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Psychosis in Children and Young People
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Tony James, Lakshmeesh Muttur Somashekhar
Although recent trials in adults indicate that amisulpride may be more effective than other antipsychotics, there is little to choose between these medications, and the patient’s choice may be guided by the side-effect profile. Convention dictates that a failed trial of up to six weeks, since research suggests early benefit should be seen by three weeks, of two antipsychotics should be followed by a trial of clozapine, recognised as the most effective antipsychotic. A recent study in adults suggests that a single trial of amisulpride may be all that is necessary and that a second trial of another antipsychotic confers little, or no, advantage (Kahn et al., 2018). Clozapine is not used first line (except in China), because of the risks of agranulocytosis and cardiac effects which require regular blood and ECG monitoring. Unfortunately, around 30% of patients remain refractory to treatment, possibly higher in children and adolescents with schizophrenia, who have a higher rate of treatment resistance and corresponding poorer prognosis. Indeed, the outlook for childhood-onset schizophrenia is very poor, with 50% remaining ill at long-term follow-up (Eggers and Bunk, 2009). There is very little evidence for the use of a combination of antipsychotics, or higher than recommended doses. An important practice point for the treatment in hospital of disturbances often involving violence is that benzodiazepines are preferred for sedation, rather than high-dose antipsychotics.
Treatment of anorexia nervosa
Published in Stephen Wonderlich, James E Mitchell, Martina de Zwaan, Howard Steiger, Annual Review of Eating Disorders Part 2 – 2006, 2018
A single-blind comparison of amisulpride, fluoxetine and clomipramine in restricting AN patients was conducted by Rigerrio et al. (2001). This was a single-blind condition in which 13 patients received clomipramine, 10 patients received fluoxetine and 12 patients received amisulpride. Mean dosages were 57.7 mg, 28 mg, and 50 mg, respectively. Patients treated with amisulpride had a significantly greater increase of mean weight compared to the other two drugs. No difference was present in measures of weight phobia, body-image disturbance and amenorrhea.
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Amisulpride is weakly metabolised: two inactive metabolites, accounting for approximately 4% of the dose, have been identified. Amisulpride is eliminated unchanged in the urine. Fifty percent of an intravenous dose is excreted via the urine, of which 90% is eliminated in the first 24 hours.
Antipsychotic drug treatment of schizophrenia in later life: Results from the European cross-sectional AMSP study
Published in The World Journal of Biological Psychiatry, 2022
Oliver Zolk, Timo Greiner, Michael Schneider, Martin Heinze, Volker Dahling, Tabea Ramin, Renate Grohmann, Stefan Bleich, Tristan Zindler, Sermin Toto, Johanna Seifert
Concerning pharmacokinetics, most APDs undergo extensive metabolism and are excreted as metabolites in the urine (e.g. clozapine, olanzapine, quetiapine, risperidone, haloperidol, pipamperone, melperone) or in the faeces (e.g. aripiprazole, flupentixol, zuclopenthixol). Amisulpride is weakly metabolised and is predominantly eliminated unaltered in the urine. Several studies have shown a significant reduction in the clearance of many drugs metabolised by phase-1 pathways in the liver of older adults. The main factor is probably represented by the age-related changes in liver size and hepatic blood flow as the activity of drug metabolising enzymes is preserved. Reduction in renal function in older patients may affect the clearance of renally eliminated APDs such as amisulpride. Accordingly, many studies have shown that age has a significant effect on serum concentrations of various APDs such as clozapine, olanzapine, risperidone, and quetiapine (Castberg et al. 2017), while a few studies have failed to confirm these results (Bigos et al. 2008; Uchida et al. 2009). In particular, studies that adopted a population pharmacokinetic modelling approach using data from dose-finding and pivotal trials were often unable to show a significant effect of age (Albitar et al. 2020) due to the exclusion of older patients from participation in these trials .
Current pharmacotherapeutic approaches for dysthymic disorder and persistent depressive disorder
Published in Expert Opinion on Pharmacotherapy, 2019
Mauro Giovanni Carta, Pasquale Paribello, Antonio Egidio Nardi, Antonio Preti
A 2009 Cochrane review on the efficacy of second-generation antipsychotics in depression and dysthymia management [76], endorses the use of low-dose amisulpride (i.e. around 50 mg/die) in dysthymia, as it presents an efficacy comparable to that of antidepressants. The most significant side effects reported include prolactin increase in studies comparing amisulpride to placebo, and weight gain in studies comparing the former to antidepressants. The studies included in the analysis compared amisulpride to different antidepressants including imipramine [77], fluoxetine [78], amitriptyline [79], amineptine [80], sertraline [81]. In a previously cited metanalysis [26], amisulpride appeared superior to fluoxetine and presented a lower drop rate as compared with imipramine. In a 2016 systematic review [70], Meister et al. confirmed the efficacy of amisulpride in PDD, and as previously reported found an increased risk for prolactin elevation, weight gain and loss of libido among the most common complaints.
Strategies to counter antipsychotic-associated weight gain in patients with schizophrenia
Published in Expert Opinion on Drug Safety, 2019
Wade Marteene, Karl Winckel, Sam Hollingworth, Steve Kisely, Erin Gallagher, Margaret Hahn, Bjørn H Ebdrup, Joseph Firth, Dan Siskind
Amisulpride is a SGA that demonstrates relatively selective antagonism of D2 and D3 receptors with minimal effects on H1 and serotonergic receptors [98]. Amisulpride exhibits a moderate potential for weight gain [6,98]. A year-long open-label study of 46 Chinese inpatients switched from SGAs (mostly olanzapine and risperidone) to amisulpride (doses between 600 and 1000 mg daily) were compared to 46 inpatients who remained on their original SGA [99]. Compared to their baseline weight, patients switched to amisulpride lost 7.8 kg on average compared to patients who remained on their SGA, who lost 2.6 kg on average [99]. Within patients switched to amisulpride, 13 did not complete the study, largely due to psychotic symptom exacerbation (69.2%) [99].