Amisulpride

Question 1

What is the dose at which amisulpride overdose is dangerous?

Answer 1

> 4 grams; < 4 grams are generally benign

Question 2

Discuss the minimum observation requirement for patients who have ingested > 4 grams of amisulpride and why.

Answer 2

16 hours of cardiac monitoring + all ECG intervals normal. Concern for QT prolongation with overdoses >4 grams. Most symptoms within 5-20 hours post-ingestion.

Question 3

What is the risk with > 4grams overdose of amisulpride?

Answer 3

QT prolongation, torsades, bradycardia, hypotension and CNS depression

Question 4

What is amisulpride?

Answer 4

An atypical antipsychotic, acts as a dopamine (D2/D3) receptor antagonist with minimal serotonin, histamine and muscarinic receptor affinity

Question 5

Discuss the toxicokinetics with amisulpride.

Answer 5

Oral bioavailability of 50% with two absorption peaks (1 and 4 hours). VoD of 6 L/kg with inactive metabolites. Unchanged excretion in urine/faeces. Elimination half-life of 12 hours.

Question 6

Is there a role for decontamination in amisulpride overdose?

Answer 6

Yes, if >4 grams have been taking within 4 hours previously then for activated charcoal

Question 7

If a patient with amisulpride has an episode of bradycardia, what does this mean?

Answer 7

It occurs in 25% of cases and is strongly associated with a higher risk of QT prolongation/torsades.