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Amisulpride

What is amisulpride?

Second generation antipsychotics (sometimes referred to as ‘atypical’ antipsychotics) such as amisulpride are a newer class of antipsychotic medication than first generation ‘typical’ antipsychotics. Second generation antipsychotics are effective for the positive symptoms of schizophrenia. It is sometimes claimed that they are more effective than first generation antipsychotics in treating the negative symptoms of schizophrenia. Negative symptoms include a lack of ordinary mental activities such as emotional expression, social engagement, thinking and motivation, whereas positive symptoms include the experiences of perceptual abnormalities (hallucinations) and fixed, false, irrational beliefs (delusions).

Second generation antipsychotics may also cause less extra-pyramidal side effects. These include dyskinesias such as repetitive, involuntary, and purposeless body or facial movements, Parkinsonism (cogwheel muscle rigidity, pill-rolling tremor and reduced or slowed movements), akathisia (motor restlessness, especially in the legs, and resembling agitation) and dystonias such as muscle contractions causing unusual twisting of parts of the body, most often in the neck. These effects are caused by the dopamine receptor antagonist action of these drugs.

What is the evidence for amisulpride?

High quality evidence suggests amisulpride may retain more patients in treatment, and be more effective for global state and negative symptoms than placebo. Moderate quality evidence suggests amisulpride may cause more extrapyramidal symptoms than placebo.

High quality evidence suggests amisulpride may retain more patients in treatment, and be more effective for global state, mental state and negative symptoms, but not positive symptoms, than first generation antipsychotics. Amisulpride may be less likely to cause at least one adverse event or extrapyramidal symptom when compared to first generation antipsychotics.

Moderate quality evidence suggests no differences in any outcome compared to other second generation antipsychotics in general. Moderate to low quality evidence suggests fewer people leaving the study early due to inefficacy with amisulpride compared to ziprasidone. Moderate to high quality evidence suggests amisulpride is associated with less weight gain than risperidone or olanzapine. Moderate quality evidence suggests agitation may be reported more often by patients receiving amisulpride than other second generation antipsychotics, with no difference in cardiac effects or extrapyramidal symptoms between amisulpride and risperidone, olanzapine or ziprasidone.

October 2020

Last updated at: 4:17 am, 14th October 2020
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