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[[Category: Drugs]][[Category: Antipsychotics, typical ; Antipsychotics, 1st Generation ]]
[[Category: Drugs]][[Category: Typical Antipsychotic ]]
'''Sulpiride''' (中文:[[舒必利]]) is a typical antipsychotic or 1st Generation antipsychotic medication. It is used in the treatment of psychosis associated with schizophrenia and major depressive disorder. In low dosage, it is used for anxiety and mild depression.


==Pronunciation==
[[:Category: Antipsychotic Drug | '''Antipsychotic Drug''']]
===Sulpiride 200mg===
[[File:Sulpiride 200mg.mp3]]


===Sulpiride 50mg===
'''Drug class: [[:Category: Typical Antipsychotic  | Typical Antipsychotic]]
[[File:Sulpiride 50mg.mp3]]


==Drug Names==
'''Sulpiride (DOGMATIL)'''（中文：[[舒必利]]）
{| class="wikitable"
==Common Strengths of Sulpiride Tablet==
!Generic Name 藥名
Sulpiride are available in the following strengths:
!HA Code 藥物代碼
*50 mg, 200 mg, 400 mg tablets/capsules
!Classification藥物分類
|-
|Sulpiride Cap 50 mg
|SULP19
|P1S1S3
|-
|Sulpiride Tab 200 mg
|SULP20
|P1S1S3
|}


==Mechanism of Action==
==Drug Trade Names of Sulpiride Tablet==
Sulpiride is a selective antagonist at dopamine  D2, D3 and 5-HT1A  receptors.
Dogmatil
The presumed effectiveness of antipsychotic drugs relied on their ability to block dopamine receptors. This assumption arose from the dopamine hypothesis that maintains that both schizophrenia and bipolar disorder are a result of excessive dopamine activity.


==Dosage==
==Drug Usage==
{| class="wikitable"
Treatment of acute and chronic schizophrenia
!style="text-align: left"| Indication
!style="text-align: left"| Dose
|-
!style="text-align: left"|
Schizophrenia with predominantly negative


symptoms(flattening of affect, poverty of
==Mechanism of Action==
Selective dopamine D<sub>2</sub> and D<sub>3</sub> receptor antagonist
speech, apathy, as well as depression)
|By ''mouth
ADULT:
*200 – 400 mg twice daily.
*Maximum 800 mg per day
ELDERLY or debilitated patients:
*Lower initial dose to be given
*Increased gradually according to response
|-
!style="text-align: left"|
Schizophrenia with mainly positive


symptoms(hallucinations, delusions,
==Route of Administration==
Oral


incongruity of speech) Respond to higher doses
==Dosages==
|By ''mouth
*Adults: 400 - 1200 mg daily, divided into 2 doses
ADULT:  
*200 – 400 mg twice daily
*Maximum 2.4 g per day
ELDERLY or debilitated patients:
*Lower initial dose to be given
*Increased gradually according to response
|}


==Side Effects==
==Side Effects==
Most serious and/or frequently occurring adverse effects of sulpiride include the following:
{| class="wikitable"
{| class = "wikitable"
!style="text-align: left"| Frequency
!style="text-align: left"| Endocrine disorders
!Adverse reactions
|  
|-
*Common: hyperprolactinaemia (elevated plasma levels of the hormone prolactin, which in turn lead to galactonrrhea, amornorrhea, gynecomastia etc)
| rowspan="13" | '''Common
| Dizziness
|-
|-
!style="text-align: left"| Nervous system
| Headache
|
|-
Common:
| Extrapyramidal side effects such as tremor, dystonia, akathisia, and parkinsonism
*Sedation or drowsiness
|-  
*Extrapyramidal side effects
| Drowsiness
-Tremor
 
-Akathisia – a sense of inner restlessness that cannot stay still
 
-Parkinsonism
*Anticholinergic side-effects such as:
-Dry mouth
 
-Constipation
 
-Blurred vision
Uncommon:
*Hypertonia
*Dyskinesia
Rare:
*Oculogyric crisis
Not known:
*Neuroleptic malignant syndrome
*Convulsion
*Tardive dyskinesia
|-
|-
!style="text-align: left"| Metabolism disorders
| Insomnia
|
|-
Not known:
| Weight gain or loss
*Hyponatraemia
|-
*Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
| Elevated levels of prolactin which can lead to sexual dysfunction, galactorrhea, amenorrhea, and gynecomastia
|-
| Nausea
|-
| Vomiting
|-
| Nasal congestion
|-  
| Anticholinergic effects such as dry mouth, constipation, and blurred vision
|-
| Impaired concentration
|-
| Increased skin sensitivity to sunlight
|-
|-
!style="text-align: left"| Cardiac disorders
| rowspan="8" | '''Serious
|
| Tardive dyskinesia: A potentially irreversible condition characterized by repetitive, involuntary movements of the face and tongue
Rare:
*Ventricular arrhythmia
*Ventricular fibrillation, or tachycardia
Not known:
*Electrocardiogram QT prolonged
|-
|-
!style="text-align: left"| Vascular disorder
| Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening condition marked by muscle stiffness, high fever, confusion, fast heartbeat, and sweating
|Uncommon: orthostatic hypotension
|-
|-
!style="text-align: left"| Gastrointestinal disorder
| Arrhythmias, low blood pressure, and in rare cases, cardiac arrest
|
Common: constipation
Uncommon: saliva hypersecretion
|-
|-
!style="text-align: left"| Breast disorder
| Severe allergic reactions: Anaphylactic shock, rash, and labored breathing
|Common: breast pain, galactorrhoea
|-
|-
!style="text-align: left"|
| Oculogyric crisis: Spastic movements that fix the eyes in an upward position
|
Common:  
*weight gain
|}
 
==Pharmacokinetics==
{|class="wikitable"
!style="text-align: left"| Oral bioavailability
|Sulpiride is readily absorbed after oral doses.
|-
|-
!style="text-align: left"| Onset of action
| Venous thromboembolism
|Peak plasma concentrations are reached 3 – 6 hours after an oral dose.
|-
|-
!style="text-align: left"| Metabolism
| Increased liver enzymes: Indicating potential liver dysfunction
|It is metabolized in the liver  
|-
|-
!style="text-align: left"| Elimination half-life
| Aspiration pneumonia
|
It is excreted in the urine and faeces.
 
The elimination half-life is approximately 8 hours.
|}
|}


==Drug Management==
==Pharmacokinetics==
===Monitoring===
*Time to peak plasma concentration: between 3 to 6 hours after dosing
*Sulpiride does not affect blood pressure to the same extent as other antipsychotic drugs and so blood pressure monitoring is not mandatory for this drug.  
*Sulpiride undergoes minimal metabolism in the body. About 95% excreted unchanged in urine.
*Careful monitoring is required in the elderly who are particularly susceptible to sedation, and extrapyramidal effects, chronic constipation, and possible prostatic hypertrophy.


===Drug interaction===  
==Drug Precautions==
Sulpiride does not inhibits or stimulates cytochrome P450 enzymes, so would not cause clinically significant interactions with other drugs which are metabolized by CYPs.
'''Pregnancy


{| class="wikitable"
Use only if benefits outweigh risks. Risk of extrapyramidal/withdrawal symptoms in newborns exposed in 3rd trimester.
!style="text-align: left"| Drugs given with sulpiride
!style="text-align: left"| Potential Effect
|-
|style="text-align: left"|
*CNS-depressant drugs including alcohol,
hypnotics, anxiolytics, sedative H1 antihistamines,
central antihypertensives, baclofen, thalidomide and opioids.
|
Potentiates the sedative effect.
|-
|style="text-align: left"|
*Lithium
|Increased risk of extrapyramidal effects.
|-
| style="text-align: left"|
*Tricyclic antidepressants such as amitriptyline, a CYP2D6 substrate, and pericyazine is potent inhibitor of CYP2D6.
|Metabolism and elimination of tricyclics significantly decreased, increased toxicity such as anticholinergic and cardiovascular side effects.
|-
| style="text-align: left"|
*Levodopa,
*Antiparkinsonian drugs (including ropinirole)
|
Antipsychotics with dopamine-blocking activity and dopaminergic drugs such as those used to treat parkinsonism may be mutually antagonistic.
|-
| style="text-align: left"|
*Drugs that prolong the QT interval e.g. amiodarone, sotalol, quinidine
*Drugs which induce bradycardia e.g. diltiazem, verapamil
*Drugs which can cause hypokalaemia such as diuretics e.g. frusemide
|
*An increased risk of ventricular arrhythmias – avoid concomitant use.
|}


===Caution===
'''Breastfeeding
*Sulpiride may increase prolactin levels. Therefore, caution should be exercised in patients with a history or a family history of breast cancer.
*In patients with impaired liver
*In patients with cardiovascular disorders, bradycardia, hypokalaemia or prolongation of QT, because of a risk of worsening of long QT-syndrome, which may also elevate the risk of tachycardia and sudden death.
*Concomitant use with QT prolonging drugs should be avoided
*In epileptics due to a possible lowering of the seizure threshold. The occurrence of convulsive seizures necessitates the discontinuation of treatment.
*In patients with a history of glaucoma, urine retention or hyperplasia of the prostate.


===Contra-indications===
Excreted in breast milk.  
Use of sulpiride should be avoided in individuals with:
*CNS depression
*Comatose states
*Parkinson’s disease
*Phaeochromocytoma
*Concomitant prolactin-dependent tumours e.g. pituitary gland prolactinomas and breast cancer


===Hepatic impairment===
'''Children and Elderly
*Can precipitate coma.
*Children: Not recommended for children under 14 years
*Elderly: Lower starting doses recommended


===Renal impairment===
'''Renal Impairment
*Start with small doses in severe renal impairment because of increased cerebral sensitivity.


===Pregnancy===
Use with caution, dose adjustment may be needed
*Should be avoided in pregnancy.


===Breast-feeding===
'''Monitoring Requirements
*Use during breast feeding is not recommended.
*Extrapyramidal symptoms
*Monitor for increased sedation when sulpiride is used with other CNS depressants
*Regular ECG in patients at risk of QT prolongation
*Monitor potassium levels when sulpiride is used with diuretics or stimulant laxatives.
*Complete blood count
*Liver function tests
*Blood pressure
*Eye examinations (long-term use)


===Driving and skilled tasks===
'''Drug Interactions
Drivers and machine operators should be told about the risk of drowsiness with this medication especially at the start of treatment. Affected patients should not drive or operate machinery.
*Increased sedation with CNS depressants:
**Sedatives and Sleeping Pills: Drugs like nitrazepam, diazepam, and temazepam can increase the sedative effects of sulpiride, leading to enhanced drowsiness and sedation
**Narcotics and Strong Pain Relievers: Medications such as codeine phosphate, morphine, and dihydrocodeine can also amplify CNS depression when taken with sulpiride
*Increased risk of arrhythmias with drugs that prolong QT interval
**Antiarrhythmics: Drugs such as disopyramide, amiodarone, sotalol, and quinidine can increase the risk of cardiac arrhythmias when used with sulpiride
**Antihypertensives and Heart Medications: Clonidine, verapamil, diltiazem, and digitalis may have enhanced effects, potentially leading to hypotension and other cardiovascular issues
**Diuretics and Laxatives: These can lower potassium levels, increasing the risk of cardiac arrhythmias when taken with sulpiride
*Levodopa and Ropinirole: These drugs can antagonize the effects of sulpiride, and their combination should be avoided
*Lithium (increased extrapyramidal effects risk)
*Sucralfate and Magnesium Hydroxide (antacid) can decrease the absorption of sulpiride, reducing its effectiveness. It is recommended to administer sulpiride two hours before these medications


==FAQ==
==FAQ==
===How should I take the tablet?===
'''How Should I Take the Tablet?
You will be prescribed the lowest dose needed to control your symptoms. Take with food. Food reduces irritation.
 
===What should I avoid while taking?===
It can be taken with or without food.
Avoid drinking alcohol while taking sulpiride because it may enhance the side effects of sedation.  
 
'''What Should I Avoid While Taking?
 
Avoid alcohol and activities requiring mental alertness until you know how trifluoperazine affects you.


Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.
'''What Happens if I Miss a Dose?


===What happen if I overdose?===
Take the missed dose as soon as you remember unless it is almost time for your next dose. Do not double doses.
Contact your primary care doctor.
If emergency situation, call 999
===What happen if I miss a dose?===
Take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the
regular time. Do not double the dose to catch up.

Latest revision as of 23:22, 31 July 2024


Antipsychotic Drug

Drug class: Typical Antipsychotic

Sulpiride (DOGMATIL)（中文：舒必利）

Common Strengths of Sulpiride Tablet[edit]

Sulpiride are available in the following strengths:

  • 50 mg, 200 mg, 400 mg tablets/capsules

Drug Trade Names of Sulpiride Tablet[edit]

Dogmatil

Drug Usage[edit]

Treatment of acute and chronic schizophrenia

Mechanism of Action[edit]

Selective dopamine D2 and D3 receptor antagonist

Route of Administration[edit]

Oral

Dosages[edit]

  • Adults: 400 - 1200 mg daily, divided into 2 doses

Side Effects[edit]

Frequency Adverse reactions
Common Dizziness
Headache
Extrapyramidal side effects such as tremor, dystonia, akathisia, and parkinsonism
Drowsiness
Insomnia
Weight gain or loss
Elevated levels of prolactin which can lead to sexual dysfunction, galactorrhea, amenorrhea, and gynecomastia
Nausea
Vomiting
Nasal congestion
Anticholinergic effects such as dry mouth, constipation, and blurred vision
Impaired concentration
Increased skin sensitivity to sunlight
Serious Tardive dyskinesia: A potentially irreversible condition characterized by repetitive, involuntary movements of the face and tongue
Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening condition marked by muscle stiffness, high fever, confusion, fast heartbeat, and sweating
Arrhythmias, low blood pressure, and in rare cases, cardiac arrest
Severe allergic reactions: Anaphylactic shock, rash, and labored breathing
Oculogyric crisis: Spastic movements that fix the eyes in an upward position
Venous thromboembolism
Increased liver enzymes: Indicating potential liver dysfunction
Aspiration pneumonia

Pharmacokinetics[edit]

  • Time to peak plasma concentration: between 3 to 6 hours after dosing
  • Sulpiride undergoes minimal metabolism in the body. About 95% excreted unchanged in urine.

Drug Precautions[edit]

Pregnancy

Use only if benefits outweigh risks. Risk of extrapyramidal/withdrawal symptoms in newborns exposed in 3rd trimester.

Breastfeeding

Excreted in breast milk.

Children and Elderly

  • Children: Not recommended for children under 14 years
  • Elderly: Lower starting doses recommended

Renal Impairment

Use with caution, dose adjustment may be needed

Monitoring Requirements

  • Extrapyramidal symptoms
  • Monitor for increased sedation when sulpiride is used with other CNS depressants
  • Regular ECG in patients at risk of QT prolongation
  • Monitor potassium levels when sulpiride is used with diuretics or stimulant laxatives.
  • Complete blood count
  • Liver function tests
  • Blood pressure
  • Eye examinations (long-term use)

Drug Interactions

  • Increased sedation with CNS depressants:
    • Sedatives and Sleeping Pills: Drugs like nitrazepam, diazepam, and temazepam can increase the sedative effects of sulpiride, leading to enhanced drowsiness and sedation
    • Narcotics and Strong Pain Relievers: Medications such as codeine phosphate, morphine, and dihydrocodeine can also amplify CNS depression when taken with sulpiride
  • Increased risk of arrhythmias with drugs that prolong QT interval
    • Antiarrhythmics: Drugs such as disopyramide, amiodarone, sotalol, and quinidine can increase the risk of cardiac arrhythmias when used with sulpiride
    • Antihypertensives and Heart Medications: Clonidine, verapamil, diltiazem, and digitalis may have enhanced effects, potentially leading to hypotension and other cardiovascular issues
    • Diuretics and Laxatives: These can lower potassium levels, increasing the risk of cardiac arrhythmias when taken with sulpiride
  • Levodopa and Ropinirole: These drugs can antagonize the effects of sulpiride, and their combination should be avoided
  • Lithium (increased extrapyramidal effects risk)
  • Sucralfate and Magnesium Hydroxide (antacid) can decrease the absorption of sulpiride, reducing its effectiveness. It is recommended to administer sulpiride two hours before these medications

FAQ[edit]

How Should I Take the Tablet?

It can be taken with or without food.

What Should I Avoid While Taking?

Avoid alcohol and activities requiring mental alertness until you know how trifluoperazine affects you.

What Happens if I Miss a Dose?

Take the missed dose as soon as you remember unless it is almost time for your next dose. Do not double doses.

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