Sulpralex
Generic Name
Sulpiride
Manufacturer
Beximco Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| sulpralex 250 mg capsule | ৳ 6.52 | ৳ 65.20 |
Description
Overview of the medicine
Sulpiride is an atypical antipsychotic used to treat various psychiatric conditions, particularly schizophrenia, and sometimes depression with psychotic features. It can also be used for vertigo and short-term anxiety.
Uses & Indications
Dosage
Adults
Schizophrenia: Initially 400-800 mg/day in divided doses. May be increased to 1200 mg/day in severe cases. Vertigo/Minor psychiatric disorders: 150-300 mg/day.
Elderly
Lower initial doses (e.g., 50-100 mg/day), gradually titrate upwards with close monitoring due to increased sensitivity and potential for side effects.
Renal_impairment
Dose reduction required based on creatinine clearance (e.g., CrCl 30-60 mL/min, 50% of usual dose; CrCl <30 mL/min, 25% of usual dose).
How to Take
Oral, usually taken with water. Can be taken with or without food. Avoid sudden discontinuation.
Mechanism of Action
Sulpiride is a selective dopamine D2 and D3 receptor antagonist. At low doses, it primarily blocks presynaptic dopamine D2/D3 receptors, leading to increased dopamine release. At higher doses, it blocks postsynaptic D2/D3 receptors, which is its primary antipsychotic action.
Pharmacokinetics
Onset
Variable, typically within days to weeks for therapeutic effect in psychiatric conditions.
Excretion
Primarily excreted unchanged in the urine (about 70%) and feces (about 30%).
Half life
Approximately 6-8 hours, but can extend to 10-14 hours in some individuals.
Absorption
Poorly absorbed (25-35%) from the GI tract. Peak plasma concentrations are reached in 1-2 hours.
Metabolism
Minimal hepatic metabolism; less than 5% is metabolized.
Side Effects
Contraindications
- Hypersensitivity to sulpiride or any excipients
- Prolactin-dependent tumors (e.g., prolactinoma, breast cancer)
- Pheochromocytoma
- Concomitant use with levodopa
- Acute porphyria
- Known or suspected QT prolongation
Drug Interactions
Levodopa
Antagonistic effect, leading to reduced efficacy of both drugs.
Antihypertensives
Potential for additive hypotensive effects.
CNS Depressants (alcohol, hypnotics, anxiolytics)
Increased CNS depression.
Sucralfate, Antacids containing Aluminium or Magnesium
Reduce sulpiride absorption. Administer sulpiride at least 2 hours before these agents.
Drugs prolonging QT interval (e.g., antiarrhythmics, tricyclic antidepressants)
Increased risk of ventricular arrhythmias, including Torsades de Pointes.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms include blurred vision, sedation, hypotension, extrapyramidal symptoms, convulsions, and coma. Management is supportive, including gastric lavage, activated charcoal, and symptomatic treatment. ECG monitoring is recommended.
Pregnancy & Lactation
Not recommended during pregnancy, especially in the first trimester, unless clearly necessary and potential benefits outweigh risks. Avoid during breastfeeding as sulpiride is excreted in breast milk.
Side Effects
Contraindications
- Hypersensitivity to sulpiride or any excipients
- Prolactin-dependent tumors (e.g., prolactinoma, breast cancer)
- Pheochromocytoma
- Concomitant use with levodopa
- Acute porphyria
- Known or suspected QT prolongation
Drug Interactions
Levodopa
Antagonistic effect, leading to reduced efficacy of both drugs.
Antihypertensives
Potential for additive hypotensive effects.
CNS Depressants (alcohol, hypnotics, anxiolytics)
Increased CNS depression.
Sucralfate, Antacids containing Aluminium or Magnesium
Reduce sulpiride absorption. Administer sulpiride at least 2 hours before these agents.
Drugs prolonging QT interval (e.g., antiarrhythmics, tricyclic antidepressants)
Increased risk of ventricular arrhythmias, including Torsades de Pointes.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach of children.
Overdose
Symptoms include blurred vision, sedation, hypotension, extrapyramidal symptoms, convulsions, and coma. Management is supportive, including gastric lavage, activated charcoal, and symptomatic treatment. ECG monitoring is recommended.
Pregnancy & Lactation
Not recommended during pregnancy, especially in the first trimester, unless clearly necessary and potential benefits outweigh risks. Avoid during breastfeeding as sulpiride is excreted in breast milk.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months from manufacturing date
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Off-patent
Clinical Trials
Extensive clinical trials have established Sulpiride's efficacy in schizophrenia, depression, and vertigo, demonstrating its role as a selective dopamine D2/D3 antagonist.
Lab Monitoring
- Prolactin levels (especially if symptoms of hyperprolactinemia occur)
- Liver function tests (LFTs)
- ECG (especially in patients with cardiovascular risk factors or those on concomitant QT-prolonging drugs)
- Renal function (creatinine clearance)
Doctor Notes
- Monitor patients for extrapyramidal symptoms, particularly at higher doses, and consider anticholinergic co-medication if necessary.
- Regularly assess prolactin levels, especially in female patients, and manage hyperprolactinemia if clinically significant.
- Advise patients about the potential for sedation and orthostatic hypotension, especially during initiation of therapy or dose titration.
- Exercise caution in patients with cardiovascular disease or a family history of QT prolongation.
Patient Guidelines
- Take your medicine exactly as prescribed by your doctor.
- Do not stop taking Sulpralex abruptly, as this can lead to withdrawal symptoms or worsening of your condition.
- Avoid alcohol while taking this medicine as it can increase drowsiness and other side effects.
- Inform your doctor about all other medications you are taking, including over-the-counter drugs and herbal supplements.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
Sulpiride may cause drowsiness, dizziness, or blurred vision. Avoid driving or operating heavy machinery until you know how this medicine affects you.
Lifestyle Advice
- Maintain a healthy lifestyle with a balanced diet and regular exercise to manage potential weight gain.
- Stay hydrated and avoid excessive exposure to heat to prevent overheating, especially if experiencing sweating issues.
- Report any unusual or severe side effects to your healthcare provider immediately.
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