug Interactions
Amisulpride should be used only with special caution together with these agents:
- diuretics (diuretic agents)
- amphotericin B (antifungal agents)
- tricyclic antidepressants (like amitriptyline)
- older antihistamines (medications for allergies) that are able to cross the blood-brain barrier (such as doxylamine, diphenhydramine)
- Beta-blockers (such as bisoprolol) and certain calcium channel blockers (such as verapamil and diltiazem)
- lithium (drug used for bipolar disorder)
- centrally depressant drugs (such as benzodiazepines, phenobarbital, clonidine)
Amisulpride may increase the central effects of alcohol. Therefore, refrain from drinking alcohol during therapy with amisulpride.
Age Limitation
Amisulpride should not be used in children and adolescents younger than 15 years of age (contraindication). It is not recommended to be used between 15 and 18 years of age.
Pregnancy and lactation
Stable patients on amisulpride are not usually switched shortly before or during pregnancy, but they are closely monitored psychiatrically.
Amisulpride passes into breast milk in large quantities. Full breastfeeding should therefore be critically assessed. However, in individual cases, especially with regular plasma level determinations in the newborn and observation of any symptoms, breastfeeding may be acceptable.
How to obtain medication with amisulpride
Amisulpride is available by prescription in Germany, Austria, and Switzerland at any dosage.
How long has amisulpride been known?
The first atypical antipsychotic to be developed was clozapine in 1971. Since then, other “atypicals” have been brought to market, including amisulpride, which was approved in Germany in 1999 for the treatment of schizophrenia.