SGA / Selective D2/D3·Psychiatry - Oral Antipsychotics

Amisulpride

Schizophrenia (both acute exacerbations and maintenance)

Authority requiredPBSSGASolian400 mg tablet+2

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

1200 mg/day

Half-life

12 h

Caution: Prolactin

HIGH RISK

Caution: Renal Adj.

DOSE RED.

Cautions

Avoid / Cautions

Prolactin-dependent tumors (e.g., pituitary prolactinoma, certain breast cancers), pheochromocytoma, severe renal failure. Pregnancy Category B3.

Where it stands

Rapid Summary

Overview

Highly selective D2/D3 antagonist. Acts differently depending on the dose (low doses for negative symptoms, high doses for psychosis). Very low metabolic risk but causes profound hyperprolactinemia.

Clinical Focus

Unlike most antipsychotics which are cleared by the liver, Amisulpride is cleared almost entirely by the kidneys. Unadjusted doses in CKD cause severe toxicity.

Bottom Line

Amisulpride is a selective D2/D3 antagonist effective for both positive and negative symptoms of schizophrenia, but causes significant hyperprolactinaemia and requires renal dose adjustment.

Formulation & Access

Brand Names

Solian

Oral Routes

Tablets (100, 200, 400 mg). Oral liquid (100 mg/mL).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Schizophrenia (both acute exacerbations and maintenance).

Clinical Place

Highly effective. Often ranked second only to Clozapine in efficacy for schizophrenia. Excellent for patients with prominent negative symptoms (apathy, anhedonia).

Quick reference

Class & Role

SGA / Selective D2/D3 — Highly selective D2/D3 antagonist.

Route / Formulation

Tablets (100, 200, 400 mg). Oral liquid (100 mg/mL). (Solian)

Usual Dose & Max

PO 400-800 mg/day in divided doses. Max 1200 mg/day.

Key Indication Doses

Acute Psychosis (Positive Symptoms): PO 400-800 mg/day in divided doses. Max 1200 mg/day. Predominantly Negative Symptoms: PO 50-300 mg OD. Renal Impairment: If eGFR 30-60, halve the dose. If eGFR 10-30, reduce dose to one-third. If eGFR < 10, avoid.

Best Uses

Amisulpride is a selective D2/D3 antagonist effective for both positive and negative symptoms of schizophrenia, but causes significant hyperprolactinaemia and requires renal dose adjustment.

Key Risks

Endocrine: Severe hyperprolactinemia (galactorrhea, amenorrhea, sexual dysfunction). The highest risk of all SGAs alongside Risperidone/Paliperidone. Neurological: EPS, akathisia, tremor (dose-dependent > 400mg). Cardiovascular: QTc prolongation, bradycardia.

Key Interactions

Concurrent use of Levodopa (directly antagonizes Parkinson's therapy). QTc prolonging agents (Amiodarone, SSRIs). Zero significant CYP450 interactions (Safe to mix with liver-metabolized drugs).

Monitoring

eGFR must be checked prior to initiation. Monitor serum Prolactin if symptoms develop. Baseline ECG (QTc monitoring).

Clinical Pearl

Because it ignores histamine, muscarinic, and alpha receptors, Amisulpride does not cause sleepiness, dry mouth, or massive blood pressure drops. Patients feel 'clear-headed' compared to Olanzapine or Quetiapine.

Access

Authority requiredSolian400 mg tablet

Brand: Solian
PBS status: Authority required
Formulation: Tablets (100, 200, 400 mg). Oral liquid (100 mg/mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.

SGA / Selective D2/D3·Psychiatry - Oral Antipsychotics

Amisulpride

Schizophrenia (both acute exacerbations and maintenance)

Authority requiredPBSSGASolian400 mg tablet+2

No source link confirmed for this record yet. Its own source notes are under Additional.

At a glance

Max Dose

1200 mg/day

Half-life

12 h

Caution: Prolactin

HIGH RISK

Caution: Renal Adj.

DOSE RED.

Cautions

Avoid / Cautions

Prolactin-dependent tumors (e.g., pituitary prolactinoma, certain breast cancers), pheochromocytoma, severe renal failure. Pregnancy Category B3.

Where it stands

Rapid Summary

Overview

Highly selective D2/D3 antagonist. Acts differently depending on the dose (low doses for negative symptoms, high doses for psychosis). Very low metabolic risk but causes profound hyperprolactinemia.

Clinical Focus

Unlike most antipsychotics which are cleared by the liver, Amisulpride is cleared almost entirely by the kidneys. Unadjusted doses in CKD cause severe toxicity.

Bottom Line

Amisulpride is a selective D2/D3 antagonist effective for both positive and negative symptoms of schizophrenia, but causes significant hyperprolactinaemia and requires renal dose adjustment.

Formulation & Access

Brand Names

Solian

Oral Routes

Tablets (100, 200, 400 mg). Oral liquid (100 mg/mL).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Schizophrenia (both acute exacerbations and maintenance).

Clinical Place

Highly effective. Often ranked second only to Clozapine in efficacy for schizophrenia. Excellent for patients with prominent negative symptoms (apathy, anhedonia).

Quick reference

Class & Role

SGA / Selective D2/D3 — Highly selective D2/D3 antagonist.

Route / Formulation

Tablets (100, 200, 400 mg). Oral liquid (100 mg/mL). (Solian)

Usual Dose & Max

PO 400-800 mg/day in divided doses. Max 1200 mg/day.

Key Indication Doses

Best Uses

Amisulpride is a selective D2/D3 antagonist effective for both positive and negative symptoms of schizophrenia, but causes significant hyperprolactinaemia and requires renal dose adjustment.

Key Risks

Key Interactions

Concurrent use of Levodopa (directly antagonizes Parkinson's therapy). QTc prolonging agents (Amiodarone, SSRIs). Zero significant CYP450 interactions (Safe to mix with liver-metabolized drugs).

Monitoring

eGFR must be checked prior to initiation. Monitor serum Prolactin if symptoms develop. Baseline ECG (QTc monitoring).

Clinical Pearl

Access

Authority requiredSolian400 mg tablet

Brand: Solian
PBS status: Authority required
Formulation: Tablets (100, 200, 400 mg). Oral liquid (100 mg/mL).

From this page

No calculator, monitoring schedule or factsheet is linked to this medicine page yet.