Amisulpride

CLINICAL USE

Treatment of acute and chronic
schizophrenia

DOSE IN NORMAL RENAL FUNCTION

50–1200 mg daily (in divided doses if
>300 mg); varies according to indication

PHARMACOKINETICS

  • Molecular weight                           :
    369.5
  • %Protein binding                           :
    16
  • %Excreted unchanged in urine     :
    50
  • Volume of distribution (L/kg)       :
    5.8
  • half-life – normal/ESRD (hrs)      :
    12/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    30–60 Reduce dose by 50%
    10–30 Use a third of the dose.

  • <10           :
    Use with caution. Start with
    minimum dose and increase
    according to patient’s response

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :
    Not dialysed. Dose as in
    GFR <10 mL/min
  • HD                     :
    Poorly dialysed. Dose as in
    GFR <10 mL/min
  • HDF/high flux   :
    Unknown dialysability. Dose as in
    GFR <10 mL/min
  • CAV/VVHD      :
    Poorly dialysed. Dose as in
    GFR=10–30 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Alcohol: may enhance CNS effects ofalcohol
  • Anaesthetics: enhanced hypotensive effect
  • Analgesics: increased risk of convulsionswith tramadol; enhanced hypotensive and
    sedative effects with opioids
  • Antiarrhythmics: increased risk ofventricular arrhythmias with antiarrhythmics that prolong the QT interval;
    avoid concomitant use with amiodarone,
    disopyramide and procainamide (risk of
    ventricular arrhythmias)
  • Antibacterials: avoid concomitant use withparenteral erythromycin (increased risk of
    ventricular arrhythmias)
  • Antidepressants: increased level oftricyclics
  • Antiepileptics: antagonises anticonvulsanteffect
  • Antihypertensives: increased risk ofhypotension
  • Antimalarials: avoid concomitant use withartemether/lumefantrine
    Antipsychotics: increased risk of

    ventricular arrhythmias with sertindole –
    avoid concomitant use

  • Antivirals: concentration possiblyincreased by ritonavir
    Anxiolytics & hypnotics: increased

    sedative effects

  • Atomoxetine: increased risk of ventriculararrhythmias
  • Beta-blockers: increased risk of ventriculararrhythmias with sotalol
    Diuretics: increased risk of ventricular

    arrhythmias due to hypokalaemia

  • Pentamidine: increased risk of ventriculararrhythmias – avoid
  • Sibutramine: increased risk of CNStoxicity – avoid concomitant use

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    Elimination half-life is unchanged in

    patients with renal insufficiency, while
    systemic clearance is reduced by a factor
    of 2.5–3. The area under the curve of
    amisulpride in mild renal failure is
    increased 2-fold, and almost 10-fold in
    moderate renal failure. Experience is
    limited and there is no data with doses
    >50 mg

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