Amisulpride
SOLIAN
“Am I soul bride?”
QT prolongation
prolactin elevation
What it isSubstituted benzamide D2/D3 antagonist. Oral SOLIAN treats schizophrenia outside the US; at lower doses it preferentially blocks presynaptic D2/D3 autoreceptors. In the US it is approved only as IV BARHEMSYS, for postoperative nausea and vomiting.
Why this oneRelatively little antimuscarinic or antihistamine burden and usually less weight gain than many antipsychotics.
What limits itOral SOLIAN is renally cleared, and its label reduces the dose in renal impairment; the BARHEMSYS label finds renal exposure changes not clinically meaningful for its single IV dose. Hyperprolactinemia and QT prolongation are the practical constraints.
FDA-approved for
- postoperative nausea/vomiting (IV) (2020)
Principal riskQT prolongation; hyperprolactinemia
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilitySedation, QT prolongation, extrapyramidal symptoms or anticholinergic toxicity vary by receptor target.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Prevention of postoperative nausea and vomiting (PONV) | Adult | 5 mg IV single dose at induction | 5 mg once | 5 mg |
| Treatment of PONV | Adult | 10 mg IV single dose | 10 mg once | 10 mg |
Renal Undefined
Hepatic Undefined
Single-dose administration only.
Instructions
- Infuse IV over 1–2 minutes; dilution not required.
- Protect from light; administer within 12 hours of removing the vial from its carton.
Available strengths
- inj 5 mg/2 mL
- inj 10 mg/4 mL
Cautions
- Dose- and concentration-dependent QT prolongation—avoid in congenital long QT syndrome and with droperidol; ECG monitoring with pre-existing arrhythmias/conduction disorders, electrolyte abnormalities, CHF, or other QT-prolonging drugs (e.g., ondansetron)
Adverse reactions
- Increased blood prolactin
- Chills
- Hypokalemia
- Procedural hypotension
- Abdominal distension
- Infusion site pain (treatment indication)
Pregnancy Insufficient human data; no adverse developmental effects in animal studies.
Lactation Present in human milk (11–20× plasma with chronic oral use); consider pumping and discarding milk for 48 h after a dose.
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 5 mg/2 mL | inj | per unit | not offered | |
| 10 mg/4 mL | inj | per unit | not offered |
Generic entry2034 est.
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Memory aids: interaction avatars
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Self-check
- When should amisulpride be dose-reduced?
Renal impairment. - Which endocrine effect constrains amisulpride use?
Hyperprolactinemia.