CLINICAL USE


Antipsychotic:Acute and chronic schizophrenia

DOSE IN NORMAL RENAL FUNCTION

400–800 mg daily increasing to maximum 2.4 g daily

PHARMACOKINETICS

  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :341.4
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :40
  • %Excreted unchanged in urine &nbsp &nbsp : 90–95

  • Volume of distribution (L/kg) &nbsp &nbsp &nbsp :1.2–1.7

  • half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :8–9/26

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50 &nbsp &nbsp : Give 66% of normal dose, or increase dosing interval by factor of 1.5
  • 10 to 20 &nbsp &nbsp : Give 50% of normal dose, or incease dosing interval by factor of 2
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Give 30% of normal dose, or increase dosing interval by factor of 3

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR <10 mL/min
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Partly dialysed. Dose as in GFR <10 mL/min
  • HDF/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min
  • CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anaesthetics: enhanced hypotensive effect
  • Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioids
  • Anti-arrhythmics: increased risk of ventricular arrhythmias with anti-arrhythmics that prolong the QT interval, e.g. procainamide, disopyramide and amiodarone – avoid concomitant use with amiodarone
  • Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin – avoid concomitant use
  • Antidepressants: increased level of tricyclics; possibly increased risk of ventricular arrhythmias and antimuscarinic side effects
  • Anti-epileptics: antagonism (convulsive threshold lowered)
  • Antimalarials: avoid concomitant use with artemether/lumefantrine
  • Antipsychotics: increased risk of ventricular arrhythmias with pimozide – avoid concomitant use
  • Antivirals: concentration possibly increased with ritonavirAnxiolytics and hypnotics: increased sedative effects
  • Beta-blockers: enhanced hypotensive effect; increased risk of ventricular arrhythmias with sotalol
  • Diuretics: enhanced hypotensive effect
  • Lithium: increased risk of extrapyramidal side effects and possibly neurotoxicity
  • Pentamidine: increased risk of ventricular arrhythmias
  • Sibutramine: increased risk of CNS toxicity – avoid concomitant use

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    Sulpiride is almost entirely excreted in the urine as unchanged drug. Administer with caution and decrease the dose in renal impairment.
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