Amisulpride extrapyramidal adverse

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,... 

A lower dose of amisulpride (50 mg) has been tested in 20 healthy elderly volunteers (aged 65-79 years) (2). There were no serious adverse events, but one subject reported a moderate headache for 18 hours, a second subject vomited 9 hours after dosing, and a further subject complained of mild somnolence for 12 hours starting 4 hours after dosing however, there were no extrapyramidal symptoms, clinically significant hemodynamic variations, or electrocardiographic abnormalities. 

There were moderate but significant improvements in neurocognition (including executive function, working memory, and declarative memory) in a randomized, double -blind, 8-week study in 52 patients with schizophrenia assigned either to olanzapine (10-20 mg/day n = 18) or amisulpride (400-800 mg/day n = 18) (11). Of 16 dropouts, six were due to adverse events olanzapine—sedation (n = 2) and increased transaminases (n = 1) amisulpride—rash, extrapyramidal symptoms, and galactorrhea (n — 1 each). 

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... 

A 6-week, randomised, open-label study compared amisulpride initiated at 800 mg per day and amisulpride initiated at 400 mg per day [86 j. Both doses were associated with hyperprolactinaemia and extrapyramidal symptoms but there were no statistically significant differences in the overall incidence of adverse events between the two. 

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