Clinical Evaluation of Sulpiride in Schizophrenic Patients ‐ A Double‐blind Comparison with Chlorpromazine

Abstract

To evaluate the clinical potential of sulpiride for the treatment of schizophrenic patients, a double‐blind study was performed comparing fixed doses of sulpiride (800 mg daily) and chlorpromazine (400 mg daily). Twentyfive schizophrenic (RDC) patients participated in each treatment group. Antipsychotic effects were evaluated by CPRS and NOSIE ratings before and after 1, 2, 4 and 8 weeks of treatment. Interrater reliabilities for CPRS items and subscales were satisfactory. Treatment with sulpiride or chlorpromazine resulted in a significant reduction of psychotic morbidity as estimated by CPRS and global ratings. CPRS scores reflecting autism were significantly reduced in all ratings of sulpiride‐treated patients, but only after four weeks in the chlorpromazine group. Total NOSIE scores indicated improvement in both treatment groups. A significant difference in favour of sulpiride was obtained for the NOSIE subscale “retardation”. Extrapyramidal side effects occurred at a similar frequency in both treatment groups. Autonomic side effects occurred to a greater extent in chlorpromazine‐treated patients. Lactation was reported only in four sulpiride‐treated patients. Liver transaminase enzymes in serum were markedly elevated only in chlorpromazine‐treated patients. The results indicate that sulpiride has a marked antipsychotic effect which is at least not inferior to that of chlorpromazine. A better effect on autistic components of behaviour was demonstrated for sulpiride. The results indicate a higher risk of lactation but a lower risk of anticholinergic side effects and liver toxicity for treatment with sulpiride than with chlorpromazine.

A Risk-Benefit Assessment of Sulpiride in the Treatment of Schizophrenia

“…[3I) This is in agreement with literature data on the effect of sulpiride in patients with 293 schizophrenia with a prevalence of negative symptoms. [40,56) Harnryd et all 40 ] compared the effect of chlorpromazine versus sulpiride on 50 patients with schizophrenia on an 'autism' scale, comprising inability to feel, lassitude, withdrawal, reduced speech and slowness of movement. Sulpiride produced a significantly greater improvement than chlorpromazine at I to 8 weeks on this scale, although there was no overall difference in the change in positive symptoms or global ratings.…”

“…On the basis of data from the studies listed in table II, extrapyramidal reactions generally appear to be mild and to occur as frequently as with chlorpromazine [32,34,40,42] but less frequently than with haloperidol. [35.39,41 ,43] In 1985, Alberts et al [59] reviewed data from 65 published reports, including a total of 2851 patients with psychosis, neurosis or other psychiatric disorders in order to evaluate the tolerability of sulpiride; 13% of patients had extrapyramidal manifestations.…”

A systematic microdialysis study of dopamine transmission in the accumbens shell/core and prefrontal cortex after acute antipsychotics

“…AP representative of different pharmacological categories were selected, namely haloperidol and chlorpromazine (high to intermediate D2R affinity and EPS liability), clozapine and quetiapine (low D2R, high to intermediate 5HT2A affinity and low EPS liability), amperozide (high 5HT2A, low D2R affinity and weak AP activity), risperidone and olanzapine (high D2R and 5HT2A affinity and mild EPS liability), raclopride (a benzamide with high D2R affinity, fast plasmabrain equilibration and high EPS liability) and, finally, (S)-sulpiride and amisulpride (benzamides with high D2R affinity, slow plasma-brain equilibration and low EPS liability) (Cassano et al 1975;Csernansky et al 1994;Harnryd et al 1984;Leucht et al 2013;Mauri et al 1996;Rummel-Kluge 2010).…”

Plasma Free 3-Methoxy-4- Hydroxyphenylglycol in Acute Schizophrenics before and after Treatment

“…The plasma free M H P G (pMHPG) level is cor related not only with the cerebrospinal fluid level but also with the brain level of M H P G [9,10]. High pM H PG lev els have been found in untreated schizophrenic patients [8,[11][12][13], However, there are few reports of pM H PG levels during neuroleptic therapy. The present study was designed to investigate the relations between clinical find ings and pM H PG in acute schizophrenia, and the effect of neuroleptic therapy on pM H PG.…”