Formulary
Sulpiride: Indications, Dosing, Side Effects and Interactions
Sulpiride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Sulpiride: Indications, Dosing, Side Effects and Interactions
Sulpiride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Schizophrenia with predominantly negative symptoms**
- **Adult** (By Mouth): 200-400 mg twice daily; maximum 800 mg per day.
- **Elderly** (By Mouth): Lower initial dose to be given, increased gradually according to response.
**Schizophrenia with mainly positive symptoms**
- **Adult** (By Mouth): 200-400 mg twice daily; maximum 2.4 g per day.
- **Elderly** (By Mouth): Lower initial dose to be given, increased gradually according to response.
**Schizophrenia with predominantly negative symptoms for sulpiride**
- **Child 14-17 years (under expert supervision)** (By mouth): 200-400 mg twice daily; maximum 800 mg per day.
**Schizophrenia with mainly positive symptoms for sulpiride**
- **Child 14-17 years (under expert supervision)** (By mouth): 200-400 mg twice daily; maximum 2.4 g per day.
**Tourette syndrome (under expert supervision) for sulpiride**
- **Child 2-11 years** (By mouth): 50-400 mg twice daily.
- **Child 12-17 years** (By mouth): 100-400 mg twice 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) Cautions For sulpiride Aggressive patients (even low doses may aggravate symptoms); agitated patients (even low doses may aggravate symptoms); excited patients (even low doses may aggravate symptoms)
Contraindications
CNS depression; comatose states; phaeochromocytoma
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 sulpiride Common or very common Breast abnormalities Uncommon Muscle tone increased; orgasm abnormal Rare or very rare Oculogyric crisis Frequency not known Cardiac arrest; dyspnoea; embolism and thrombosis; hyponatraemia; SIADH; trismus; urticaria
Interactions
**Other interactions (9):**
- Associations contra-indicated Levodopa, antiparkinsonian drugs (including ropinirole): reciprocal antagonism of effects between levodopa or antiparkinsonian drugs (including ropinirole) and...
- Associations not recommended Alcohol: Enhances the sedative effects of neuroleptics.
- Avoid the consumption of alcoholic beverages and drugs containing alcohol.
- Combination with the following medications could induce torsades de pointes or prolong the QT interval (see section 4.4): - Bradycardia-inducing medications such as beta-blockers,...
- Electrolyte imbalance should be corrected - Class Ia antiarrhythmic agents such as quinidine, disopyramide.
- CNS depressants including narcotics, analgesics, sedative H1 antihistamines, barbiturates, benzodiazepines and other anxiolytics, clonidine and derivatives.
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.
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.
Renal impairment
Dose adjustments Reduce dose or increase dose interval; increase in small steps. M
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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