Sulpiride

Drug Class: Antipsychotics, typical ; Antipsychotics, 1st Generation Sulpiride (中文:[[ ]])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

Sulpiride 200mg

Sulpiride 50mg

Drug Names

Generic Name 藥名	HA Code 藥物代碼	Classification藥物分類
Sulpiride Cap 50 mg	SULP19	P1S1S3
Sulpiride Tab 200 mg	SULP20	P1S1S3

Mechanism of Action

Sulpiride is a selective antagonist at dopamine D2, D3 and 5-HT1A receptors. 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

Indication	Dose
Schizophrenia with predominantly negative symptoms(flattening of affect, poverty of 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
Schizophrenia with mainly positive symptoms(hallucinations, delusions, incongruity of speech) Respond to higher doses	By mouth 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

Most serious and/or frequently occurring adverse effects of sulpiride include the following:

Endocrine disorders	Common: hyperprolactinaemia (elevated plasma levels of the hormone prolactin, which in turn lead to galactonrrhea, amornorrhea, gynecomastia etc)
Nervous system	Common: Sedation or drowsiness Extrapyramidal side effects -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
Metabolism disorders	Not known: Hyponatraemia Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Cardiac disorders	Rare: Ventricular arrhythmia Ventricular fibrillation, or tachycardia Not known: Electrocardiogram QT prolonged
Vascular disorder	Uncommon: orthostatic hypotension
Gastrointestinal disorder	Common: constipation Uncommon: saliva hypersecretion
Breast disorder	Common: breast pain, galactorrhoea
	Common: weight gain

Pharmacokinetics

Oral bioavailability	Sulpiride is readily absorbed after oral doses.
Onset of action	Peak plasma concentrations are reached 3 – 6 hours after an oral dose.
Metabolism	It is metabolized in the liver
Elimination half-life	It is excreted in the urine and faeces. The elimination half-life is approximately 8 hours.

Drug Management

Monitoring

• 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.
• Careful monitoring is required in the elderly who are particularly susceptible to sedation, and extrapyramidal effects, chronic constipation, and possible prostatic hypertrophy.

Drug interaction

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