Formulary
Amisulpride: Indications, Dosing, Side Effects and Interactions
Amisulpride is a selective dopamine receptor antagonist with high affinity for mesolimbic D 2 and D 3 receptors.
MedNext Academy | 4 min read
Amisulpride: Indications, Dosing, Side Effects and Interactions
Amisulpride is a selective dopamine receptor antagonist with high affinity for mesolimbic D 2 and D 3 receptors.
Drug action
Amisulpride is a selective dopamine receptor antagonist with high affinity for mesolimbic D 2 and D 3 receptors.
Indications and dose
**Acute psychotic episode in schizophrenia**
- **Adult** (By Mouth): 400-800 mg daily in 2 divided doses, adjusted according to response; maximum 1.2 g per day.
**Schizophrenia with predominantly negative symptoms**
- **Adult** (By Mouth): 50-300 mg daily.
**Acute psychotic episode in schizophrenia for amisulpride**
- **Child 15-17 years (under expert supervision)** (By mouth): 200-400 mg twice daily, adjusted according to response; maximum 1.2 g per day.
**Schizophrenia with predominantly negative symptoms for amisulpride**
- **Child 15-17 years (under expert supervision)** (By mouth): 50-300 mg daily.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated); photosensitisation (may occur with higher dosages); prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention)
Contraindications
CNS depression; comatose states; phaeochromocytoma; prolactin-dependent tumours
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For amisulpride Common or very common Anxiety; breast pain; nausea; oculogyric crisis; orgasm abnormal; trismus; vision blurred Uncommon Bone disorders; dyslipidaemia; hepatic disorders; nasal congestion; pneumonia aspiration Rare or very rare Angioedema; embolism and thrombosis; hyponatraemia; neoplasms; SIADH; urticaria Frequency not known Photosensitivity reaction
Interactions
**Other interactions (5):**
- Amisulpride may oppose the effect of dopamine agonists e.g.
- Combinations not recommended: Medicinal products which enhance the risk of torsade de pointes or could prolong the QT interval: bradycardia-inducing medicinal products such as beta-blockers,...
- Hypokalaemia should be corrected.
- Therefore alcohol should not be consumed during treatment.
- Combinations which require precautions for use: Concomitant use of the following agents can lead to potentiation of the effect: CNS depressants including narcotics, anaesthetics, analgesics,...
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. Pregnancy For amisulpride Avoid.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting. Breast feeding For amisulpride Avoid-no information available.
Renal impairment
Manufacturer advises caution if creatinine clearance less than 10 mL/minute (no information available). Dose adjustments See Prescribing in renal impairment . Manufacturer advises halve dose if creatinine clearance 30-60 mL/minute. Manufacturer advises use one-third dose if creatinine clearance 10-30 mL/minute.
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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