Amisulpride: uses and side effects of this antipsychotic drug.

An antipsychotic-type drug that affects dopamine and serotonin.

Schizophrenia and other psychotic disorders are some of the most severe mental health problems and cause the most disturbance and suffering. Hallucinations, delusions, catatonia, erratic and disorganized behavior, flight of ideas or altered speech are some of the symptoms that may appear, and involve a split or partial break with reality.

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

Amisulpride: a potent antipsychotic drug

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

It is an antipsychotic derived from an antipsychotic derived from the atypical or second generation neuroleptics, which were developed with thewhich were developed with the purpose of combating the previously mentioned symptomatology without the frequent side effects that the first generation ones have.

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

This drug is marketed in tablet formand its main route of administration is oral. With a half-life of 12 hours, it is partially metabolized and excreted through urine and feces. Its high potency makes it comparable to typical highly recognized antipsychotics such as haloperidol, although it is much safer and generates less discomfort and side effects than the latter. 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 atypical or second-generation drug, which usually implies that in addition to dopamine, it also has an effect on the dopaminergic system. also has an effect on the serotonergic system, amisulpride is a second generation atypical.amisulpride is an exception: it only has a relevant effect on dopamine receptors.

Specifically, amisulpride is a dopamine receptor antagonist. an antagonist of dopamine D2 and D3 receptors.. At doses lower than 300 mg, its effect is on the receptors of presynaptic neurons, which has the effect of increasing dopamine levels by inhibiting its reuptake. This aspect is fundamental to treat negative symptomatology, 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 are produced on the postsynaptic neurons, which implies that dopamine will not be used by these neurons and will be degraded, with dopamine having less effect and its levels being reduced over time. This is very useful to combat positive symptomatologylinked to an excess of dopamine in the mesolimbic pathway.

Main indications.

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

In addition, it should be noted 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 sometimes also been used in cases of depression and dysthymia.

Side effects

Although amisulpride is a very useful drug, its administration can generate a series of can generate a number of bothersome or even dangerous side effects (although comparatively (although these side effects tend to occur comparatively less frequently and to a lesser extent than with typical drugs).

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 which can lead to sexual alterations (menstrual problems, erectile dysfunction or galactorrhea or emission of milk from the breasts, among others). At gastric level they can cause constipation, nausea and vomiting. Although to a lesser extent than other neuroleptics, they can also cause some drowsiness and slight weight gain. Other frequent side effects are dystonia or dyskinesia, anxiety and irritability.

Other more dangerous side effects include possible hyperglycemia, cardiac disturbances and arrhythmias, convulsive crises, agranulocytosis (agranulocytosis), andagranulocytosis (reduction of granulocytes, a type of white blood cell), leukopenia (the number of leukocytes is reduced), hypercholesterolemia or hyponatremia. In addition, cardiac arrest, venous thromboembolism, angioedema or even the potentially fatal neuroleptic malignant syndrome may occur. It may also contribute to the growth of various types of tumors.

Contraindications

The use of amisulpride is contraindicated in all those who are allergic to this drug or any of its components. It should also be avoided by people who suffer or have suffered from tumors such as breast, pituitary or adrenal gland tumors. People who have or have had epilepsy should avoid taking it.

It should also not be taken by people with heart or cardiovascular problems, kidney problems or kidney failure (at least the dose should be reduced). (at least the dose should be reduced and controlled), Parkinson's disease (the drug may impair Parkinson's symptoms) or other dementias (the risk of stroke is tripled and the risk of death from infectious causes is increased). Diabetic patients should also be especially cautious, as the drug can cause hypotension or high blood pressure. In this regard, people with cardiovascular problems should also avoid it or consult their suitability for controlling 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 women and nursing mothers are also contraindicated for this drug.Although there is not enough data on the subject, exposure to antipsychotics during pregnancy may cause alterations in infants, or even neonatal abstinence syndrome.

Bibliographic references:

• Spanish Agency of Medicines and Health Products (2015). Package leaflet: information for the patient: Amisulpride Zentiva 200 mg tablets EFG. Available at: https://cima.aemps.es/cima/pdfs/es/p/63998/Prospecto_63998.html.pdf
• Carretero, 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 at: https://www.cochrane.org/es/CD001357/amisulprida-para-la-esquizofrenia