Amisulpride is an antipsychotic known in pharmacies as Solian, prescribed by psychiatrists to treat schizophrenia with both types of symptoms: hallucinations and delusions on the one hand, and withdrawal and emotional flatness on the other. It is distinguished by being less sedating and less harmful to weight than many medicines in its class, but it is one of the strongest at raising the hormone prolactin, and it leaves the body through the kidneys rather than the liver. These three things determine who the medicine suits and what needs monitoring. You won’t find doses here; starting, adjusting and stopping amisulpride are decisions for the doctor following your case.
What is amisulpride?
Amisulpride belongs to the second generation of antipsychotics, but works more selectively than its peers: it specifically targets dopamine D2 and D3 receptors and isn’t much occupied with histamine or acetylcholine receptors, which explains its low drowsiness and dry mouth. It is available in a number of European countries, Egypt and elsewhere, but isn’t approved in the United States, so you won’t find a page for it in American references such as MedlinePlus. You will find the broader picture of this class in our article on antipsychotics.
What is it used for?
Schizophrenia: positive symptoms
At full therapeutic doses it calms hallucinations, delusional ideas and disordered thinking, and helps prevent relapse if the patient continues on it. The details of the full plan are in our article on schizophrenia treatment.
Negative symptoms
This is a point the medicine is known for: it may be used in some patients for negative symptoms such as withdrawal, poverty of speech and weak motivation when these are the main complaint. The response remains variable, and choosing the medicine for this purpose is up to the doctor after assessing the case.
Another use in some countries
Some doctors in various countries prescribe amisulpride in very small amounts for mild cases of chronic depression (dysthymia). This isn’t an internationally approved use, and is only practised under the doctor’s supervision.
What sets it apart from others?
| Aspect | Amisulpride | What it means for the patient |
|---|---|---|
| Sedation | Generally light | Suitable for someone who needs a clear head for study or work |
| Weight gain | Less than olanzapine and clozapine | Doesn’t exempt from monitoring weight and sugar |
| Prolactin | Clearly raised | The effect that needs the most attention |
| Metabolism | Mainly through the kidneys | Kidney function is reviewed before starting and during treatment |
| Heart | May lengthen the QT interval | An ECG when there are risk factors |
Prolactin: the most prominent effect
Amisulpride raises the hormone prolactin in most people who take it; the person may feel nothing, or symptoms may appear that they are embarrassed to mention, so they remain untreated:
- In women: disturbed or absent periods, milk discharge from the breast, and difficulty becoming pregnant.
- In men: weak desire and erection, and breast enlargement.
- In both sexes: in the long term, bone building may be affected.
These symptoms don’t mean stopping the medicine. The doctor requests a prolactin test, then decides between adjusting the plan, adding a medicine that lowers it, or switching to an antipsychotic that doesn’t raise it. Anyone planning a pregnancy or suffering from disturbed periods should start the conversation with their doctor early. You will find a close comparison in our article on risperidone, which is also one of the medicines that raise prolactin.
The kidneys: why does it matter?
Because the body clears amisulpride through the kidneys, weak kidney function means the medicine stays longer and its level rises. So creatinine is checked before starting in older people and those with kidney disease and diabetes, and the doctor adjusts the plan accordingly. Someone with severe kidney failure may not be suited to the medicine. And if the family notices their elderly relative has become slower or drowsier than usual after starting the medicine, this isn’t something to leave.
The heart and its rhythm
Like other antipsychotics, amisulpride may lengthen the QT interval on an ECG, an indicator of the risk of a rare but serious rhythm disturbance. This receives more attention if:
- The patient or their family has a history of heart rhythm disorders or unexplained fainting.
- They are taking other medicines that affect the same indicator.
- Potassium or magnesium levels are low, as happens with repeated vomiting or diarrhea.
That is why it is better for your doctor to know every medicine you take, even antibiotics and supplements.
Other side effects
- Movement: restlessness, stiffness and tremor, usually milder than with the first generation but possible at higher doses. Tardive dyskinesia is possible in the long term, so the doctor examines movement regularly.
- Sleep: it may cause insomnia rather than drowsiness in some patients, and changing the time it is taken helps, only on the doctor’s advice.
- Dizziness: a drop in blood pressure on standing up quickly.
- Weight: moderate gain in some patients, so don’t neglect measuring it.
Pregnancy, breastfeeding and older people
Pregnancy and breastfeeding are decisions discussed with the doctor before any change, as the risk of relapse after stopping suddenly may in some cases outweigh the risks of continuing. And for older people with dementia, antipsychotics carry a warning of an increased risk of death and stroke when used for dementia-related behaviors, and amisulpride is only used for this with great caution.
Call an ambulance on 123 immediately if you see
Or go to the nearest emergency department if someone taking amisulpride shows:
- Fainting or severe, irregular palpitations
- A high temperature with severe muscle rigidity and clouded consciousness
- A sudden spasm of the neck or jaw, or difficulty swallowing
- Deep drowsiness or slowed breathing after taking an excessive amount
- Thoughts of harming oneself or others; for psychological support, the mental health hotline 16328
Does amisulpride cause addiction?
No, it doesn’t give a high or push toward increasing the amount. But stopping suddenly risks the return of psychotic symptoms, and may cause insomnia, nausea and anxiety. Every change goes through the doctor. This general picture is repeated with most psychiatric medicines, as our article are psychiatric medicines addictive? explains.
When does it start working, and how is the response assessed?
Insomnia and agitation usually settle within days, while hallucinations and delusions usually need several weeks, and negative symptoms longer still. The most frequent mistake is judging the medicine in its first week, so the patient leaves it or the family asks for it to be changed before it has had its chance. The doctor assesses the response by comparing symptoms across visits, and sometimes asks the family before the patient, because they see behavior change before he does. And someone who forgets a dose shouldn’t double the next one on their own, but ask their doctor about the right rule for their case.
Questions to ask your doctor
- Is my prolactin raised now, and when do we recheck it?
- Is my kidney function suitable, and do I need an ECG?
- How will I know the medicine has started working, and when do we assess the negative symptoms?
- Does it affect my plans for pregnancy or marriage?
- Are there medicines or herbs I should avoid with it?
How can Riviera Life help you?
If you or a relative are on this medicine and feel a change in periods, desire or movement and don’t know who to mention it to, book a free first consultation with a consultant psychiatrist at Riviera Life in Sheikh Zayed. We review the diagnosis, the medicine and the tests, and build a plan that takes clarity of mind and daily life into account, in complete confidentiality and with round-the-clock medical follow-up.
More from our psychiatric medicines guide
- Antipsychotics: first and second generation, side effects and monitoring
- Psychiatric medicines: types and uses
- Quetiapine
- Schizophrenia: the complete guide
Questions many people ask
Generally less drowsiness than many medicines in its class, but some patients feel drowsy or have insomnia. The response varies from person to person.
Because the medicine blocks dopamine, which restrains prolactin release from the pituitary gland, so the hormone rises. Disturbance of periods or desire may appear, and the doctor has several solutions.
Yes, because the medicine leaves through the kidneys. Older people and kidney patients need a more precise plan.
Some doctors in some countries prescribe it in very small amounts for mild chronic depression, but this isn't an internationally approved use and is decided under the doctor's supervision.
It isn't stopped on your own, because stopping suddenly raises the risk of psychosis returning. If the doctor decides to reduce it, it will be gradual.
