Sulpiride, dose

Compared to antipsychotics, there are even fewer studies on the prescribing patterns of antidepressants done in Asian countries. Pi etal. (1985) conducted a survey of psychotropic prescribing practices reported by psychiatrists in 29 medical schools in 9 Asian countries. Daily dose range of tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and nortriptyline in Asian countries was comparable to the practice in USA. This is despite differences found between Asian and non-Asian populations in the pharmacokinetics of TCAs (Pi et al, 1993). A questionnaire on the practical prescribing approaches in mood disorders administered to 298 Japanese psychiatrists was reported by Oshima et al. (1999). As first-line treatment, the majority of respondents chose newer TCAs or non-TCAs for moderate depression and older TCAs for severe depression. Combination of antidepressants and anxiolytics was preferred in moderate depression, while an antidepressant and antipsychotic combination was common in severe psychotic depression. Surprisingly, sulpiride was the most favored drug for dysthymia. In a naturalistic, prospective follow-up of 95 patients with major depression in Japan, the proportion of patients receiving 125 mg/day or less of imipramine was 69% at one month and 67% at six months (Furukawa et al., 2000). 

Other newer agents were claimed to provide the benefits of clozapine without the drawback of potentially lethal agranulocytosis, but recent studies indicate that older agents like perphenazine and sulpiride when used in sensitive dose regimens provide as good an outcome as any other drugs. 

Tiapride and sulpiride are neuroleptics of the substituted benzamide class. These selective Dj blockers have weak antipsychotic properties and are not available in the United States, although they are commonly used in Europe for the treatment of tics. In a pair of 6-week controlled trials involving 27 children with TS, at doses ranging from 4 to 6 mg/kg/day, tiapride was superior to placebo and produced a 30%-44% decrease in videotaped tic counts (Eggers et ah, 1988). 

In an uncontrolled retrospective study of 63 patients with TS, ages 10-68 years, many of whom were on other medications, sulpiride produced a positive response in 60% of subjects (Robertson et ah, 1990). The modal daily dose of responders was 400 mg (dose range 200-1000 mg/day). Drowsiness, depression, ak-athisia, and weight gain were common side effects. 

Kahn NH, Shelton SJ Defensive behaviors in infant rhesus monkeys environmental cues and neurochemical regulation. Science 243 1718-1721, 1989 Kahnowsky LB, Kennedy F Observations in electric shock therapy apphed to problems of epilepsy. J Nerv Ment Dis 98 56-67, 1943 Kampen D, Sherwin B Estrogen use and verbal memory in healthy postmenopausal women. Obstet Gynecol 83 979-983, 1994 Kane JM, Quitkin FM, Rifkin A, et al Lithium carbonate and imipramine in the prophylaxis of unipolar and bipolar 11 illness a prospective placebo-controlled comparison. Arch Gen Psychiatry 39 1065-1069, 1982 Kaneno S, Komatsu H, Fukamauchi F, et al Biochemical basis of antidepressant-effect of low dose of sulpiride. Japanese Journal of Psychiatry and Neurology 45 131-132, 1991... 

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... 

As opposed to the disorders of the preceding paragraph, a decrease in dopaminergic transmission may be one of the neurochemical alterations in depression (Dailly et al. 2004). The selective antagonists at D2-like receptors sulpiride and amisulpride, when given at low doses, reduce depression symptoms, presumably by blockade of D2-autoreceptors and enhancement of dopamine release (Racagni et al. 2004). Sulpiride in fact increased the release of [3H]-dopamine in human neocortex slices... 

In addition, we calculate the relative specificity of the antagonists by determining the minimum dose required to attenuate bradykinin or isoproterenol divided by the minimum dose required to attenuate DA. As noted in Table II, sulpiride is the most potent antagonist and also has a large range of specificity. 

Figure 6.17 The classification of 42 drugs in the (solubility-dose ratio, apparent permeability) plane of the QBCS. The intersection of the dashed lines drawn at the cutoff points form the region of the borderline drugs. Key 1 acetyl salicylic acid 2 atenolol 3 caffeine 4 carbamazepine 5 chlorpheniramine 6 chlorothiazide 7 cimetidine 8 clonidine 9 corticosterone 10 desipramine 11 dexamethasone 12 diazepam 13 digoxin 14 diltiazem 15 disopyramide 16 furosemide 17 gancidovir 18 glycine 19 grizeofulvin 20 hydrochlorothiazide 21 hydrocortisone 22 ibuprofen 23 indomethacine 24 ketoprofen 25 mannitol 26 metoprolol 27 naproxen 28 panadiplon 29 phenytoin 30 piroxicam 31 propanolol 32 quinidine 33 ranitidine 34 salicylic acid 35 saquinavir 36 scopolamine 37 sulfasalazine 38 sulpiride 39 testosterone 40 theophylline 41 verapamil HC1 42 zidovudine.

Pich EM, Samanin R (1986) Disinhibitory effects of buspirone and low doses of sulpiride and haloperidol in two experimental anxiety models in rats possible role of dopamine. Psychopharmacology 89 125-130. 

PHENOTHIAZINES, SULPIRIDE ANTACIDS 1 levels of these antipsychotics 1 absorption Separate doses by 2 hours (in the case of sulpiride, give sulpiride 2 hours after but not before the antacid)... 

Compared to sulpiride, amisulpride has better oral bioavailability and more potency, thus allowing lower dosing, less weight gain, and fewer extrapyramidal symptoms... 

Low doses of sulpiride may be more effective at reducing negative symptoms than positive symptoms in schizophrenia high doses may be equally effective at reducing both symptom dimensions... 

Sulpiride is eliminated by the renal route in cases of severe renal insufficiency, the dose should be decreased and intermittent treatment or switching to another antipsychotic should be considered... 

Sulpiride is poorly absorbed from fhe gasfroinfesfinal fracf and penefrafes fhe blood brain barrier poorly, which can lead fo highly variable clinical responses, especially af lower doses... 

Since the potency (therapeutic efficacy in relation to weight) of antipsychotic agents varies markedly between compounds, it is useful to think of the effective antipsychotic dose of classical agents in terms of chlorpromazine equivalents (see Table 19.5). For example, haloperidol has a relatively high anh-psychotic potency, such that 2-3 mg is equivalent to chlorpromazine 100 mg, whereas sulpiride 200 mg (low potency) is required for the same antipsychotic effect. 

An immediate improvement in the drug properties could be obtained by the replacement of the sulfamido group with a more lipophilic group such as halogen. Compound (70) inhibited apomorphine-induced stereotypy in rats at a 30-fold lower dose than sulpiride (330). Whereas the racemic 2,6-di-methoxy derivative (71) was equipotent with sulpiride against apomorphine mediated behaviors, the S-enantiomer of the 3-bromo-2,6-dimethoxy derivative (remoxipride) (72) closely resembled haloperidol in its ability to block apomorphine-induced hyperactivity. The sevenfold ratio of stereotypy to hyperactivity for remoxipride suggested a low propensity to produce EPS in the clinic. Remoxipride was briefly used in clinical practice, but the development of aplastic anemia in a minority of patients led to its eventual withdrawal (331). 

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