Amisulpride: uses and side effects of this antipsychotic drug

Schizophrenia and the rest of psychotic disorders are some of the most severe mental health problems and the ones that generate the most disturbance and suffering. Hallucinations, delusions, catatonia, erratic and disorganized behavior, flight of ideas or speech altered are some of the symptoms that can appear, and they suppose a split or partial rupture with the reality.

But fortunately, over time and from various branches of science, different methodologies have been generated. to reduce the symptoms and maintain the stability of the sufferer, in such a way that he can maintain a life normative. Among them, the use of antipsychotic drugs stands out, a fundamental pillar of the treatment of this condition. And one of the many that exist is the amisulpride, which we are going to talk about throughout this article.

• Related article: "Psychoactive drugs: drugs that act on the brain"

Amisulpride: a powerful antipsychotic

Amisulpride is an antipsychotic drug, that is, a medicine or substance with psychoactive properties whose effects contribute to combat psychotic symptoms, especially with regard to problems such as hallucinations and delusions.

Is about an antipsychotic derived from included within the atypical or second-generation neuroleptics, which were developed with the purpose of combating the aforementioned symptoms without the frequent side effects that the first generation have.

In addition to this, one of the main advantages of the second generation is that they achieve a therapeutic effect on negative symptoms. (those that imply a mental impoverishment of the patient and a loss of functionality, such as apathy and apathy, alogia or impoverishment of language), something in which first-generation neuroleptics fail or do not have much effect (in some cases even get worse).

This medication is available in the form of tablets., and its main route of administration is oral. With a half-life of 12 hours, it is partially metabolized and excreted in the urine and feces. Its high potency makes it comparable with highly recognized typical antiscotics, such as haloperidol, although it is much safer and generates less discomfort and side effects than these. It has also been compared with other drugs such as risperidone, a comparison in which amisulpride has a slight superiority in terms of efficacy.

Mechanism of action

The mechanism of action of amisulpride is based on its effect on our brain chemistry, specifically on the dopaminergic system. Although it is an outlier or second generation, something that usually implies that in addition to dopamine an effect is also exerted on the serotonergic system, amisulpride is an exception: it only has a relevant effect on receptors of dopamine.

Specifically, amisulpride is a dopamine D2 and D3 receptor antagonist drug. With doses of less than 300 mg, its effect occurs in the receptors of presynaptic neurons, something that has the effect of increasing dopamine levels by inhibiting its reuptake. This aspect is essential to treat negative symptoms, since this is linked to a dopaminergic deficit in the mesocortical pathway.

On the other hand, if the doses are greater than or equal to 400 mg, the antagonistic effects occur on postsynaptic neurons, which implies that dopamine will not be used by these neurons and will be degraded, with dopamine having less effect and reducing its levels over time. time. This is very useful to combat positive symptoms, linked to an excess of dopamine in the mesolimbic pathway.

• You may be interested in: "Types of antipsychotics (or neuroleptics)"

Main indications

Amisulpride, as the antipsychotic or neuroleptic that it is, has schizophrenia as its main therapeutic indication. In this sense, amisulpride is useful. both in the treatment of psychotic outbreaks and acute states as well as in more chronic phases, as well as in the prevention of new outbreaks.

In addition to this, it must be taken into account that this drug is effective in both positive and negative symptoms, with great efficacy in both. Although it is not an official indication, it has also been used on occasions in cases of depression and dysthymia.

Side effects

Although amisulpride is a very useful drug, its administration It can cause a number of annoying or even dangerous side effects. (despite the fact that comparatively these effects tend to occur in a smaller magnitude and less frequently than with the typical ones).

Some of the most common are the existence or appearance of tremors, hypotension, reduced libido and difficulties in reaching orgasm, increased prolactin in the blood that can cause sexual disorders (menstrual problems, erectile dysfunction or galactorrhea or emission of milk from the breasts, among others). At the gastric level they can cause constipation, nausea and vomiting. Although to a lesser extent than other neuroleptics, it can also cause some drowsiness and slight weight gain. Other common side effects are dystonia or dyskinesia, anxiety, and irritability.

Others with greater danger can be possible hyperglycemia, cardiac disorders and arrhythmias, seizures, agranulocytosis (decreased granulocytes, a type of white blood cell), leukopenia (decreased number of white blood cells), hypercholesterolemia or hyponatremia. It can also appear for cardiac, venous thromboembolism, angioedema or even life-threatening neuroleptic malignant syndrome. It can also contribute to the growth of various types of tumors.

contraindications

The use of amisulpride is contraindicated for all those people who are allergic to this drug or any of its components. People who have or have had tumors such as breast, pituitary, or adrenal gland tumors should also avoid it. Those people who have or have had epilepsy should avoid its consumption.

Neither should it be taken by people with heart or cardiovascular problems, kidney problems or failure (at a minimum the dose should be reduced and controlled), Parkinson's (the drug may impair the symptoms Parkinsonians) or other dementias (the risk of stroke triples and the risk of death from causes increases). infectious). Diabetic patients should also be especially careful, as the drug can cause hypotension or arterial hypertension. In this sense, people with cardiovascular problems should also avoid it or consult its suitability to control the doses.

Its consumption should be avoided together with alcohol, lithium salts, antacids, antidepressants, antihypertensives, antiarrhythmics, antipsychotics, or levodopa, among others. Those who suffer from blood or endocrine problems should monitor and control their condition, given the risk of alterations in white blood cells and blood composition.

Pregnant and lactating women are also contraindicated with this drug, given that although there are not enough data in this regard, exposure to antipsychotics during pregnancy can cause alterations in babies, or even neonatal abstinence syndrome.

Bibliographic references:

• Spanish Agency for Medicines and Health Products (2015). Package leaflet: information for the patient: Amisulpride Zentiva 200 mg tablets EFG. Available in: https://cima.aemps.es/cima/pdfs/es/p/63998/Prospecto_63998.html.pdf
• Carter, M. (2004). Amisulpride. Offarm, 23(3): 11-178.
• Mota Nota, J.S., Silva de Lima, M., Soares, B., Silveira de Mota Neto, J.I. (2002). Amisulpride for schizophrenia. Cochrane Database of Systematic Reviews. Available in: https://www.cochrane.org/es/CD001357/amisulprida-para-la-esquizofrenia