Clinical Overview
Sulpiride is an atypical antipsychotic with selective dopamine D2/D3 receptor antagonism, primarily available in European and other international markets. It has a dose-dependent mechanism similar to amisulpride, where low doses may improve negative symptoms while higher doses treat positive symptoms. It is indicated for schizophrenia and may also have antidepressant properties at lower doses.
Primary Clinical Applications
Sulpiride is indicated for schizophrenia and other psychotic disorders. At low doses (200-600 mg), it may be particularly useful for negative symptoms and depression, while higher doses (600-1600 mg) are used for positive symptoms. It may also be used for depression and dysthymia in some countries at lower doses.
Mechanism and Clinical Benefits
Sulpiride selectively blocks dopamine D2 and D3 receptors without significant activity at other neurotransmitter systems. Like amisulpride, it demonstrates dose-dependent effects: low doses preferentially block presynaptic autoreceptors (potentially improving negative symptoms), while higher doses block postsynaptic receptors (treating positive symptoms).
Clinical Considerations
The medication has minimal anticholinergic, antihistaminergic, or alpha-adrenergic effects, resulting in fewer side effects compared to many other antipsychotics. However, it can cause dose-related prolactin elevation and extrapyramidal symptoms. It is not metabolized by the liver and is eliminated unchanged by the kidneys, requiring dose adjustment in renal impairment.
Prescribing Information
Dosing & Administration
Schizophrenia – Acute Episodes:
- Initial: 600-800 mg daily in divided doses
- Range: 600-1600 mg daily
- Maximum: 1600 mg daily
Schizophrenia – Predominantly Negative Symptoms:
- Dose: 200-600 mg daily
- Optimal range: 300-400 mg daily
Depression (where approved):
- Dose: 150-300 mg daily
Administration:
- May take with or without food
- Divide doses >400 mg into twice daily dosing
- Lower doses may be given once daily
Indications
- Treatment of schizophrenia and other psychotic disorders
- Depression and dysthymia (in some countries)
- Vertigo and other vestibular disorders (specific formulations)
Contraindications
- Hypersensitivity to sulpiride
- Prolactin-dependent tumors (prolactinoma, breast cancer)
- Pheochromocytoma
- Concomitant use with levodopa
- Severe renal impairment
Warnings & Precautions
- Hyperprolactinemia: Dose-related, monitor prolactin levels
- Extrapyramidal symptoms: Dose-related risk
- QT prolongation: Monitor ECG in predisposed patients
- Neuroleptic malignant syndrome: Rare but serious risk
- Tardive dyskinesia: Risk with long-term use
- Hyperglycemia: Monitor glucose in diabetic patients
Drug Interactions
- Levodopa: Contraindicated – mutual antagonism
- QT-prolonging drugs: Additive QT prolongation risk
- CNS depressants: Enhanced sedation
- Antihypertensives: Enhanced hypotensive effects
Adverse Reactions
Common (>10%):
- Hyperprolactinemia, galactorrhea, amenorrhea
- Extrapyramidal symptoms (dose-related)
Endocrine:
- Prolactin elevation, sexual dysfunction
- Weight gain (generally modest)
Serious:
- Neuroleptic malignant syndrome, tardive dyskinesia
- QT prolongation
Special Populations
- Renal Impairment: Reduce dose for moderate-severe impairment
- Hepatic Impairment: No dose adjustment needed (not hepatically metabolized)
- Elderly: Start with lower doses, monitor for hypotension
- Pregnancy: Category C – use only if benefits outweigh risks
- Prolactin monitoring: Regular assessment for hyperprolactinemia
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.
