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Re: to amisulpride users » JohnL

Posted by SLS on October 1, 2000, at 9:36:56

In reply to Re: to amisulpride users, posted by JohnL on October 1, 2000, at 8:25:49

Andrew does better at 50mg than he does at 100mg. Sigolene was not at 50mg for a week. Only 4 days. A Dr. Levine in NYC specializing in TRD and experienced with sulpiride counseled my old doctor that 50mg of sulpiride (the archetypical substituted benzamide neuroleptic displaying a preference for DA presynaptic autoreceptors) was more effective than 100mg. That would equate to no more than 25mg of amisulpride. I found this to be true, as the small improvement sulpiride gave me disappeared immediately when I increased the dosage to 100mg. Perhaps Sigolene will respond at 25mg and not at 50mg. She took 25mg for only 3 days. There is probably a point at which there is a reversal of net DA activity. This would be evidenced by both Andrew's experience with amisulpride and mine with sulpiride. I would say that it is unlikely that Sigolene will respond to amisulpride at this point, but I can't say for sure how her brain works, nor have I seen a large study producing a statistical range of the lengths of time needed for improvements to become evident in responders to amisulpride. I cannot tell her that she won't yet respond.

The drug ain't hurting her. Studies of the use of amisulpride in major depression and dysthymia set the target dosage at 50mg. If she has nothing else better to do at this point, I think she should explore the bottom end, and perhaps the top end, of this drug's antidepressant dosage range. It would be ashame to later come back to amisulpride because of a "what if".

Just a bit of common sense, that's all. (Always easier said than done).

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10512080&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9892856&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9495601&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9165379&dopt=Abstract

By the way, I had my doctor ask Dr. Levine about amisulpride. He said that it was too much of an antipsychotic, and sulpiride would be the better of the two for depression. The binding affinity of amisulpride to DA D2 and D3 receptors is much greater than that of sulpiride. Amisulpride probably has a narrower and finicky window of dosages in which one can adjust for its antidepressant result.

The same pharmaceutical company, Sanofi, markets both sulpiride (Dogmatil) and amisulpride (Solian). Sulpiride is an old drug that is dirt cheap. They can't raise the price on it - sort of like rent-control, so of course they are going to push amisulpride as being better than sulpiride. Amisulpride is much, much more expensive than sulpiride and represents a profit potential an order of magnitude greater than that they are "suffering" from with sulpiride.

Definitely pass the salt on this one.


- Scott

 

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