sulpiride: clinical use

Prescribing considerations

• Initiation for schizophrenia should be undertaken by a specialist with continuing supervision.
• Review renal function, as sulpiride is eliminated largely unchanged and exposure increases with renal impairment.
• Assess arrhythmia risk, including bradycardia, electrolyte disturbance, cardiovascular disease, QT prolongation and interacting medicines.
• Use particular caution with epilepsy, Parkinson’s disease, older age, diabetes risk, stroke risk, glaucoma, urinary retention and gastrointestinal obstruction.
• Avoid abrupt withdrawal where clinically significant discontinuation symptoms or relapse are a concern.

Contraindications and cautions

• Hypersensitivity to sulpiride or relevant excipients
• Prolactin-dependent tumours, including prolactinoma and breast cancer
• Phaeochromocytoma
• Acute porphyria
• Concomitant levodopa or antiparkinson dopamine agonists, including ropinirole
• For the selected oral solution: severe renal, haematological or hepatic disease, and alcoholic intoxication or other CNS-depressant states

Monitoring

• Renal function before treatment and when clinical status changes
• ECG and electrolytes when cardiac or interaction risk factors are present
• Blood glucose in people with diabetes or diabetes risk factors
• Prompt full blood count for unexplained fever, sore throat, infection or lymphadenopathy
• Movement effects, orthostatic blood pressure, weight and symptoms of raised prolactin
• Mental state, adherence, effectiveness and adverse effects under specialist supervision

Clinical pharmacology

Sulpiride is a substituted benzamide dopamine-receptor antagonist. Protein binding is limited, and most absorbed compound is eliminated unchanged in urine and faeces, making renal function clinically important.

Formulation and product differences

• The selected tablet contains lactose; its score line is for easier swallowing, not equal division.
• The oral solution contains maltitol, parahydroxybenzoates, propylene glycol and small quantities of benzyl alcohol; maltitol may have a mild laxative effect.
• The oral solution has formulation-specific contraindications not listed for the selected tablet.
• The oral solution should be stored below its stated temperature limit and used within three months after opening; record the opening date.

Oral solution

Route: Oral

Strengths: 200 mg/5 mL

Tablet

Route: Oral

Strengths: 50 mg, 100 mg, 200 mg, 400 mg