Sulpiride

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Sulpiride
Sulpiride.svg
Sulpiride ball-and-stick.png
Clinical data
Trade names Dogmatil, Others
AHFS/Drugs.com International Drug Names
Routes of
administration 		By mouth (tablets, capsules, solution), intramuscular injection
ATC code
Legal status
Legal status
  • BR: Class C1 (Other controlled substances) [1]
  • UK: POM (Prescription only)
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability 25–40% [2] [3]
Protein binding <40% [2]
Metabolism Not metabolized; [4] [5] [6] [7] [8] 95% is exerted as the unchanged drug [2] [4]
Elimination half-life 6–8 hours [2] [9]
Excretion Urine (70–90%), [9] [3]
Feces. [4]
Identifiers
  • N-[(1-ethylpyrrolidin-2-yl)methyl]-2-methoxy-5-sulfamoylbenzamide
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard 100.036.124 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C15H23N3O4S
Molar mass 341.43 g·mol−1
3D model (JSmol)
  • NS(=O)(=O)c1ccc(OC)c(c1)C(=O)NCC1CCCN1CC
  • InChI=1S/C15H23N3O4S/c1-3-18-8-4-5-11(18)10-17-15(19)13-9-12(23(16,20)21)6-7-14(13)22-2/h6-7,9,11H,3-5,8,10H2,1-2H3,(H,17,19)(H2,16,20,21) Yes check.svgY
  • Key:BGRJTUBHPOOWDU-UHFFFAOYSA-N Yes check.svgY
   (verify)

Sulpiride, sold under the brand name Dogmatil among others, is an atypical antipsychotic (although some texts have referred to it as a typical antipsychotic) [10] medication of the benzamide class which is used mainly in the treatment of psychosis associated with schizophrenia and major depressive disorder, and is sometimes used in low dosage to treat anxiety and dysthymia.

Contents

The drug is chemically and clinically similar to amisulpride. Levosulpiride is its purified levo-isomer and is sold in some countries for similar purposes.

Sulpiride is commonly used in Asia, Central America, Europe, South Africa and South America. It is not approved in the United States, Canada, or Australia.

Medical uses

Schizophrenia

Sulpiride's primary use in medicine is in the management of the symptoms of schizophrenia. [2] It has been used as both a monotherapy and adjunctive therapy (in case of treatment-resistance) in schizophrenia. [2] [11] [12] [13] [14] [15]

Depression and anxiety

It has also been used in the treatment of dysthymia. [16] There is evidence, although low quality, that sulpiride could accelerate antidepressant response in patients with major depressive disorder. [17] In Japan, sulpiride is both approved as a treatment for schizophrenia and for major depressive disorder (low dose). [18] [19]

There is also evidence of its efficacy in treating panic disorder. [20] [21] It was studied at low doses in the treatment of refractory panic disorder and was reported to be effective in a small open-label study. [21]

Other uses

Sulpiride is indicated for the treatment of vertigo in some countries. [22]

Contraindications

Contraindications [2]

Cautions [2]

Pregnancy and lactation

Side effects

Sulpiride is usually well tolerated, producing few adverse effects. Their incidences are as follows: [2] [11] [23] [24] [25] [26] [27] [28] [29]

Common (>1%) adverse effects
- Tremor
- Dystonia
- Akathisia — a sense of inner restlessness that presents itself with the inability to stay still
- Parkinsonism
- Dry mouth
- Constipation
- Blurred vision
Rare (<1% incidence) adverse effects
- Agranulocytosis — a significant drop in white blood cell count, leaving individuals wide open to life-threatening opportunistic infections
- Neutropenia
- Leucopenia
- Leukocytosis [30]
Unknown incidence adverse effects include

Overdose

Sulpiride has a relatively low order of acute toxicity. Substantial amounts may cause severe but reversible dystonic crises with torticollis, protrusion of the tongue, and/or trismus. In some cases all the classical symptoms typical of severe Parkinson's disease may be noted; in others, over-sedation/coma may occur. The treatment is largely symptomatic. Some or all extrapyramidal reactions may respond to the application of anticholinergic drugs such as biperiden or benzatropine. All patients should be closely monitored for signs of long QT syndrome and severe arrhythmias.

Interactions

Sulpiride neither inhibits nor stimulates cytochrome P450 family (CYP) of oxidizing enzymes in human, thus would not cause clinically significant interactions with other drugs, [5] which are metabolized by CYPs. However, the risk or severity of adverse effects can be increased when sulpiride is combined with other drugs, but this is not related to substrates, inducers and inhibitors of CYPs.

Pharmacology

Pharmacodynamics

Sulpiride [33]
Receptor Affinity (Ki, nM)
DAT >10,000
5-HT1A >10,000
5-HT2A 4,786
5-HT3 >10,000
5-HT6 5,011[ unreliable source? ]
5-HT7 5,011[ unreliable source? ]
α1 >10,000
α2 >10,000
D1 >10,000
D2 9.8
D3 8.05
D4 54
H1 >10,000
V3 >10,000
Affinity values are toward cloned human receptors.

Sulpiride is a selective antagonist at dopamine D2, D3 and to a lesser extent D4 receptors. Antagonism at 5-HT2A dominates in doses exceeding 600 mg daily. In doses of 600 to 1,600 mg sulpiride shows mild sedating and antipsychotic activity. Its antipsychotic potency compared to chlorpromazine is only 0.2 (1/5). In low doses (in particular 50 to 200 mg daily) its prominent feature is antagonism of presynaptic inhibitory dopamine and serotonin receptors, accounting for some antidepressant activity and a stimulating effect. Additionally, it alleviates vertigo.

The benzamide neuroleptics (including sulpiride, amisulpride, and sultopride) have been shown to activate the endogenous gamma-hydroxybutyrate receptor in vivo at therapeutic concentrations. [34] Sulpiride was found in one study in rats to upregulate GHB receptors. [35] GHB has neuroleptic properties and it is believed binding to this receptor may contribute to the effects of these neuroleptics.

Sulpiride, along with clozapine, and valproate has been found to activate DNA demethylation in the brain. [36]

History

Sulpiride was discovered in 1966 as a result of a research program by Justin-Besançon and C. Laville at Laboratoires Delagrange who were working to improve the anti-dysrhythmic properties of procainamide; the program led first to metoclopramide and later to sulpiride. [37] [38] Laboratoires Delagrange was acquired by Synthelabo in 1991 [39] [40] which eventually became part of Sanofi. [41]

Society and culture

Brand names

Sulpiride is marketed under the brand names Dogmatil (DE, HK, SG, PH, ID), Dolmatil (IE, UK, NL), Eglonyl (RU, ZA, HR, SI), Espiride (ZA), Modal (IL), Prometar (UY), Equilid (BR) and Sulpor (UK), among many others. [42]

Medicinal forms

These include tablet and oral solution [43]

Patient aversions

Some individuals from the Caribbean region may have an aversion to taking the medication due to the association with the brand name of Dogmatil. Dogmatil has been associated with dog medication.

Research

Hormonal contraception

Sulpiride has been studied for use as a hormonal contraceptive in women in whom conventional oral contraceptives are contraindicated and to potentiate progestogen-only contraceptives. [44] [45] The contraceptive effects of sulpiride are due to its prolactin-releasing and antigonadotropic effects and the hyperprolactinemia–amenorrhea state that it induces. [44] [45]

Irritable bowel syndrome

Since the use of psychotropic drugs is efficient in treating irritable bowel syndrome (IBS), [46] sulpiride is studied as potential sole maintenance therapy in the treatment of IBS. [47] [48] [46]

References

  1. ↑ Anvisa (31 March 2023). "RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 4 April 2023). Archived from the original on 3 August 2023. Retrieved 16 August 2023.
  2. 1 2 3 4 5 6 7 8 9 10 11 "Sulpiride Tablets 200mg, 400mg (SPC)". electronic Medicines Compendium (eMC). Sanofi. 21 January 2010. Archived from the original on 19 October 2013. Retrieved 19 October 2013.
  3. 1 2 Bressolle F, Brès J, Fauré-Jeantis A (January 1992). "Absolute bioavailability, rate of absorption, and dose proportionality of sulpiride in humans". Journal of Pharmaceutical Sciences. 81 (1): 26–32. doi:10.1002/jps.2600810106. PMID   1619566.
  4. 1 2 3 Imondi AR, Alam AS, Brennan JJ, Hagerman LM (March 1978). "Metabolism of sulpiride in man and rhesus monkeys". Archives Internationales de Pharmacodynamie et de Therapie. 232 (1): 79–91. PMID   96745.
  5. 1 2 Niwa T, Inoue S, Shiraga T, Takagi A (January 2005). "No inhibition of cytochrome P450 activities in human liver microsomes by sulpiride, an antipsychotic drug". Biological & Pharmaceutical Bulletin. 28 (1): 188–191. doi: 10.1248/bpb.28.188 . PMID   15635191.
  6. ↑ Telles-Correia D, Barbosa A, Cortez-Pinto H, Campos C, Rocha NB, Machado S (February 2017). "Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity". World Journal of Gastrointestinal Pharmacology and Therapeutics. 8 (1): 26–38. doi: 10.4292/wjgpt.v8.i1.26 . PMC   5292604 . PMID   28217372.
  7. ↑ Lv Q, Yi Z (February 2018). "Antipsychotic Drugs and Liver Injury". Shanghai Archives of Psychiatry. 30 (1): 47–51. PMC   5925599 . PMID   29719358.
  8. ↑ Kobari T, Namekawa H, Kato Y, Yamada S (June 1985). "Biotransformation of sultopride in man and several animal species". Xenobiotica; the Fate of Foreign Compounds in Biological Systems. 15 (6): 469–476. doi:10.3109/00498258509045020. PMID   4036171.
  9. 1 2 Brès J, Bressolle F (December 1991). "Pharmacokinetics of sulpiride in humans after intravenous and intramuscular administrations". J Pharm Sci. 80 (12): 1119–24. doi:10.1002/jps.2600801206. PMID   1815069.
  10. ↑ Joint Formulary Committee (2013). British National Formulary (BNF) (65 ed.). London, UK: Pharmaceutical Press. ISBN   978-0-85711-084-8.
  11. 1 2 Taylor D, Paton C, Shitij K (2012). The Maudsley prescribing guidelines in psychiatry. West Sussex: Wiley-Blackwell. ISBN   978-0-470-97948-8.
  12. ↑ Wang J, Omori IM, Fenton M, Soares B (January 2010). "Sulpiride augmentation for schizophrenia". The Cochrane Database of Systematic Reviews (1): CD008125. doi:10.1002/14651858.CD008125.pub2. PMID   20091661.
  13. ↑ Lai EC, Chang CH, Kao Yang YH, Lin SJ, Lin CY (May 2013). "Effectiveness of sulpiride in adult patients with schizophrenia". Schizophrenia Bulletin. 39 (3): 673–83. doi:10.1093/schbul/sbs002. PMC   3627763 . PMID   22315480.
  14. ↑ Soares BG, Fenton M, Chue P (2000). "Sulpiride for schizophrenia". The Cochrane Database of Systematic Reviews (2): CD001162. doi:10.1002/14651858.CD001162. PMID   10796605.
  15. ↑ Omori IM, Wang J, Soares B, Fenton M (October 2009). "Sulpiride versus other antipsychotics for schizophrenia (Protocol)". The Cochrane Database of Systematic Reviews (4): CD008126. doi:10.1002/14651858.CD008126.
  16. ↑ Pani L, Gessa GL (2002). "The substituted benzamides and their clinical potential on dysthymia and on the negative symptoms of schizophrenia". Molecular Psychiatry. 7 (3): 247–53. doi:10.1038/sj.mp.4001040. hdl: 11380/1212064 . PMID   11920152. S2CID   3153728.
  17. ↑ Uchida H, Takeuchi H, Suzuki T, Nomura K, Watanabe K, Kashima H (December 2005). "Combined treatment with sulpiride and paroxetine for accelerated response in patients with major depressive disorder". Journal of Clinical Psychopharmacology. 25 (6): 545–51. doi:10.1097/01.jcp.0000185425.00644.41. PMID   16282835. S2CID   10727911.
  18. ↑ "Search results detail| Kusurino-Shiori(Drug information Sheet)". www.rad-ar.or.jp. Retrieved 16 March 2020.
  19. ↑ Towlson EK, Vértes PE, Müller-Sedgwick U, Ahnert SE (12 September 2019). "Brain Networks Reveal the Effects of Antipsychotic Drugs on Schizophrenia Patients and Controls". Frontiers in Psychiatry. 10: 611. doi: 10.3389/fpsyt.2019.00611 . PMC   6752631 . PMID   31572229.
  20. ↑ Bell C, Bhikha S, Colhoun H, Carter F, Frampton C, Porter R (February 2013). "The response to sulpiride in social anxiety disorder: D2 receptor function". Journal of Psychopharmacology. 27 (2): 146–51. doi:10.1177/0269881112450778. PMID   22745189. S2CID   32951554.
  21. 1 2 Nunes EA, Freire RC, Dos Reis M, de Oliveira E, Silva AC, Machado S, et al. (September 2012). "Sulpiride and refractory panic disorder". Psychopharmacology. 223 (2): 247–9. doi:10.1007/s00213-012-2818-6. PMID   22864966. S2CID   14870287.
  22. ↑ "Medicinanet - Equilid 50" . Retrieved 5 September 2018.
  23. ↑ Lepola U, Koskinen T, Rimón R, Salo H, Gordin A (July 1989). "Sulpiride and perphenazine in schizophrenia. A double-blind clinical trial". Acta Psychiatrica Scandinavica. 80 (1): 92–6. doi:10.1111/j.1600-0447.1989.tb01305.x. PMID   2669445. S2CID   28719315.
  24. ↑ Munk-Andersen E, Behnke K, Heltberg J, Nielsen H, Gerlach J (1984). "Sulpiride versus haloperidol, a clinical trial in schizophrenia. A preliminary report". Acta Psychiatrica Scandinavica. Supplementum. 311: 31–41. doi:10.1111/j.1600-0447.1984.tb06857.x. PMID   6367362. S2CID   31689174.
  25. ↑ Gerlach J, Behnke K, Heltberg J, Munk-Anderson E, Nielsen H (September 1985). "Sulpiride and haloperidol in schizophrenia: a double-blind cross-over study of therapeutic effect, side effects and plasma concentrations". The British Journal of Psychiatry. 147 (3): 283–8. doi:10.1192/bjp.147.3.283. PMID   3904885. S2CID   24056594.
  26. ↑ Standish-Barry HM, Bouras N, Bridges PK, Watson JP (1983). "A randomized double blind group comparative study of sulpiride and amitriptyline in affective disorder". Psychopharmacology. 81 (3): 258–60. doi:10.1007/bf00427274. PMID   6417717. S2CID   28134446.
  27. ↑ Quinn N, Marsden CD (August 1984). "A double blind trial of sulpiride in Huntington's disease and tardive dyskinesia". Journal of Neurology, Neurosurgery, and Psychiatry. 47 (8): 844–7. doi:10.1136/jnnp.47.8.844. PMC   1027949 . PMID   6236286.
  28. ↑ Peselow ED, Stanley M (1982). "Clinical trials of benzamides in psychiatry". Advances in Biochemical Psychopharmacology. 35: 163–94. PMID   6756060.
  29. ↑ Edwards JG, Alexander JR, Alexander MS, Gordon A, Zutchi T (December 1980). "Controlled trial of sulpiride in chronic schizophrenic patients". The British Journal of Psychiatry. 137 (6): 522–9. doi:10.1192/bjp.137.6.522. PMID   7011469. S2CID   789670.
  30. ↑ Levkovitz H, Abramovitch Y, Nitzan I (June 1994). "Leukocytosis related to the therapeutic dosage of sulpiride". Biological Psychiatry. 35 (12): 963. doi:10.1016/0006-3223(94)91244-0. PMID   8080896. S2CID   43471005.
  31. ↑ Melzer E, Knobel B (December 1987). "Severe cholestatic jaundice due to sulpiride". Israel Journal of Medical Sciences. 23 (12): 1259–60. PMID   3326861.
  32. ↑ Ohmoto K, Yamamoto S, Hirokawa M (December 1999). "Symptomatic primary biliary cirrhosis triggered by administration of sulpiride". The American Journal of Gastroenterology. 94 (12): 3660–1. doi:10.1111/j.1572-0241.1999.01634.x. PMID   10606349. S2CID   33986018.
  33. ↑ Roth BL, Driscol J. "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 13 November 2020.
  34. ↑ Maitre M, Ratomponirina C, Gobaille S, Hodé Y, Hechler V (April 1994). "Displacement of [3H] gamma-hydroxybutyrate binding by benzamide neuroleptics and prochlorperazine but not by other antipsychotics". European Journal of Pharmacology. 256 (2): 211–4. doi:10.1016/0014-2999(94)90248-8. PMID   7914168.
  35. ↑ Ratomponirina C, Gobaille S, Hodé Y, Kemmel V, Maitre M (April 1998). "Sulpiride, but not haloperidol, up-regulates gamma-hydroxybutyrate receptors in vivo and in cultured cells". European Journal of Pharmacology. 346 (2–3): 331–7. doi:10.1016/S0014-2999(98)00068-5. PMID   9652377.
  36. ↑ Dong E, Nelson M, Grayson DR, Costa E, Guidotti A (September 2008). "Clozapine and sulpiride but not haloperidol or olanzapine activate brain DNA demethylation". Proceedings of the National Academy of Sciences of the United States of America. 105 (36): 13614–9. Bibcode:2008PNAS..10513614D. doi: 10.1073/pnas.0805493105 . PMC   2533238 . PMID   18757738.
  37. ↑ Sneader W (31 October 2005). Drug Discovery: A History. John Wiley & Sons. pp. 205–. ISBN   978-0-470-01552-0.
  38. ↑ Sanger GJ (December 2009). "Translating 5-HT receptor pharmacology". Neurogastroenterology and Motility. 21 (12): 1235–8. doi: 10.1111/j.1365-2982.2009.01425.x . PMID   19906028. S2CID   35544028.
  39. ↑ Conard D (17 October 1991). "Synthélabo rachète les laboratoires Delagrange". Les Echos.
  40. ↑ "Laboratoires Delagrange". Bibliothèque nationale de France. Retrieved 24 August 2016.
  41. ↑ Meek T (24 May 2013). "A look back at Sanofi's merger with Synthélabo". PMLiVE.
  42. ↑ "Sulpiride". Drugs.com.
  43. ↑ "Sulpiride 200mg/5ml Oral Solution". EMC. Datapharm.
  44. 1 2 Buvat J, Decroix-Blacker C, Legal F, Gasnault JP (January 1976). "[One thousand months of contraception with sulpiride]". Revue Française de Gynécologie et d'Obstétrique (in French). 71 (1): 53–61. PMID   959705. Archived from the original on 15 April 2018. Retrieved 15 April 2018.
  45. 1 2 Payne MR, Howie PW, McNeilly AS, Cooper W, Marnie M, Kidd L (August 1985). "Sulpiride and the potentiation of progestogen only contraception". British Medical Journal. 291 (6495): 559–61. doi:10.1136/bmj.291.6495.559. PMC   1418199 . PMID   2994800.
  46. 1 2 Sato M, Murakami M (August 2006). "[Treatment for irritable bowel syndrome--psychotropic drugs, antidepressants and so on]". Nihon Rinsho (in Japanese). 64 (8): 1495–500. PMID   16898620.
  47. ↑ El-Reshaid K, Al-Bader S (2019). "New regimen for treatment of irritable bowel syndrome with emphasis on Sulpride as the sole maintenance therapy". Journal of Drug Delivery and Therapeutics. 9 (5): 154–157. doi: 10.22270/jddt.v9i5.3424 . S2CID   208163204.
  48. ↑ Komarov FI, Rapoport SI, Ivanov SV, Kharaian LV, Kolesnikov DB, Kurikov AV (2000). "[Sulpiride treatment of irritable colon syndrome]". Klin Med (Mosk) (in Russian). 78 (7): 22–6. PMID   10979637.
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