Amisulpride, often sold under the brand name Solian, is an antipsychotic and anti-nausea medication. It is used intravenously in smaller doses to treat postoperative nausea and vomiting, and orally in larger doses to treat schizophrenia in adults.

Amisulpride brand names

There are various brand names for amisulpride, the most prominent of which is Solian.

Other brand names include Amgrace, Amisure, Amisyt, Amplicon, ARIDE, Barhemsys, Bipo-Life, Doxamil, Goldpride, Psyride, Sizopride, Solaze, Sulpitac, Sulpra, Zonapride, and Zulpride.

What is amisulpride prescribed for?

The primary use of amisulpride is as a first-line treatment for the management of acute psychosis.[1] Adults with schizophrenia are often prone to psychotic episodes, where the patient can, along with hallucinations and delusions (positive symptoms), appear “distressed, not necessarily cooperative, out of touch, and agitated”.[1] The goal of using amisulpride here is to reduce patient distress. It is often associated with the management of agitation and sometimes aggressive behavior.[1]

Another common use of amisulpride is for treating postoperative nausea and vomiting (PONV). After an operation, patients can often feel nauseous and potentially vomit. This can cause distress for patients and can prolong care requirements.[2] If PONV persists after the administration of more conventional first-line anti-nausea prophylaxis, amisulpride has been found to be safe and effective as prophylaxis of postoperative nausea and vomiting when given in combination with an anti-nausea medication from another class.[2]

Studies have also shown that amisulpride can be very effective in the treatment of depression in patients with schizophrenia, in comparison to the more conventional treatment, risperidone.[3]

How does amisulpride work?

When used for treating schizophrenia, high doses of amisulpride work by blocking the dopamine D2 and D3 receptors in the brain. These receptors help regulate our locomotion (ability to move), attention, sleep, memory, learning, cognition (perception and understanding), and impulse control. The blocking of these receptors inhibits dopamine production, which in turn reduces the symptoms of psychosis (hallucinations, delusions, agitation, etc.).[4]

When used to treat depression in schizophrenic patients, smaller doses work by blocking the inhibitory receptors in the brain. This helps to increase dopamine production and thus aids with depression and anxiety (negative symptoms of schizophrenia).

When used to treat PONV, amisulpride blocks the signals to the brain that cause nausea and vomiting.

How is amisulpride usually taken?

When used to treat schizophrenia, amisulpride is usually taken orally in tablet form. The recommended daily dosage of oral amisulpride is between 400 and 800 milligrams per day.[5]

When used to treat PONV, it is injected intravenously (directly into the veins). The recommended dosage for treating PONV is five to ten milligrams.[6]

How long does amisulpride stay in and leave your system?

After an oral dose, the elimination half-life (the time it takes for the full dosage of a drug to reduce to half within the body) is around 12 hours.

For an intravenous dose, the elimination half-life is four to five hours.

Amisulpride is expelled from the body in the urine.

Amisulpride side effects

Like most antipsychotic medications, amisulpride can cause side effects, although the occurrence of side effects is rare. This is why there are few common side effects of the medication and any side effects from the below warrants further medical advice.

You should stop taking amisulpride immediatelyand seek medical attention if you have any of the following side effects:

  • Swelling of the hands, feet, ankles, face, lips, or throat. This can cause difficulty breathing or swallowing and could be accompanied by hives or rashes. This could mean you are having an allergic reaction to amisulpride.
  • Seizures/fits.
  • More frequent infections. This can be caused by a blood disorder or a decrease in white blood count.
  • Chest pain or an unusually fast heartbeat.
  • High temperature, sweating, or stiff muscles.
  • Blood clots (which cause swelling, pain, and redness).
  • Liver failure (symptoms include fatigue, loss of appetite, nausea, vomiting, abdominal pain, or yellow discoloration of the eyes or skin).

A doctor should be contacted as soon as possible if any of the following adverse effects are present:

  • Trembling, muscle stiffness, spasms, slow movement, overproduction of saliva, or restlessness.
  • Extrapyramidal symptoms (uncontrolled movements in the arms and legs).

Other side effects include:

  • Insomnia or anxiety
  • Drowsiness/tiredness
  • Constipation
  • Weight gain
  • Menstrual cycle disturbance
  • Breast enlargement in men
  • Difficulty in getting or maintaining an erection
  • Dizziness
  • Blurred vision

Amisulpride precautions

Before you take amisulpride, inform your doctor if you:

  • Are pregnant, plan on becoming pregnant, or are breast-feeding.
  • Have breast cancer.
  • Have a tumor on their adrenal gland.
  • Are under 18 years of age.
  • Have kidney problems.
  • Have diabetes.
  • Have Parkinson’s disease.
  • Have ever had epileptic fits.
  • Have an irregular heartbeat.
  • Are elderly.
  • Have low levels of potassium in your blood.
  • Are at risk of strokes.
  • Have a low white blood cell count.
  • Have frequent infections (such as fever or sore throat).
  • Have a family history of breast cancer.
  • Have high levels of prolactin (the hormone that causes breast milk production).

Amisulpride interactions

Before taking amisulpride, you should always inform your doctor or pharmacist if you are taking other medications, including medicines without prescriptions or herbal medicines. Amisulpride can have adverse reactions on the way other medicines work and vice versa.

Tell your doctor if you are taking any of the following:

  • Levodopa
  • Dopamine agonists (drugs that stimulate parts of the brain influenced by dopamine like ropinirole).
  • Medication to control heart rate (such as quinidine).
  • Clozapine
  • Medication used to control blood pressure and migraines (such as clonidine).
  • Mefloquine
  • Sleep aids such as benzodiazepines and barbiturates.
  • Painkillers (such as tramadol).
  • Anesthetics.
  • Antihistamines like promethazine (which makes you drowsy).
  • Medicines that affect the level of sodium and potassium in the blood (such as laxatives and glucocorticoids).

Do not drink alcohol while taking amisulpride, as it can alter the effect alcohol has on you.

Amisulpride storage

Keep amisulpride in a safe place and out of the reach of children. Do not use it when it has passed its expiration date.

What to do if you overdose on amisulpride

Studies have shown that overdoses of amisulpride can be highly cardiotoxic (harmful to the heart) and can cause various cardiovascular responses, including:

  • QT prolongation (your heart takes longer than usual to recover after each heartbeat).
  • Hypotension (low blood pressure).
  • Bradycardia (slow heart rate).
  • Torsades de Pointes (atypical heart rhythm).[7]

These conditions can all have potentially dangerous complications, and you should therefore seek medical assistance at the earliest opportunity.

Resources:

  1. Nuss P, Hummer M, Tessier C. The use of amisulpride in the treatment of acute psychosis. Ther Clin Risk Manag. 2007 Mar;3(1):3-11. doi: 10.2147/tcrm.2007.3.1.3. PMID: 18360610; PMCID: PMC1936283.
  2. Kranke P, Bergese SD, Minkowitz HS, Melson TI, Leiman DG, Candiotti KA, Liu N, Eberhart L, Habib AS, Wallenborn J, Kovac AL, Diemunsch P, Fox G, Gan TJ. Amisulpride prevents postoperative nausea and vomiting in patients at high risk: A randomized, double-blind, placebo-controlled trial. Anesthesiology. 2018 Jun; 128(6):1099-1106. doi: 10.1097/ALN.0000000000002133. PMID: 29543631.
  3. Kim SW, Shin IS, Kim JM, Lee SH, Lee JH, Yoon BH, Yang SJ, Hwang MY, Yoon JS. Amisulpride versus risperidone in the treatment of depression in patients with schizophrenia: a randomized, open-label, controlled trial. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Oct 1;31(7):1504-9. doi: 10.1016/j.pnpbp.2007.07.005. Epub 2007 Jul 13. PMID: 17692448.
  4. Bhatia A, Lenchner JR, Saadabadi A. Biochemistry, dopamine receptors. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from:https://www.ncbi.nlm.nih.gov/books/NBK538242/
  5. Curran MP, Perry CM. Amisulpride: A review of its use in the management of schizophrenia. Drugs. 2001;61(14):2123-50. doi: 10.2165/00003495-200161140-00014. PMID: 11735643.
  6. Täubel J, Ferber G, Fox G, Fernandes S, Lorch U, Camm AJ. Thorough QT study of the effect of intravenous amisulpride on QTc interval in Caucasian and Japanese healthy subjects. Br J Clin Pharmacol. 2017 Feb; 83(2):339-348. doi: 10.1111/bcp.13128. Epub 2016 Oct 21. PMID: 27618796; PMCID: PMC5237697.
  7. Isbister GK, Balit CR, Macleod D, Duffull SB. Amisulpride overdose is frequently associated with QT prolongation and torsades de pointes. J Clin Psychopharmacol. 2010 Aug;30(4):391-5. doi: 10.1097/JCP.0b013e3181e5c14c. PMID: 20531221.