Amisulpride effects

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... 

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. 

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... 

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. 

Perroud N, Huguelet P. A possible effect of amisulpride on a prolactinoma growth in a woman with borderline personality disorder. Pharmacol Res 2004 50 377-9. 

The atypical antipsychotics are divided into two major pharamacological groups, namely the multiple receptor antagonists, such as clozapine, olanzapine and quetiapine, and the more selective 5-HT2/D2 antagonists as exemplified by risperidone, sertindole, ziprasidone and zotepine. The benzamide antipsychotic amisulpride is the most selective antagonist for the D2/D3 receptors which presumably gives it the mesocortical selectivity of action with a minimal effect on the dopamine receptors in the basal ganglia. 

Peretti, C. S., Danion, J. M., Kauffmann-Muller, R, Grange, D., Patat, A., Rosenzweig, P. 1997, Effects of haloperidol and amisulpride on motor and... 

In a randomized, double-blind, multicenter comparison of amisulpride 1000 mg/day (n = 70) and flupenthixol 25 mg/day (n = 62) for 6 weeks, the two drugs significantly improved the acute psychotic symptoms to a similar extent (32). The total numbers of dropouts were 19 with amisulpride and 25 with flupenthixol. Adverse effects accounted for 8.6 and 18% respectively of the totals. Amisulpride caused significantly fewer extrapyramidal adverse effects. Apart from the extrapyramidal adverse effects, there were treatment-related adverse events in 87% of the patients given amisulpride and 92% of those given flupenthixol. Prolactin concentrations were higher with amisulpride. 

Fixed doses of amisulpride (100, 400, 800, and 1200 mg/ day) and haloperidol (16 mg/day) have been compared in a 4-week, double-blind, randomized trial in 319 patients with acute exacerbations of schizophrenia (33). Amisulpride 400 mg/day and 800 mg/day was effective in treating the positive symptoms of schizophrenia, with fewer extrapyramidal adverse effects than haloperidol,... 

Amisulpride 600-1200 mg/day for 3 months was effective and well tolerated in 445 patients with schizophrenia aged 18 15 years (1). During this time, 124 patients (28%) dropped out of the study 21% reported adverse events, neurological (35%), psychiatric (15%), or endocrine (9.1%). Seven adverse events were assessed as serious two suicides, two suicide attempts, one neuroleptic malignant syndrome, one somnolence, and one worsening of arteritis. 

In a randomized double-blind study, there were no differences in the numbers of patients with at least one adverse effect with amisulpride 100 mg (24% n = 18), amisulpride 50 mg (25% n = 21), or placebo (33% n = 27) (5). Few patients had endocrine symptoms (2 out of 160 in the amisulpride groups). 

In a randomized, double-blind, crossover study in 21 healthy volunteers who took amisulpride 50 mg/day, amisulpride 400 mg/day, haloperidol 4 mg/day, or placebo, amisulpride 400 mg had several adverse effects on psychomotor performance and cognitive performance, similar to those of haloperidol, at the end of the 5-day course of treatment however, there were no signs of mental disturbances on clinical rating scales or during a structured psychiatric interview (17). 

FLECAINIDE ANTIPSYCHOTICS -PHENOTHIAZINES, AMISULPRIDE, PIMOZIDE, SERTINDOLE Risk of arrhythmias Additive effect. Also, haloperidol and thioridazine inhibit CYP2D6-mediated metabolism of flecainide Avoid co-administration... 

Although animal studies have not shown teratogenic effect, amisulpride is not recommended for use during pregnancy... 

The newer atypical psychotropics vary widely in their receptor binding profiles. Olanzapine and quetiapine bear resemblance to the profile of clozapine in that their therapeutic effects appear to derive from action on different receptors and transmitter systems. All atypicals (except amisulpride) exhibit greater antagonism of SHT -receptors than Baroceptors compared with the classical agents. Atypical drugs that do antagonise dopamine D -receptors appear to have affinity for those in the... 

Clozapine and olanzapine are the most likely of the atypical agents to cause anticholinergic (anti-muscarinic) effects. They are more likely than other atypicals to cause weight gain (glucose tolerance may be impaired and should be monitored in susceptible individuals) and are second only to quetiapine in their sedative effects. Sexual dysfunction and skin problems are rare with atypical antipsychotics. Risperidone and amisulpride are as likely as classical antipsychotics to raise prolactin concentrations and cause galactorrhoea. 

Two narrative reviews of amisulpride have been published (4,5). The authors emphasized that amisulpride in low dosages (below 300 mg/day) causes a similar incidence of adverse effects to placebo nevertheless, at higher dosages (400-1200 mg/day), the overall incidence of adverse events in those taking amisulpride was similar to that in patients taking haloperidol, flupenthixol, or risperidone. The most commonly reported adverse events associated with higher dosages of amisulpride were extrapyramidal... 

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