Amisulpride

Economic data relating to amisulpride are very few, despite the longstanding availability of this dmg in France. There appears to be only one published economic evaluation—a comparison with haloperidol (Souetre et al, 1992). In this French study, direct medical... 

A search of Medline, EMBASE and PsycLIT was conducted in August 2000, using the following terms Amisulpride, clozapine, olanzapine, risperidone, sertindole, zotepine, ziprasidone, economics, healthcare, costs. All manufacturers of atypical antipsychotic drugs were contacted in April 2000 and asked to supply primary reference data on their product, and all companies had complied with this request by August 2000. A further manual search was conducted of files and journals kept in the National Centre for Information on Psychotropics at the Maudsley Hospital. Reference sections from all retrieved papers were scrutinized for further relevant references. 

Amisulpride is a substituted benzamide, which acts as a highly selective blocker of D2 and D3 receptors (Kerwin, 2000). As with all the other drugs, it can easily be demonstrated to be effective compared with placebo and haloperidol, with a lower extrapyramidal symptom profile (Moller et al, 1995). The strength of amisulpride lies in the quality of the evidence to show that it is effective against primary negative symptoms and affective symptoms. Two studies have shown convincing superiority for negative symptoms... 

There is evidence that amisulpride might also be useful in clozapine-resistant patients as an adjunct (Kerwin, Mathiassen and Munro, personal communication). 

As amisulpride has no hepatic metabolism, low protein binding, and is directly excreted in urine, there is little reason to suspect pharmacokinetic ethnic differences. Of course body mass and pharmacodynamic differences might occur, but to date have received little investigative attention. 

Rein W. Amisulpride versus imipramine and placebo in dysthymia and major depression. Amisulpride Study Group. J Affective Disord 1997 43(2) 95-103. 

Erythromycin (especially intravenous use), halofantrine, some quinolones Amisulpride, haloperidol, sertindole, thioridazine, pimozide Cisapride... 

Some drugs giving less EPS were discovered serendipitously, such as metoclopramide, first used to treat gastro-intestinal disorders, led to the development of a series of related drugs for psychosis such as sulpiride, sultopride, and amisulpride. 

Table 41.5 summarizes existing studies on the use of atypical antipsychotics in EOS. As the table demonstrates, most studies have been carried out with clozapine, only three with olanzapine and two with risperidone each, and only one study has assessed use of amisulpride and one quetiapine. 

Several clinical trials with adults have demonstrated that amisulpride is effective in improving positive and negative symptoms of schizophrenia (Moller, 2000). There is one clinical trial including adolescent and young adulthood schizophrenia (Paillere-Martinot, 1995). Amisulpride was generally well tolerated and improved both positive and negative symptoms. 

Pailere-Martinot, M.L., Lecrubier, Y., Martin, J.L., and Aubin, F. (1995) Improvement of some schizophrenic deficit symptoms with low dose of amisulpride. Am J Psychiatry 152 130—133. 

Chlorpromazine and clozapine at low doses lead to an increase in slow (delta, theta) waves and a decrease in alpha activity in the pharmaco-EEG of healthy subjects. Findings regarding beta activity are less uniform. Rohloff et ul. (1992) reported on an increase in slow frequency components and a decrease of alpha and beta activity after 4.0 mg of haloperidol. Low doses of amisulpride (up to 50 mg) were reported to display an alertness-enhancing effect (Rosenzweig et ul., 2002). 

Antipsychotic drugs with strong sedative clinical effects (e.g. chlorpromazine. clozapine, olanzapine) produce subjective and objective sedation and impair most areas of performance in healthy volunteers, usually at doses far below those typically used in patients. Antipsychotic drugs with little sedative clinical action (e.g. pimozide, sulpiride, amisulpride) produce few subjective and objective effects in healthy... 

Cassano, G.B., Jori, M.C., on behalf of the AMIMAJOR investigators Efficacy and safety of amisulpride 50mg versus paroxetine 20 mg in major depression a randomized, double-blind, parallel group study, bit. Clin. Psvchopharmacol. 17, 27-32, 2002. 

Legangneux, E., McEwen, J., Wesnes, K., et a/. The acute effects of amisulpride (50 and 200mg) and haloperidol (2mg) on cognitive function in healthy elderly volunteers. J. Psvchopharmacol. 14, 164-171, 2000. 

Ramaekers, J.G., Louwerens, J.W., Munjewerff, N.D., et al. Psychomotor, cognitive, extrapyramidal, and affective functions of healthy volunteers during treatment with an atypical (amisulpride) and a classic (haloperidol) antipsychotic. J. Clin. Psychopharmacol. 19, 209-221, 1999. 

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