Adult: Initially, 200-400 mg bid, may increase to max of 1,200 mg bid in patients w/ mainly positive symptoms or up to a total of 800 mg daily in patients w/ mainly negative symptoms. Patients w/ mixed positive and negative symptoms (neither predominating): 400-600 mg bid. Child: ≥14 yr Same as adult dose. Elderly: Lower initial dose, adjust as required.
Renal Impairment
May require dosage reduction or longer dosage interval.
Administration
May be taken with or without food.
Contraindications
Phaeochromocytoma and acute porphyria; concomitant prolactin-dependent tumours (e.g. pituitary gland prolactinomas, breast cancer). Combination w/ levodopa.
Postural hypotension, hyperprolactinaemia, wt gain, increase in hepatic enzymes, sedation or drowsiness, insomnia, extrapyramidal symptoms, maculopapular rash, venous thromboembolism, pulmonary embolism, DVT, leucopenia, neutropenia, agranulocytosis. Potentially Fatal: Neuroleptic malignant syndrome, QT prolongation and ventricular arrhythmias (e.g. torsades de pointes and ventricular tachycardia).
Patient Counseling Information
This drug may cause sedation, if affected, do not drive or operate machinery.
Overdosage
Symptoms: Restlessness, clouding of consciousness, extrapyramidal symptoms, agitation, confusion, low BP, coma. Management: Symptomatic and supportive treatment. May be partially removed by haemodialysis or treated w/ alkaline osmotic diuresis and anti-parkinsonian drugs, if necessary.
Drug Interactions
Combination w/ bradycardia-inducing medications (e.g. β-blockers, some Ca channel blockers) or medications which induce electrolyte imbalance (e.g. hypokalaemic diuretics, stimulant laxatives, IV amphotericin B, glucocorticoids, tetracosactides) may induce torsades de pointes or prolong the QT interval. Enhanced postural hypotension if used w/ other antihypertensive drugs. Concurrent use w/ other CNS depressants may cause increased CNS depression. Co-admin w/ antacids or sucralfate may decrease sulpiride absorption. Concurrent use w/ lithium increases the risk of extrapyramidal side effects. May reduce effectiveness of ropinorole. Potentially Fatal: Reciprocal antagonism of effects between levodopa and neuroleptics.
Food Interaction
Enhanced sedative effects w/ alcohol.
Action
Description: Sulpiride is a substituted benzamide antipsychotic which is a selective antagonist of central dopamine (D2, D3, D4) receptor. Pharmacokinetics: Absorption: Slowly absorbed from the GI tract. Time to peak plasma concentration: 3-6 hr. Low bioavailability and subject to interindividual variation. Distribution: Rapidly distributed to the tissues but passage across the blood-brain barrier is poor; distributed into breast milk. Plasma protein binding: Approx 40%. Excretion: Excreted 95% (mainly as unchanged drug) via urine and faeces. Plasma half-life: Approx 8-9 hr.
Chemical Structure
Sulpiride Source: National Center for Biotechnology Information. PubChem Database. Sulpiride, CID=5355, https://pubchem.ncbi.nlm.nih.gov/compound/Sulpiride (accessed on Jan. 23, 2020)
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